Long-term services and supports (LTSS) refers to both home- and community-based services (HCBS) as well as institutional care. Medicaid is the primary payer of LTSS, covering nearly 59 percent of total LTSS expenditures nationally in federal fiscal year 2019. Because LTSS can greatly differ in the types of services provided, how often they are used, their costs, and where they are delivered, it’s important to have a detailed understanding of how Medicaid spending and usage work. While research exists on use and spending of Medicaid LTSS users, there is relatively little research at a more granular level across various demographic characteristics, LTSS subpopulations, and HCBS taxonomy categories.
This issue brief conducts a comparative review of methodological approaches for analyzing Medicaid LTSS data, focusing specifically on four key analytic frameworks. Those approaches include: (1) Centers for Medicare & Medicaid Services LTSS expenditure and user reports, (2) HCBS taxonomy work sponsored by the Assistant Secretary for Planning and Evaluation, (3) DQ Atlas HCBS methodology brief, and (4) HCBS analyses performed by KFF. It highlights critical differences in how these methodologies identify and categorize HCBS and institutional care claims using the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.
