Long-Term Services and Supports
Long-term services and supports (LTSS) refers to both institutional care and home- and community-based services (HCBS). Medicaid beneficiaries who use LTSS are a diverse group, spanning a range of ages with different types of physical and cognitive disabilities. They often receive services and supports for many years, or even decades. The types and intensity of services they require vary, both across and within subgroups.
People who receive Medicaid LTSS often have complex conditions and high needs, and thus are among the program’s most expensive beneficiaries.
Trends in LTSS delivery include increasing use of HCBS relative to institutional care, development of new quality measures for HCBS, and the increasing delivery of LTSS through managed care.
Click here for our Medicaid 101 series on YouTube.
Learn More about These Topics
- Home- and community-based services
- Managed long-term services and supports
- Eligibility for long-term services and supports
- Nursing facilities
- Quality of home- and community-based services
- Who uses Medicaid long-term services and supports?
Featured Publications
March 2026 Report to Congress on Medicaid and CHIP
March 12, 2026
MACPAC’s March 2026 Report to Congress on Medicaid and CHIP contains four chapters of interest to Congress: (1) a recommendation to help promote the home- and community-based services (HCBS) workforce, (2) behavioral health in Medicaid and the State Children’s Health Insurance Program (CHIP), (3) Medicaid for justice-involved youth, and (4) Medicaid for children in foster care.
Chapter 1 makes […]
Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce
March 12, 2026
Chapter 1 of the March 2026 report includes a recommendation aimed at bolstering the home- and community-based services (HCBS) workforce by requiring states to report hourly wages paid to HCBS workers to help states set effective HCBS payment rates. Workforce shortages reduce Medicaid’s ability to serve people with long-term care needs in the home or […]
Exploring the Role of the State Medicaid Agency in the Program of All-Inclusive Care for the Elderly: Interview Findings
March 5, 2026
The Program of All-Inclusive Care for the Elderly (PACE) model provides fully integrated care to frail adults ages 55 and older who meet nursing-facility level of care criteria and can live safely in the community. Findings in the June 2025 report to Congress raised questions about transparency, particularly around state and federal monitoring of PACE […]