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. In fiscal year 2019, Medicaid spending for beneficiaries who used LTSS through fee-for-service arrangements was $187.6 billion, or approximately 32.8 percent of total Medicaid spending, a disproportionate amount given that this group comprised only about 5.4 percent (4.4 million) of Medicaid beneficiaries that year (MACPAC 2021).
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.
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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
Access in Brief: Differences in Demographics and Access to Care by Source of Health Coverage for Adults with Intellectual and Developmental Disabilities
June 26, 2025
Medicaid is the largest payer of long-term services and supports, including home- and community-based services (HCBS) for individuals with intellectual and developmental disabilities (I/DD). However, data on adults with I/DD are limited. As an initial step toward addressing the gap in available research on people with I/DD, this issue brief highlights data from the National […]
Self-Direction for Home- and Community-Based Services
June 10, 2025
Chapter 5 looks at self-direction for Medicaid home- and community-based services (HCBS). The chapter begins with a discussion of the required elements in self-direction and the key stakeholders in program administration. The chapter continues by reviewing state design considerations, including Medicaid HCBS authorities, populations served, services provided, and flexibilities for beneficiaries. Next, it describes state […]
Understanding the Program of All-Inclusive Care for the Elderly
June 10, 2025
Chapter 4 provides an overview of the Program of All-Inclusive Care for the Elderly (PACE), which provides fully integrated care to adults ages 55 and older with nursing-facility level of care needs while allowing them to remain in the community. Most PACE enrollees are dually eligible for Medicare and Medicaid, and PACE is considered a […]