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
Self-Directed Services in Medicaid Home- and Community-Based Services
December 12, 2024
Medicaid home- and community-based services (HCBS) are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or a home-like setting in the community. Self-direction is an HCBS delivery model that allows the individual choice in their service provider(s) and control over the amount, duration, and scope of services […]
Spending and Utilization for Medicaid Home- and Community-Based Services
December 12, 2024
Medicaid home- and community-based services (HCBS) are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or a home-like setting in the community. While all states operate HCBS programs under various optional flexibilities in the Medicaid statute and provide services to a diverse population, there is limited research […]
Findings from a Technical Expert Panel on Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce
December 12, 2024
Home- and community-based services (HCBS) workforce shortages affect the ability of Medicaid programs to serve people with long-term care needs in the home or community. Although some factors that affect the HCBS workforce are outside of Medicaid’s purview, many states are exploring ways to use Medicaid payment policy to expand the HCBS workforce and reduce […]
