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
Streamlining Medicaid Section 1915 Authorities for Home- and Community-Based Services
March 13, 2025
Chapter 3 includes an analysis of federal administrative requirements for home- and community-based services (HCBS) programs and makes a recommendation to reduce the administrative burden for states and the federal government.
HCBS are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or in a home-like setting in the […]
Timely Access to Home- and Community-Based Services
March 13, 2025
Chapter 2 focuses on states’ eligibility and enrollment processes for home- and community-based services (HCBS) programs and makes a recommendation for guidance on provisional plans of care.
Medicaid 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 HCBS is […]
March 2025 Report to Congress on Medicaid and CHIP
March 13, 2025
MACPAC’s March 2025 Report to Congress on Medicaid and CHIP contains three chapters of interest to Congress: (1) recommendations to improve the usability and transparency of the managed care external quality review process, (2) improvements on timely access to home- and community-based services (HCBS), and (3) ways to streamline Medicaid Section 1915 authorities for home-and community-based services […]