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
Understanding the Program of All-Inclusive Care for the Elderly (PACE) Model: Interviews with Key Stakeholders
January 23, 2025
The Program of All-Inclusive Care for the Elderly (PACE) is a provider-led model that provides fully integrated care to frail adults ages 55 and older with nursing-facility level of care needs while allowing them to remain in the community. In September, staff provided the Commission with an overview of the PACE model, including information on […]
Home- and Community-Based Services Payment Policy Option
January 23, 2025
Home- and community-based services (HCBS) workforce shortages reduce Medicaid’s ability 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 rate setting to expand the HCBS workforce and reduce worker turnover. In […]
Timely Access to Home- and Community-Based Services
January 23, 2025
This session previewed a draft chapter on timely access to home- and community-based services (HCBS) that will be included in the March 2025 report to Congress. States have a number of ways in which they can expedite Medicaid eligibility determinations and enrollment for individuals whose income is not determined using modified adjusted gross income (MAGI) […]
