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Who uses Medicaid long-term services and supports?

Medicaid beneficiaries who use long-term services and supports (LTSS) are a diverse group, extending from young to old, with many different types of physical and cognitive disabilities.

Adults age 65 and older

About half of Medicaid beneficiaries receiving LTSS are adults age 65 and older (MACPAC 2014). Given beneficiary preferences to age in place at home or in a home-like setting, Medicaid spending for these beneficiaries increasingly is for home and community-based services (HCBS). However, Medicaid serves about half of people age 65 and older in the community, compared to about 80 percent of non-elderly people with disabilities (Sowers et al. 2016). With HCBS, a beneficiary may receive a few hours of personal care services each day for assistance with bathing, dressing, and preparing meals. Such services usually supplement support from informal caregivers such as family members and neighbors.

Individuals with physical disabilities

Individuals with physical disabilities can include both young and older adults with functional impairments, such as individuals paralyzed as a result of spinal cord injuries, or individuals with traumatic brain injuries. Depending on the severity of their functional limitations, they may require different levels of services, and depending on their age at the onset of disability, they may require services for many years. Individuals wishing to remain in the community may require—in addition to personal care and other services—assistive technologies such as wheelchairs or equipment to assist caregivers in moving them from a bed to a wheelchair.

Individuals with intellectual or developmental disabilities

Individuals with intellectual or developmental disabilities (ID/DD) include people with a set of conditions such as cerebral palsy or autism that originate at a young age. Individuals with ID/DD may require LTSS for many years, and as their needs vary substantially over their lifespan, their services vary accordingly. For example, children with ID/DD often receive school-based services, while adults may receive supported employment services (e.g., job coaches).

Other LTSS users

Individuals with severe mental illness (e.g., bipolar disorder or schizophrenia) also receive LTSS, but made up only about 1 percent of enrollment in state HCBS waiver programs in 2014 (Watts and Musumeci 2018). States also provide LTSS to other individuals who have medically complex conditions. They include individuals who are ventilator dependent and medically fragile children, who may require assistive equipment and aids.