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
Overview of Recently Published Final Rules
September 19, 2024
In this session, staff presented a summary of the provisions in four final rules that the Centers for Medicare & Medicaid Services (CMS) recently issued on eligibility and enrollment, access to care, managed care, and nursing facility staffing and payment transparency. For each rule, staff provided an overview of key requirements, highlighted how CMS responded […]
Section 1915 Medicaid Home- and Community-Based Services Authorities: Revisiting Policy Options
September 19, 2024
Section 1915 authorities allow states to provide home- and community-based services (HCBS) to Medicaid beneficiaries. Operationalizing HCBS programs can be administratively burdensome for states, and MACPAC has engaged in work to identify opportunities to alleviate some of that burden. We proposed policy options at the March 2024 meeting, and based on Commissioner feedback, conducted additional […]
Timely Access to Home- and Community-Based Services: Use of Presumptive Eligibility and Expedited Eligibility for Non-Modified Adjusted Gross Income Populations
September 19, 2024
States have a number of ways to expedite Medicaid eligibility determinations and enrollment for individuals in need of home- and community-based services (HCBS). This session focused specifically on the use of presumptive eligibility and expedited eligibility for individuals whose income is not determined using modified adjusted gross income (MAGI). MACPAC staff presented on the preliminary […]
