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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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Featured Publications

Timely Access to Home- and Community-Based Services: Environmental Scan Results

April 10, 2024

Timely access to home- and community-based services (HCBS) is essential to ensure individuals receive care in the setting of their choice. To receive HCBS, individuals must undergo a multi-step eligibility and enrollment process that includes an eligibility determination based on financial and functional eligibility criteria and the development of a person-centered service plan (PCSP). States […]

Medicaid Home- and Community-Based Services: Addressing Administrative Requirements

March 7, 2024

During this session, staff presented follow-on work from their November 2023 presentation that compared federal requirements across the various Section 1915 authorities that states use to operate home- and community-based services (HCBS) programs. The presentation began with an overview of Section 1915 authorities and the Centers for Medicare & Medicaid Services’ notice of proposed rulemaking […]

Findings from Interviews about Medicaid Payment Policies to Support the Home- and Community-Based Services Workforce

March 7, 2024

This session reviewed findings from interviews focused on how Medicaid payment policies for home- and community-based services (HCBS) are used to support HCBS workers, including direct care workers, direct support professionals, and independent providers. Building off of findings from initial interviews with national experts that were discussed at MACPAC’s November 2023 public meeting, this presentation […]