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
Methodological Approaches for Analyzing Use and Spending in Medicaid Long-Term Services and Supports: A Comparative Review
August 27, 2024
Long-term services and supports (LTSS) refers to both home- and community-based services (HCBS) as well as institutional care. Medicaid is the primary payer of LTSS, covering nearly 59 percent of total LTSS expenditures nationally in federal fiscal year 2019. Because LTSS can greatly differ in the types of services provided, how often they are used, […]
Medicaid Eligibility Policies Affecting the Timeliness of Access to Home- and Community-Based Services
August 20, 2024
State Medicaid programs provide home- and community-based services (HCBS) to enrollees through state plan and waiver authorities. This policy brief provides an overview of state-level practices designed to accelerate Medicaid eligibility determinations and how these policies affect the timeliness of access to HCBS. A related compendium provides a comprehensive examination of how state Medicaid programs […]
Compendium on Medicaid Eligibility Policies Affecting the Timeliness of Access to Home- and Community-Based Services
August 19, 2024
State Medicaid programs provide home- and community-based services (HCBS) to enrollees through state plan and waiver authorities. This compendium of Medicaid eligibility policies affecting the timeliness of access to HCBS provides a comprehensive examination of how state Medicaid programs across all 50 states and Washington, DC design their programs. Included in the compendium is information […]
