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 2013, Medicaid spending for beneficiaries who used LTSS through fee-for-service arrangements was $171.7 billion, or approximately 42 percent of total Medicaid spending, a disproportionate amount given that this group comprised only about 6 percent (4.2 million) of Medicaid beneficiaries that year (MACPAC 2017).

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

Medicaid Home and Community-Based Services: Characteristics and Spending of High-Cost Users

June 2018 | ,

Medicaid enrollees increasingly are receiving long-term services and supports (LTSS) through home and community-based services (HCBS). This fact sheet describes the characteristics and service use of Medicaid enrollees who used HCBS in 44 states in 2012, and analyzes Medicaid spending for these HCBS users. We focused particularly on high-cost users, defined as the 3 percent […]

Managed Long-Term Services and Supports: Status of State Adoption and Areas of Program Evolution

June 2018 |

Chapter 3 offers a status report on state adoption of managed long-term services and supports (MLTSS). State Medicaid programs increasingly use managed care as one of several strategies to improve care coordination and manage spending for populations with complex health care needs and disproportionately high Medicaid expenditures. As states gain experience with MLTSS, attention is […]

Comments on Money Follows the Person Rebalancing Demonstration Report to the President and Congress

March 2018 |

In late March 2018, MACPAC wrote to the chairmen and ranking members of the Senate Finance and House Energy and Commerce Committees and the Secretary of the U.S. Department of Health and Human Services, commenting on the Secretary’s final report on the Money Follows the Person (MFP) demonstration program. In its comments, the Commission observed […]