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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- Who uses Medicaid long-term services and supports?
- Eligibility for long-term services and supports
- Nursing facilities
- Quality of home- and community-based services
- Home- and community-based services
- Managed long-term services and supports
Featured publications
Response to CMS RFI on Revising the Requirements for Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels
In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure responding to a request for information on revising requirements for long-term care facilities to establish mandatory minimum staffing levels, MACPAC explored policies to ensure adequate staffing in nursing facilities while encouraging CMS to apply a health equity lens in its analyses …
State Efforts to Address Medicaid Home-and Community-Based Services Workforce Shortages
Medicaid is the primary payer for home- and community-based services (HCBS). There is a national shortage of workers who provide HCBS to Medicaid beneficiaries, which limits the ability of state Medicaid agencies to provide adequate services to beneficiaries in the community. Low wages, high rates of turnover, and lack of advancement opportunities all contribute to …
Revisiting the Money Follows the Person Qualified Residence Criteria
Chapter 1 fulfills a congressionally mandated study on Money Follows the Person (MFP), which has provided participating states with flexibility and enhanced funding to support more than 100,000 Medicaid beneficiaries in transitioning from institutional settings back into the community. Specifically, Congress asked the Commission to compare the MFP residence criteria, which requires participants to be …