Medicaid’s Critical Role in Providing Long Term Services and Supports (LTSS)

Millions of Americans, including a significant number of individuals 65+, need long-term services and supports (LTSS) because of disability and chronic illnesses. Medicaid is the primary provider for LTSS across a wide range of care settings.

  1. Medicaid is the primary source of coverage for LTSS, providing more than half of all national spending on these vital services.
  2. LTSS consist of a wide range of medical and personal care, provided by both paid and unpaid caregivers, needed by people dealing with long-term conditions, disabilities, or frailty.
  3. Demographic trends indicate that LTSS services will only become more critical moving forward. More than half of Americans 65+ are expected to develop disabilities and require LTSS in the future. As of 2015, the average person turning 65 is expected to incur $138,000 for LTSS services in their lifetime.
  4. LTSS are provided across 3 main settings: nursing homes, home/community-based care, and residential facilities. The Medicaid share of nursing home care is particularly high. Of the people residing in nursing homes, an estimated 63% have Medicaid as a payer source.
  5. Community-based LTSS programs help Americans 65+ receiving care at home live as independently and safely as possible when they are no longer able to perform all of their daily activities on their own.
    • More than half of all Medicaid spending for LTSS is now for services provided in the home or community (also known as “home and community based services” or “HCBS”) that enable Americans 65+ and people with disabilities to live independently rather than in facilities.
  6. Managed care options for LTSS services are becoming increasingly popular for Medicaid beneficiaries. Managed LTSS (or MLTSS) provide an opportunity to improve care coordination and access to HCBS for beneficiaries, as well as lower costs and improve health outcomes.
    • In 24 states, some or all LTSS benefits are provided through managed care. Currently more than 7 million people receive LTSS through Medicaid managed care organizations.

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