Long-term services and supports (LTSS) refers to both institutional care and home- and community-based services (HCBS). They are used by individuals of all ages with functional limitations and chronic illnesses who need assistance to perform routine daily activities (eating, dressing, using the toilet, bathing, getting out of bed) and/or instrumental activities of daily living (writing checks, paying bills, cleaning the house, cooking, and going shopping).
Deeper dive
Older adults 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 years, or even decades. The types and intensity of services they require vary, both across and within subgroups.
Long-term services and supports for the elderly and younger populations with disabilities are a significant component of national health care spending. Many of these services are provided by Medicaid in both institutional and home and community- based settings, though the range of services offered differs substantially by state. States must offer certain Medicaid institutional services to eligible beneficiaries, yet the majority of Medicaid home and community-based services (HCBS) are optional for states.
The Affordable Care Act contains certain provisions that allow states to more easily expand access to LTSS. Key programs include:
- Community First Choice.
- Balance Incentive Payments Program.
- Money Follows the Person (MFP).
- Demonstration Grant for Testing Experience and Functional Assessment Tools (TEFT).