Long-Term Care and LTSS

Overview

• Spending on long-term services and supports (LTSS) is a significant component of personal health care spending in the United States.
• Of the $2.4 trillion spent in 2012 on all U.S. personal health care services, $324.2 billion, or 13.7%, was spent on formal, or paid, LTSS.
• Spending for LTSS includes services in both institutional settings—nursing facilities and intermediate care facilities for individuals with intellectual and developmental disabilities (ICFs/IDD)—and a wide range of home and community-based services such as home health, personal care, and adult day health services.
• The majority of spending on formal, or paid, LTSS is publicly financed by federal, state, and local governments through programs such as Medicaid, Medicare, the Veterans Health Administration (VHA), and the State Children’s Health Insurance Program (CHIP), among others.
• For 2012, Medicaid (combined federal and state spending) was the single largest payer, at $136.3 billion, or 42.0%, of spending on LTSS.
• However, LTSS spending may be underestimated as spending data do not include informal, or uncompensated, care provided by family caregivers.
• The probability of needing LTSS increases with age. As the older population continues to increase in size, and as individuals continue to live longer post-retirement, the demand for health care services and LTSS is also expected to increase.
• In 2012, an estimated 43 million individuals were age 65 and older. Over the next 50 years, that number is projected to increase to 92 million in 2060.  In addition, advances in medical and supportive care may allow younger persons with disabilities to live longer lives.
• With respect to public LTSS financing, policy makers are generally concerned with issues of access, cost, and quality of care. For example, federal requirements as well as state decisions concerning eligibility for, or coverage of, certain LTSS determine who receives access to publicly financed LTSS. These requirements and decisions also determine the care settings and the services that may be provided.
• Costly LTSS may exhaust an individual’s financial resources, which may lead to reliance on public support.
• Source: Long-Term Services and Supports:  In Brief

Background Reports

• Overview of Long-Term Services and Supports
• Who Pays for Long-Term Services and Supports?
• Medicaid Coverage of Long-Term Services and Supports
• Medicaid Financial Eligibility for Long-Term Services and Supports
• AARP: Long-Term Support and Services March 2017
• Long-Term Care Services for Veterans
• GAO: Long-Term Care Workforce  Sept 15 2016
• Improving the Balance – The Evolution of Medicaid Expenditures for Long-Term Services and Supports  June 3 2016
• Nonpartisan Long-Term Care Financing Collaborative (LTCFC) Announces Final Recommendations Feb 22 2016
  • The Collaborative proposes: clear private and public roles for long-term care financing; a new universal catastrophic long-term care insurance program. This would shift today’s welfare-based system to an insurance model; redefining Medicaid LTSS to empower greater autonomy and choice in services and settings; encouraging private long-term care insurance initiatives to lower cost and increase enrollment; and increasing retirement savings and improving public education on long-term care costs and needs.
• CBO: Rising Demand for Long-Term Services and Supports for Elderly People June 2013