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Long Term Services & Supports

2020 Total Medicaid Spending

Total federal and state Medicaid spending was $597.6 billion.

Over 30% was on long-term care services.

Source: 2020 Medicaid Long Term Services and Supports Annual Expenditures Report: Federal Fiscal Year 2020

Millions of Americans, including children, adults, and seniors, need long-term care services because of disabling conditions and chronic illnesses. Medicaid is the primary payer across the nation for long-term care services. Medicaid allows for the coverage of these services through several vehicles and over a continuum of settings, ranging from institutional care to community-based long-term services and supports (LTSS). 

The Centers for Medicare & Medicaid Services (CMS) is working in partnership with states, consumers and advocates, providers and other stakeholders to create a sustainable, person-driven long-term support system in which people with disabilities and chronic conditions have choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health and quality of life.

The programs and partnerships contained in this section are aimed at achieving a system that is:

  • Person-driven: The system affords older people, people with disabilities and/or chronic illness the opportunity to decide where and with whom they live, to have control over the services they receive and who provides the services, to work and earn money, and to include friends and supports to help them participate in community life.
  • Inclusive: The system encourages and supports people to live where they want to live with access to a full array of quality services and supports in the community.
  • Effective and accountable: The system offers high quality services that improve quality of life. Accountability and responsibility is shared between public and private partners and includes personal accountability and planning for long-term care needs, including greater use and awareness of private sources of funding. 
  • Sustainable and efficient: The system achieves economy and efficiency by coordinating and managing a package of services paid that are appropriate for the beneficiary and paid for by the appropriate party.
  • Coordinated and transparent: The system coordinates services from various funding streams to provide a coordinated, seamless package of supports, and makes effective use of health information technology to provide transparent information to consumers, providers and payers.
  • Culturally competent: The system provides accessible information and services that take into account people's cultural and linguistic needs.