The ongoing repeal and replace debate has brought to light something that most Americans are not aware of—the fact that nursing home and other long term services and supports are financed almost entirely by the Medicaid program and about half of Americans will need Medicaid at some point in their lives. At the same time, the U.S. population is aging. By 2040, more than one in five of us will be over age 65. Most seniors want to live independently in their own homes for as long as possible and age in place.
More than 13 million Americans, many of them seniors, use assistance with basic daily tasks like eating, dressing and bathing, as well as activities such as preparing meals, money management, house cleaning and transportation—long term supports and services or LTSS. LTSS services can be provided in a home- or community-based setting and can extend the amount of time a person can remain independent. The Department of Health and Human Services estimates that for people who are age 65, more than half (52%) will have LTSS needs for up to two years. Medicaid is the primary payer of LTSS in the U.S. and spent over $150 billion for LTSS in 2014, the latest year for which data are available.
In recent years, more and more states have begun to incorporate LTSS into Medicaid managed care programs. Today 22 states have Medicaid managed LTSS (MLTSS) programs and more are implementing or exploring MLTSS. Managed care plans have greater flexibility to pay for a range of covered and non-covered services that can help keep people in their home.