Medicaid Beneficiaries Who Use Long-Term Services and Supports: 2019

The definition of long-term services and supports (LTSS) can differ across different entities and studies. We examined Medicaid LTSS users using two set of definitions of LTSS: (1) the long-standing categories of LTSS that the Centers for Medicare & Medicaid Services (CMS) track through the Medicaid LTSS Annual Expenditures Reports and (2) the categories defined in section 9817 of the American Rescue Plan Act of 2021 (ARP). Using the long-standing categories of LTSS tracked by CMS, we found that 11.0 million Medicaid beneficiaries across 51 states received LTSS through fee-for-service (FFS) or managed care (MC) delivery systems in 2019. However, three states had clear reporting errors with the Health Homes program. Excluding these states, 8.8 million beneficiaries across 48 states received LTSS in 2019. Of these, 1.6 million beneficiaries (18.4 percent) received institutional services, 7.5 million (85.0 percent) received home and community-based services (HCBS), and 0.3 million (3.5 percent) received both. Using the ARP service categories, we found that 8.8 million Medicaid beneficiaries across 51 states received LTSS through FFS or MC delivery systems in 2019. Of these, 1.7 million beneficiaries (19.0 percent) received institutional services, 7.4 million (84.3 percent) received HCBS, and 0.3 million (3.3 percent) received both.