On-Demand Education: Long-Term Services and Supports

Long-Term Services and Supports (LTSS) include a broad range of medical, functional and social services delivered to individuals who have complex health needs due to aging, chronic illness or a disability. These services can be provided in a range of settings, including nursing homes, assisted living facilities, convalescent homes, and home and community-based settings.

In this video, UnitedHealthcare Community & State leaders explore the types of care these programs provide, who is eligible, how LTSS programs are funded, and the advantages of delivering these services through managed care. 

Video

Long-Term Services and Supports

How well do you know the LTSS program?

LTSS refers to a broad range of medical, functional, and social services that are needed by individuals who have complex health needs. How well do you know the LTSS program? Test yourself! Take the LTSS knowledge quiz.

LTSS programs allow people to live more independently by assisting with personal and health care needs, including:

Correct!

LTSS programs allow people to live more independently by assisting with personal and health care needs, including activities of daily living such as meal preparation, eating, dressing, and personal hygiene.

Sorry, that wasn't right.

LTSS programs allow people to live more independently by assisting with personal and health care needs, including activities of daily living such as meal preparation, eating, dressing, and personal hygiene.

Long term services & supports can only be delivered in a nursing facility.

Correct!

LTSS are provided in a variety of settings, including institutional facilities, such as nursing homes, as well as at an individual's home and within the community.

Sorry, that wasn't right.

LTSS are provided in a variety of settings, including institutional facilities, such as nursing homes, as well as at an individual's home and within the community.

Facility-based care is a mandatory Medicaid benefit in every state.

Correct!

Facility-based care is a mandatory Medicaid benefit in every state. Certain home health services, like post-surgery wound care and some therapies, are also covered under Medicaid.

Sorry, that wasn't right.

Facility-based care is a mandatory Medicaid benefit in every state. Certain home health services, like post-surgery wound care and some therapies, are also covered under Medicaid.

Home & Community based care is mandatory Medicaid benefit in every state?

Correct!

Home- and Community-Based Services are not a required benefit that states must provide in their Medicaid program. Still, all states choose to provide Home- and Community-Based Services as an optional benefit for some or all of their Medicaid enrollees through waivers. Medicaid provides states flexibility to design their own LTSS delivery system. This is commonly done through 1915(c) waivers, commonly known as Home- and Community-Based Services waivers.

Sorry, that wasn't right.

Home- and Community-Based Services are not a required benefit that states must provide in their Medicaid program. Still, all states choose to provide Home- and Community-Based Services as an optional benefit for some or all of their Medicaid enrollees through waivers. Medicaid provides states flexibility to design their own LTSS delivery system. This is commonly done through 1915(c) waivers, commonly known as Home- and Community-Based Services waivers.

Medicaid is the primary payer of LTSS?

Correct!

Medicaid has long been the primary payer of LTSS in the United States, covering 42% of all LTSS spending.

Sorry, that wasn't right.

Medicaid has long been the primary payer of LTSS in the United States, covering 42% of all LTSS spending.

LTSS spending makes up what percent of Medicaid spending?

Correct!

Medicaid is the primary payer of LTSS in the United States, covering 42% of all LTSS spending, which is more than 30% of the total Medicaid budget.

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Medicaid is the primary payer of LTSS in the United States, covering 42% of all LTSS spending, which is more than 30% of the total Medicaid budget.

The total expenditures associated with LTSS are considered to be underestimated.

Correct!

A substantial amount of LTSS are provided by family members and other informal caregivers. In fact, it's estimated that $470 billion in unpaid care was provided by “informal” or family caregivers in 2016.

Sorry, that wasn't right.

A substantial amount of LTSS are provided by family members and other informal caregivers. In fact, it's estimated that $470 billion in unpaid care was provided by “informal” or family caregivers in 2016.

The 2 ways LTSS can be delivered are:

Correct!

Some states provide LTSS through a managed care organization, or an MCO. Managed care is a capitated rate, meaning that the MCO gets a fixed amount of funding from the state per person, per month. The MCO then manages all of a person’s care and services within that monthly funding. This reduces unnecessary care and lowers costs. A fee-for-service (FFS) delivery system is a program model used by states without an MCO to deliver care. In a fee-for-service delivery system, the state serves the “payer” role, directly paying providers for care and services offered to their members. Each visit to a health professional under a fee-for-service payment model is billed separately.

Sorry, that wasn't right.

Some states provide LTSS through a managed care organization, or an MCO. Managed care is a capitated rate, meaning that the MCO gets a fixed amount of funding from the state per person, per month. The MCO then manages all of a person’s care and services within that monthly funding. This reduces unnecessary care and lowers costs. A fee-for-service (FFS) delivery system is a program model used by states without an MCO to deliver care. In a fee-for-service delivery system, the state serves the “payer” role, directly paying providers for care and services offered to their members. Each visit to a health professional under a fee-for-service payment model is billed separately.

States want to rebalance their LTSS spending from ___ to ___?

Correct!

The high cost of caring for people in need of LTSS presents a growing challenge for states given competing budget priorities. These costs are generally driven by the cost of nursing home care, which is many times greater than the cost of care in the community. States have made significant efforts to rebalance the proportions of care provided in individuals' homes and community settings as compared with care provided in nursing homes. In fact, 2013 marked the first year that total U.S. Medicaid expenditures for Home- and Community-Based Services exceeded expenditures for facility-based care.

Sorry, that wasn't right.

The high cost of caring for people in need of LTSS presents a growing challenge for states given competing budget priorities. These costs are generally driven by the cost of nursing home care, which is many times greater than the cost of care in the community. States have made significant efforts to rebalance the proportions of care provided in individuals' homes and community settings as compared with care provided in nursing homes. In fact, 2013 marked the first year that total U.S. Medicaid expenditures for Home- and Community-Based Services exceeded expenditures for facility-based care.

The benefits of delivering LTSS via managed care are:

Correct!

More and more states are providing LTSS through Medicaid managed care organizations, otherwise known as Managed Long-Term Services and Supports. MLTSS help expand Home- and Community-Based Services, promote community inclusion, and increase the efficiency of their programs. This is important to note because 76% of Americans, age 50 and older, report wanting to stay in their homes as they age.

Sorry, that wasn't right.

More and more states are providing LTSS through Medicaid managed care organizations, otherwise known as Managed Long-Term Services and Supports. MLTSS help expand Home- and Community-Based Services, promote community inclusion, and increase the efficiency of their programs. This is important to note because 76% of Americans, age 50 and older, report wanting to stay in their homes as they age.

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