The NCSL Blog


By Joshua Ewing

People are living longer and our largest age group in the U.S.—80 million baby boomers— began hitting retirement age in 2011. As a result, the population of those ages 85 and older is expected to triple between 2012-2050.

Long term care blogAs our population ages, the number of individuals who need help with daily activities such as bathing and dressing, or more intensive services like those provided in nursing homes grows. Today, nearly 70 percent of people over age 65 will need some form of long-term care services at some time in their lives.

These types of services are commonly referred to as Long-Term Services and Supports or LTSS. In recent years, states have grown to play an essential role in the provision of these services with Medicaid now serving as the largest payer of LTSS, accounting for 41 percent of all LTSS spending in the United States..

This has significant implications for state policymakers because providing high quality, appropriate LTSS is expensive. In 2007, the average annual spending per Medicaid beneficiary using long-term services and supports was $43,296, while the average was only $3,694 for Medicaid beneficiaries not utilizing long-term care services.

A related issue facing states is how LTSS are provided for people who qualify for benefits under both Medicare and Medicaid; around ten million people , who are commonly referred to as “dual eligibles.” Dual eligibles are typically much poorer and have greater health needs than other beneficiaries who qualify for either Medicare or Medicaid individually.  In addition, dual eligibles are also more likely to be disabled; reside in a long-term care facility; and have a poorer health status.

One of the most common options that states are choosing to explore is moving from fee-for-service to a system of Medicaid managed long-term services and supports (MLTSS). By June of 2012, 16 states had implemented MLTSS programs. This number is expected to grow to 26 by 2014.

NCSL’s Health Program is hosting a webinar on Wednesday, Oct. 23, at 2 p.m. ET/ 1 p.m. CT/12 p.m. MT/ 11 a.m. PT which will highlight opportunities and challenges states face in moving to a system of MLTSS.

Speakers will include Paul Saucier, director of integrated care systems with Truven Health Analytics; and Patti Killingsworth, chief of the Long-Term Care Division of TennCare, the Medicaid program for the state of Tennessee.

 Registration is now open and free to legislators and staff. 

Posted in: NCSL, Public Policy
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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.