Long-Term Services & Supports (LTSS)

Shifting spending and delivery of long-term services and supports (LTSS) from institutions to the home and community is often referred to as rebalancing. This report and brief describe variation in LTSS rebalancing between 2016 and 2019 by enrollee age, health condition, and demographic factors.

While the likelihood of needing any long-term services and supports (LTSS) is roughly a coin flip, the cost if one needs assistance for a long period of time can be catastrophic. For example, about one-in-five Americans turning age 65 today will have long-term care costs exceeding $200,000.

This study explores duties and activities that distinguish the DSP occupation from other direct care workforce occupations to inform the consideration of a DSP SOC code and other workforce data collection efforts. This study also identifies information beyond what is needed to create a DSP SOC code that states need on the DSP workforce to address policy and workforce planning activities.

Between 1988 and 1998, Congress established the Medicare Savings Programs (MSPs). MSPs are Medicaid programs that subsidize the cost of Medicare premiums, deductibles, co-insurance, and other cost sharing for Medicare beneficiaries with low incomes.

Over one million Americans rely on nursing homes for care, yet nursing homes face challenges in recruiting and retaining staff. Nursing homes rely on registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs) to provide care, but staff shortages that increased during the COVID-19 pandemic have persisted.

This New Jersey case study provides insights into the daunting challenges states face in seeking to address the home care worker shortage, which has become more acute as New Jersey and other states have striven to “re-balance” Medicaid long-term services and supports use and spending away from institutional care toward home and community-based services.

Direct care workers (DCWs) such as nursing assistants, home health aides, and personal care assistants play an essential role in the health and well-being of over 20 million Americans. Yet DCW wages are not enough to make jobs competitive with entry level positions in other industries with similar job requirements which exacerbates the challenges in recruitment and retention of these workers.

The purpose of this research was to understand the relationship between state Medicaid payment rates to nursing homes and those facilities’ costs of providing care to Medicaid residents.

Nursing homes have been disproportionately impacted by COVID-19. The purpose of this study was to examine whether there were racial, ethnic, and socioeconomic differences in COVID-19 infection and mortality rates at both the nursing home resident and nursing home facility levels. The study includes national data on COVID-19 outcomes for nursing home residents through the end of June 2021.

In April 2024, CMS issued the Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting final rule which established new minimum nurse staffing requirements for nursing homes by nurse type.