Medicaid and Long-Term Services
Medicaid is the public health insurance program for low-income people. It is jointly funded by the states and the federal government. While state participation is voluntary, all states operate a Medicaid program.
Medicaid is the largest single payer for long-term services. Among the nearly 60 million people Medicaid covers, there are approximately 8.5 million non-seniors with disabilities and 8.8 million individuals over 65. Both groups are likely to need long-term services. The program pays 40 percent of all long-term services costs and covers about 60 percent of all nursing home residents. For many seniors and people with disabilities who need long-term services, Medicaid is a critical safety net.
Each state has considerable flexibility in how it administers its Medicaid program, so eligibility and services vary across states. However, states must follow broad federal guidelines in order to receive federal matching funds. Federal guidelines cover many areas of state Medicaid program operation, including requirements regarding eligibility and the amount, duration, and scope of the services that are covered.
Medicaid requires that states cover nursing facility services. However, coverage of most non-institutional long-term services, referred to as home- and community-based services, is optional. Even though all states cover home- and community-based services to some extent, the difference in coverage requirements has meant that Medicaid services have been skewed toward institutional care. Today, many states are working to redirect long-term care spending from institutional care to home- and community-based services, a process referred to as “rebalancing,” because these services are more cost-effective and widely preferred by consumers.
This section of our website outlines the basics of Medicaid coverage for long-term services. Please keep in mind that while states follow the same broad principles, every state program is different. We provide a list of resources for additional information under Related Links. For more information on other aspects of the Medicaid program, see the Medicaid and Children’s Health sections of our website.
Check out our Long-Term Services and Medicaid sections below to learn more:
