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Long-Term Services & Supports, Long-Term Care

ASPE conducts research, analysis, and evaluation of policies related to the long-term care and personal assistance needs of people of all ages with chronic disabilities. ASPE’s work also highlights the financing, delivery, organization, and quality of long-term services and supports, including those supported or financed by private insurers, Medicaid, Medicare, and the Administration for Community Living (ACL). This includes assessing the interaction between health care, post-acute care, chronic care, long-term care, and supportive services needs of persons with disabilities across the age spectrum; determining service use and program participation patterns; and coordinating the development of long-term care data and policies that affect the characteristics, circumstances, and needs of people with long-term care needs, including older adults and people with disabilities. 

Most Older Adults Are Likely to Need and Use Long-Term Services and Supports

More than one-half of older adults, regardless of their lifetime earnings, are projected to experience serious LTSS needs and use some paid LTSS after turning 65. 

Older adults with limited lifetime earnings are more likely to develop serious LTSS needs than those with more earnings. 

However, fifty-six percent of older adults in the top lifetime earnings quintile receive some paid LTSS, and the likelihood of nursing home care does not vary much by lifetime earnings. Learn more.


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Which Way for Long-Term Services and Supports Financing Reform?

Despite the high costs for long-term services and supports (LTSS), the current financing system inadequately protects people from the financial devastation of long-term disabling conditions such as Alzheimer's disease or stroke. Private long-term care (LTC) insurance coverage is low and Medicare does not cover LTSS.

Long-Term Services and Supports: What are the Concerns and What are People Willing to Do?

Angela M. Greene, Nga Thach, Joshua M. Wiener and Galina Khatutsky RTI International Printer Friendly Version in PDF Format (17 PDF pages)

Older Adults' Living Expenses and the Adequacy of Income Allowances for Medicaid Home and Community-Based Services

This brief assesses the adequacy of the income allowances granted to older Medicaid HCBS enrollees and their spouses.
ASPE Issue Brief

Picture of Housing and Health Part 2: Medicare and Medicaid Use Among Older Adults in HUD-Assisted Housing, Controlling for Confounding Factors

The Lewin Group Printer Friendly Version in PDF Format (67 PDF pages)

Preliminary Outcome Evaluation of the Balancing Incentive Program

Printer Friendly Version in PDF Format (33 PDF pages)

Later-Life Household Wealth Before and After Disability Onset

To assess the financial impact on families of LTSS needs and the potential for families to set aside funds to cover future LTSS spending, this brief examines later-life household wealth before and after disability onset.

Final Process Evaluation of the Balancing Incentive Program

This is a follow-up to three earlier evaluation reports on the Balancing Incentive Program. The Balancing Incentive Program, legislated in the 2010 Affordable Care Act (ACA), offered states temporary enhanced federal financial participation for Medicaid home and community-based services (HCBS).

Health Coverage for Homeless and At-Risk Youth

This fact sheet explores eligibility for health care coverage, including through Medicaid and the Children’s Health Insurance Program (CHIP), for youth experiencing or at risk of homelessness. It provides information on subpopulations of youth who are likely to be eligible for health care coverage, which services are covered, and how to enroll.

Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Progress and Lessons from the First States Implementing Health Home Programs, Annual Report - Year Four

This report presents findings from the first four years of the five-year evaluation of Medicaid health homes, a new integrated care model authorized in Social Security Act Section 1945 and created by Section 2703 of the Affordable Care Act. The model is designed to target high-need, high-cost beneficiaries with chronic conditions or serious mental illness.

Study of Costs Associated with Community Activities under the Communities Putting Prevention to Work (CPPW) Initiative

The Centers for Disease Control and Prevention’s (CDC’s) Communities Putting Prevention to Work (CPPW) program funded 44 communities and states under the American Recovery and Reinvestment Act (ARRA) to implement community-based tobacco and obesity prevention interventions.