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Extended LTSS Utilization Makes Older Adults More Reliant on Medicaid Issue Brief

Publication Date

Extended LTSS Utilization Makes Older Adults More Reliant on Medicaid Issue Brief

Richard W. Johnson and Melissa M. Favreault
Urban Institute

Judith Dey, William Marton, and Lauren Anderson
U.S. Department of Health and Human Services

January 2021

Link to HTML Version (9 PDF pages)

ABSTRACT: Although only a minority of older adults will ever enroll in Medicaid, the program provides an important safety net for older people who need long-term services and supports (LTSS) and either earned little over their lifetime or had financial resources but depleted them over time. Based on microsimulation modeling, we estimate that more than half of adults in the bottom fifth of the lifetime earnings distribution who survive to age 65 will be enrolled in Medicaid for at least three years after age 65. Many older adults who receive extensive paid LTSS will eventually enroll in Medicaid, even those who had substantial earnings over their lifetime. Our analysis indicates that among adults who receive paid LTSS for at least five years after age 65, more than 8 in 10 in the middle fifth of the lifetime earnings distribution and nearly half in the top fifth of the earnings distribution will eventually be enrolled in Medicaid.

The full report on which this brief is based is “Economic Hardship and Medicaid Enrollment in Later Life: Assessing the Impact of Disability, Health, and Marital Status Shocks,” available at The DYNASIM projections were developed by Melissa Favreault, Karen Smith, Paul Johnson, Doug Murray, and Damir Cosic at the Urban Institute, with conceptual and modeling help from William Marton and Brenda Spillman.

This report was prepared under contract #HHSP233201600024I between HHS's ASPE/BHDAP and the Urban Institute. For additional information about this subject, you can visit the BHDAP home page at or contact the ASPE Project Officers, at HHS/ASPE/BHDAP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C., 20201;,,

DISCLAIMER: The opinions and views expressed in this report are those of the authors.  They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted on October 2020.