U.S. Spend On Long-Term Services & Supports, By Payer

An OPEN MINDS Market Intelligence Report

The Centers for Medicare and Medicaid Services (CMS) defines long term services and supports (LTSS) as the services and supports used by individuals with functional limitations and chronic illnesses who need assistance to perform routine daily activities. The primary long-term services and supports payer is Medicaid – funding almost 60% of all LTSS spending.

In 2013, spending for long-term services and supports (LTSS) totaled $282.9 billion across all insurers and represented 9.3% of the $2.9 trillion in total national health expenditures. In 2008, LTSS spending was $235.1 and totaled 9.8% of the $2.4 trillion in national health expenditures. Since 2008 there has been a 20% increase in LTSS expenditures. The percent of health care expenditures spent on LTSS has remained stable over the last five years, fluctuating between 9.3% of health care expenditures and 10.1% of health care expenditures.

LTSS are provided in two settings: institutional and community-based – and include assistance with activities such as bathing, dressing, preparing meals, and administering medications. Institutional LTSS includes LTSS services provided in nursing homes, intermediate care facilities for individuals with intellectual disabilities (ICF/ID), and mental health facilities. Community-based LTSS includes home health, personal care, adult day care and assisted living, habilitation, respite care, and self-directed personal assistance. In general, the utilization of LTSS is expected to rise, and by 2050, it is expected that 34% of non-institutionalized adults over the age of 65 will need LTSS.

The focus of this detailed report is long-term services and supports payer profiles and types of services covered. The report also answers a number of questions including:

1. What Is The Size Of The U.S. LTSS Market?
2. How Is The LTSS Market Funded?
3. What Types Of LTSS Are Covered By Medicaid?
4. What Types Of LTSS Are Covered By Medicare?
5. What Types Of LTSS Are Covered By Private Long-Term Care Insurance & Consumer Self-Pay?