In 2017, we estimate spending on long-term services and supports (LTSS) totaled $348.1 billion, an increase of 48% from 2008, when spending was $235.1 billion. Nine million consumers receive LTSS every year including the elderly, consumers with physical disabilities, consumers with intellectual and developmental disabilities, and consumers at-risk of institutionalization. LTSS is a broad category of medical and non-medical services and supports that includes home- and community-based services (HCBS) —case management, homemaker, home health aide, personal care, adult . . .