The long-term services and supports systems (LTSS) in Minnesota, Washington, Oregon, and Colorado had the highest performance and quality, as measured for five dimensions: access, consumer choice of settings, consumer quality of life, support for family caregivers, and safe transitions from institutional care to community-based settings. In these four states, LTSS performance scores were in the first and second quartiles compared to the other states and the District of Columbia. The lowest performing systems were in West Virginia, Indiana, Tennessee, Mississippi, Alabama, and Kentucky. In these five states, four of the five LTSS performance scores were in the . . .