One of Medicaid’s biggest responsibilities is providing long-term care services to elderly and disabled beneficiaries who require care over a period of months or years.  While many of these patients also have significant acute care needs, their dependence on long-term care is related to conditions that are generally ongoing and often deteriorate over time.  This central truth holds for a diverse group of Medicaid beneficiaries that includes, for example, seniors with dementia, adults with paralysis, and children with developmental disabilities.

Each month an estimated 240,000 frail elderly and physically disabled Medicaid beneficiaries receive long-term care services like nursing home care, home health services, and personal care.  This figure accounts for less than one-fourth of all elderly and disabled beneficiaries.  An additional 70,000 beneficiaries with developmental disabilities, mental retardation, or long-term mental illness are treated each year in community-based settings or residential facilities.  Because those receiving long-term care are among Medicaid’s most vulnerable and complex beneficiaries—and despite the fact that most have Medicare coverage—their costs (including acute care services) account for more than half of all Medicaid spending.