More than six million people age 65 or older in the United States need long-term supportive services. Three-quarters receive services in the community, generally a mix of informal or unpaid care and formal or paid care. Although most people with long-term care (LTC) needs rely heavily on unpaid help from family and friends, national spending on LTC totaled almost $180 billion in 2002. The Medicaid program is the largest payer for LTC services, accounting for 47 percent of this spending.
Yet, nearly all states fund community-based LTC services independent of Medicaid in order to have greater flexibility in determining eligibility, providing services, and allocating resources. These programs can provide services to people who are not eligible for the Medicaid program as well as services that may not be available under Medicaid. Such programs – for which spending was $1.4 billion in fiscal year 2002 – are described in detail in this AARP Public Policy Institute Issue Paper by Laura L. Summer and Emily S. Ihara of the Center on an Aging Society at Georgetown University's Health Policy Institute. (41 pages)