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Implementing an Integrated Long-Term Services and Supports Buy-in Program: A Cost Estimate


As the nation continues to age, the need for long-term services and supports (LTSS) will grow; however, access is limited. Public coverage of LTSS is primarily available only through the Medicaid program, accounting for 19% of total spending on LTSS (see Figure below). This forces individuals to spend down their savings and assets into Medicaid eligibility or, alternatively, rely on informal or unpaid care for their needs. In addition, acute care benefits and LTSS benefits are often administered by two disjointed programs (Medicare and Medicaid). As the magnitude of individuals with LTSS need rises, so does the long-term cost to both the Medicaid and Medicare programs through increased and fragmented utilization of acute care and institutional settings.



In collaboration with the Bipartisan Policy Center, ATI Advisory estimated the federal costs associated with subsidizing an integrated LTSS benefit for Medicare beneficiaries with LTSS needs. This analysis includes the number of Medicare beneficiaries likely in need of such LTSS, ranges of those likely to receive subsidized coverage based on different income levels, and costs associated with different approaches to coverage. Initial cost estimates were limited to Medicare beneficiaries aged 65 and older.


Policymakers continue to seek solutions to address the increasing LTSS need within our aging nation, and this study provides an initial cost estimate of subsidizing some level of LTSS for Medicare beneficiaries without full Medicaid coverage. Introducing the programs modeled in this study could address unmet need and reduce longer-term Medicare and Medicaid spending. Additional analysis is needed to determine policy and program specification of what this coverage could include.

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