The major source of public long-term services and supports (LTSS) funding in the US is the joint federal and state Medicaid program. It pays for nursing facility care and limited, but increasing, amounts of home- and community-based services. However, Medicaid has stringent criteria for financial eligibility. To qualify, people must have extremely low assets and income, or have spent almost all of their assets and income to pay for their health care and LTSS.
Medicare does not pay for LTSS. It funds medically necessary home health care, but beneficiaries must be homebound and need skilled health care in order to receive the benefit. Medicare also helps pay for a limited amount of care in a skilled-nursing facility for people who need such care and have had a prior hospital stay of at least three days (see Chapter 7, Health: Health Care Coverage—Medicare for more information on these Medicare benefits).
Smaller public programs provide LTSS, including the US Department of Veterans Affairs program, the Social Services Block Grant program, and Title III of the Older Americans Act. Each program has its own eligibility criteria and covers only limited amounts of LTSS (for more information, see this chapter’s section The Older Americans Act, and Chapter 6, Low-Income Assistance). In addition most states have LTSS programs of their own, paid for out of general revenue; but these serve only a limited number of people.