The major source of public financing for long-term services and supports (LTSS) is the joint federal and state Medicaid program. Medicaid pays for nursing facility care and increasing (but still limited) amounts of home- and community-based services (HCBS). However, to qualify for Medicaid, people must have extremely low assets and income, or have spent almost all their assets and income to pay for their health care and LTSS.
Medicare generally does not pay for LTSS. It funds medically necessary home health care, but beneficiaries must be homebound and need skilled health care to receive the benefit. Medicare also helps pay for a limited amount of care in a skilled-nursing facility if an individual has had a prior hospital stay of at least three days (see also 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 (see also The Older Americans Act in this chapter). In addition, most states have LTSS programs, paid for out of general revenue; but they serve only a limited number of people.