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The mainstay of local taxation is the tax on real estate, known as the property tax. It is used to fund an array of critical state and local services, most notably public schools.

How to improve the tax code is the subject of much debate. Proponents of reform often call for increasing fairness and simplicity. But people define those concepts in different ways. 

Policymakers use the tax system to raise revenue and to promote social policy goals. For example, tax breaks may be provided to encourage home ownership.

Federal and state governments have tried to change budget rules to control government spending. Budget rules have also been used to impose fiscal discipline.

One indicator of sensible fiscal practices is maintaining balance between spending and revenues. Occasional deficits may be necessary.

Medicaid is the single largest public funding source for long-term services and supports (LTSS). It is a combined federal-state program. Some Medicaid services are federally mandated.

Federal law and regulations specify the general eligibility and coverage requirements for mandatory and optional Medicaid long-term services and supports (LTSS).

Many chronic illnesses and other health conditions—such as heart disease, cancer, multiple sclerosis, arthritis, diabetes, and emphysema—can result in functional limitations.

Many states are enrolling Medicaid participants in capitated, risk-based managed care plans designed to coordinate all their care, including long-term services and supports (LTSS) if needed.

Government and providers of long-term services and supports (LTSS) use various approaches to promote service quality and protect consumer rights.