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

At the federal level, the two categories of budgetary expenditures are entitlement and discretionary spending. 

Residential care setting is an umbrella term for many types of certified and licensed housing plus services options.

Block grants and unfunded mandates are two government budgetary practices that can have significant implications for lower levels of government. 

Ensuring the quality of services for home care is difficult. No quality measures can assess every service delivered daily in hundreds of thousands of private homes across the country.

In 2021, an estimated 58.7 million adults age 18 and older in the U.S. had a mental illness. That is 22.8 percent of all adults. Prevalence among those over age 50 is 15 percent. 

The care provided in long-term services and supports (LTSS) settings is only as good as the personnel who provide it.

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

The primary source of public financing for long-term services and supports (LTSS) is the joint federal and state Medicaid program.

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.