Long-Term Services & Supports (LTSS) in Massachusetts

This is an excerpt of a recent report prepared by the Blue Cross Blue Shield of Massachusetts Foundation and Manatt. Download Insight to read the full report and opportunities.  

What Are Long-Term Services and Supports?

Long-Term Services and Supports (LTSS) are a range of medical and nonmedical services and supports that people of all ages with disabilities and chronic conditions use to meet their medical, personal care, and daily needs. LTSS promote independence, support one’s ability to participate in their communities, and increase overall quality of life. LTSS include services provided in home- and community-based settings and in facilities/institutions.

Most people who need LTSS consistently rely on Medicaid (known as MassHealth in Massachusetts), private long-term care insurance, or self-pay to cover these services. Private commercial health insurance coverage and Medicare cover only a subset of LTSS for a limited duration of time, whereas Medicaid typically covers more comprehensive LTSS for a longer duration.

LTSS for Older Adults

The population that is most likely to need LTSS — older adults ages 65 and over — is also the fastest growing population group in the United States and in Massachusetts.

  • In 2020, there were over 55 million people aged 65 and over in the United States, comprising 16% of the total population. This represents a nearly 40% increase from 2010. 
  • Massachusetts saw a similar trend in the growth of the population aged 65 and over, with the share of people 65+ as a percent of the total population increasing over 25% during the same time period.
  • The number of individuals ages 65 and over is expected to grow over the next 20 years, increasing the need for LTSS and the demand on the workforce. In Massachusetts, the projected total population ages 65 and over in 2040 is 1.4 million, up from 1.1 million in 2020. Nearly 70% of people turning age 65 will develop significant LTSS needs in their lifetime.

Looking Ahead: Opportunities and Considerations

Massachusetts is a national leader in LTSS, ranking fourth nationwide on LTSS system performance in the 2023 AARP LTSS State Scorecard, but there is still room to strengthen the system in several ways, including:

  • Continuing to explore strategies to increase LTSS workforce capacity to meet the growing demand for LTSS in the Commonwealth.
  • Further expanding access to HCBS and advancing “care at home” models to enable people who need LTSS to receive care in their homes and communities.
  • Exploring additional LTSS payment options for moderate-income residents, such private long-term care insurance.
  • Prioritizing enhancements to data quality and transparency, including collecting more robust data on race, ethnicity, and primary language spoken among people using LTSS and producing and publishing regular reports regarding trends in care delivery, workforce, and spending.

Click here to read the full report and opportunities.  



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