LTSS Financing
Guidance for LTSS financing, including financial planning steps, who pays for LTSS, working with your state, comparing reimbursement rates, and planning and development grants.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 22, 2020
Native Health, an urban Indian program in Phoenix, AZ, offers integrated care led by a team of providers that addresses medical, social, and behavioral health needs.
LTSS financing and reimbursement are complex topics that vary greatly from state to state. Materials here can inform you about general considerations and alert you to topics that may arise in conversations with your state. LTSS financing sections of the Technical Assistance Center include:
Financial Planning Steps
Where should you start? The financial planning steps cover:
- Guidance on budgeting
- Financial performance targets
- The roles of different revenue sources
- An explanation of the break-even analysis and why it matters
Who Pays for LTSS?
Different sources often cover different tribal LTSS, including:
- Medicaid: covers eligible people receiving eligible services
- Medicare: covers people over age 65 or with disabilities or certain diseases
- Indian Health Service funding
- Private insurance: long-term care insurance
- Tribal support: financial assistance from your tribe
- Grants: time-limited funding
Working with Your State
Successful tribal LTSS programs have identified steps for working with your state for LTSS reimbursement. Resources for further information are included in every step of this guide.
Continue100% FMAP for LTSS—Educate Your State
The 100% Federal Medicaid Assistance Percentage (FMAP) is a win-win situation for states and tribes that can help you negotiate better reimbursements with your state. Learn why in this section.
ContinueComparing Reimbursement Rates
The rate at which you might be reimbursed depends on who reimburses you as well as on many other things, like state policies. This section explains the different types of reimbursements that may help cover LTSS costs.
ContinuePlanning and Development Grants
While it is important to find other, longer-term funding sources, grants can help fund the planning and development of your program. This section describes the limited role grants can play in establishing your program.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.