The Medicare program is a health insurance program funded by the federal government for older adults, aged 65 and above, as well as younger individuals who have disabilities or end-stage renal disease. There are both strategic opportunities and challenges for health and human service provider organizations serving Medicare beneficiaries, who often have complex health and social support needs. As a result, Medicare plans are looking for innovative services and initiatives that demonstrate a return-on-investment in spending and consumer outcomes.

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The long-term services and support (LTSS) population refers to individuals with long-term conditions, disabilities, or chronic impairments that require routine assistance. Enrollment in LTSS falls into four broad categories—the elderly, the physically disabled, individuals with intellectual and developmental disabilities (I/DD), and dual eligibles (i.e., individuals who qualify for both Medicare and Medicaid). Most states are limited in how many individuals can be served in the community through the LTSS program, given the caps on the number of people who can receive 1915(c) waivers for home- and community-based services (HCBS) as an alternative to . . .
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