FAQs
Where does the data come from?
The data come from the Transformed Medicaid Statistical Information System (T-MSIS). T-MSIS provides Medicaid claims and enrollment data across all U.S. states, territories, and the District of Columbia. States report data to the Centers for Medicare and Medicaid Services (CMS) using the T-MSIS system. This dashboard includes adults ages 18 years and older from the 2021 T-MSIS data.
Why are some states not included?
T-MSIS contains information for all 50 states and the District of Columbia. However, the quality of state-reporting varies, particularly for Home- and Community-Based Services (HCBS). CMS indicates significant concerns with the quality of HCBS reporting for Alabama in the 2021 T-MSIS data. Thus, we exclude Alabama from this dashboard. We cannot report LTSS counts for Mississippi due to substantial missing demographic data for this state in the T-MSIS data. Additional notes about the quality of LTSS data for Alabama and other states are available through the Data Notes for Medicaid TAF Long-Term Services and Supports Annual Expenditures and Users, 2019-2021.
Why is race-ethnicity not available for some states?
There are also issues with the quality of race-ethnicity data in many states. In some states, there are high rates of missing data for race-ethnicity and/or inaccuracies in reporting. Based on CMS guidance, it is advised not to use race-ethnicity from these states. We excluded states categorized as “unusable” and “high concern.” Additionally, many states do not include "multiracial" as a race-ethnicity category. We do not report the "multiracial" category for these states or at the national level due to missing data.
Why can’t you look at further categories of equity?
We looked at race-ethnicity, sex, and age group based on data availability. Some race-ethnicity categories are combined due to small sample sizes. Currently, T-MSIS does not include reporting on sexual orientation and gender identity (SOGI).
How did you calculate LTSS?
LTSS encompasses two broad categories: institutional services and HCBS.
In this analysis, institutional services include:
- Nursing Facilities
- Intermediate Care Facilities for Individuals with Intellectual Disabilities
- Mental Health Facilities.
We identified individuals receiving HCBS based on methods used by CMS, which use a combination of program and service categories to define HCBS in accordance with section 9817 of the American Rescue Plan Act of 2021. This definition of HCBS includes the following service categories:
- Section 1915(c) Waiver Programs
- Section 1915(i) HCBS State Plan Option
- Section 1915(j) Self-Directed Personal Assistance Services
- Section 1915(k) Community First Choice
- Program of All-Inclusive Care for the Elderly
- Personal Care Services
- Home Health Services
- Rehabilitation Services
- Case Management Services
- Private Duty Nursing Services
Why are you rounding the numbers if the T-MSIS data includes the entire population of Medicaid beneficiaries?
We cannot show the exact numbers for small subpopulations (1-11 people) in order to protect people's identities. For small subpopulations, we use the average of these groups. In the dashboard, we round the LTSS counts to the nearest ten since we cannot report exact numbers.
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How to cite this dashboard
Community Living Equity Center (2024). Who Receives Medicaid LTSS? [Data dashboard]. The Lurie Institute for Disability Policy. https://heller.brandeis.edu/community-living-policy/clec/who-receives-medicaid-ltss.html
Funding Statement
The contents of this dashboard were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTCP0006 & 90RTCP0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDILRR, ACL, or HHS.
The dashboard is also funded by the Robert Wood Johnson Foundation via a grant entitled, Examining Disabled People of Color's Experience with Structural Racism/Ableism Barriers in Accessing Medicaid Home & Community-Based Services.