Long-Term Service and Support Expenditures for Persons With ID/DD Within the Overall Medicaid Program

In recent years there has been growing attention to the relative differences in access, quality, and costs of long-term services and supports (LTSS), especially community LTSS, for persons with different types of disabilities. These differences are attributed to various factors, including differences in the amounts of needed support and in the accepted approaches to support as well as relative effectiveness of advocacy on behalf of different constituencies and others. The interactions of such factors have led to actual and/or perceived differences among “disability groups” in access to and quality of LTSS that have been questioned in terms of fairness and appropriateness. In a discussion of these issues and their implications, Kane, Priester, and Newman (2004) observed that, “From a social justice perspective, it is not immediately apparent why different groups of persons with disabilities should be favored” (p. 16). Although perspectives may differ on...