Millions of americans including children adults and seniors need long term care services because of disabling conditions and chronic illnesses medicaid is the primary payer across the nation for long term care services medicaid allows for the coverage of these services through several vehicles and over a continuum of settings ranging from institutional care to community based long term services and supports ltss. Medicaid coverage of long term services and supports congressional research service summary long term services and supports ltss refer to a broad range of health and health related services and supports needed by individuals who lack the capacity for self care due to a physical cognitive or mental disability or condition often the individuals disability or condition results. Medicaid coverage of long term services and supports congressional research service summary long term services and supports ltss refer to a broad range of health and health related services and supports needed by individuals who lack the capacity for self care due to a physical cognitive or mental disability or condition often the individuals disability or condition results. Medicaid is the primary payer for long term care services cms and states support service delivery through a range of settings from institutional care to community based long term services and supports these services can provide beneficiaries with disabilities and chronic conditions independence improved health improved quality of life