Ever heard the term Long Term Services and Supports (LTSS) as related to home health care, long term care, or Medicaid Waivers, but you are unsure what it really means? Here is a straightforward list of Frequently Asked Questions (FAQ) that should help you understand exactly what Long Term Services and Supports (LTSS) are and how to access them in Colorado.


Q. What is the Definition of Long Term Services and Supports (LTSS)?

A. Long Term Services and Supports (LTSS) is a broad term that refers to the actual medical and non-medical services that some people with disabilities, advanced age, and/or chronic conditions need to complete their daily routines.


Q. What are Long Term Services and Supports (LTSS)?

A. Long Term Services and Supports (LTSS) include both medical and non-medical services needed over an extended period of time that individuals with disabilities require for self-care and routine care.

Those services needed for self-care are referred to as Activities of Daily Living (ADL), and include services such as caregiver assistance with eating, bathing, or dressing,

Services needed for routine care are referred to as Instrumental Activities of Daily Living (IADL) and encompass services such as homemaking/housekeeping services, shopping, and bill paying.

Additional services of LTSS include monitoring of health, safety, and well-being, nutritional counseling, physical therapy, non-medical transportation and home modification.


Q. What is the Difference Between Long Term Services and Supports (LTSS) and Home and Community Based Services (HCBS) Waivers?

A. Long Term Services and Supports LTSS does not refer to a single funding program or programs. In fact, LTSS in Colorado may be paid for by a variety of funding programs, one of which is Home and Community Based Services (HCBS) Waivers.

HCBS Waivers are Medicaid programs for people with disabilities. Qualified participants of HCBS Waivers will receive LTSS, but not everyone who qualifies to receive LTSS may qualify for—or be enrolled in—an HCBS Waiver.

Long Term Supports and Services ImageThe accompanying graphic shows how not all LTSS fall under HCBS Waiver coverage. At least half of all American LTSS payments come from Medicaid. A smaller portion of LTSS is paid for by HCBS Waivers (specific Medicaid programs that have very specific qualification criteria and sometimes waitlists).


Q. Where are Long Term Services and Supports (LTSS) Provided?

A. Long Term Services and Supports (LTSS) are provided in one of three settings:

Home based care

This is what is referred to in general as Home Health Care, and includes care provided by skilled or non-skilled caregivers, including family members.

Community based and residential care

Community based care consists of things like day care, respite care, meal programs, group homes, adult foster care homes, and senior centers. Assisted living facilities fall into this category because they are not nursing facilities, but independent living facilities.

Facility-based care

Facility based care are the institutional facilities that give a level of care unavailable even in 24 hour supervised group homes. Facility based care includes nursing homes and intermediate nursing facilities.

The LTSS provided in home and community based settings naturally fall into the Home and Community Based Services (HCBS) definition of the HCBS Waivers. HCBS Waivers are designed for individuals with disabilities who qualify for facility-based care (nursing homes) but can reasonably be cared for in their own homes at typically substantial cost savings. HCBS Waivers allow these individuals to be kept out of institutional settings, which adds to increased independence and quality of life.


Q. Are Long Term Services and Supports (LTSS) the same as Long Term Care (LTC)?

A. Essentially, Long Term Services and Supports (LTSS) means the same thing as Long Term Care (LTC). According to Colorado Health Institute, LTSS has become the modern, more preferred term.


Q. What is the federal government’s role in administering Long Term Supports and Services (LTSS)?

A. The federal government’s Centers for Medicare & Medicaid Services (CMS) work in partnership with each state to create a support system for people who need Long Term Services and Supports (LTSS). The goal of federal and state partnerships is to create programs that provide and fund LTSS with a system that is:

  • Person-driven
  • Inclusive
  • Effective and accountable
  • Sustainable and efficient
  • Coordinated and transparent
  • Culturally competent

To read more about this support system partnership between CMS and local state Medicaid systems, click here.


Q. How do Colorado Long Term Services and Supports (LTSS) rank compared to the supports and services in other states?

A. Colorado ranks favorably compared to other states for Long Term Services and Supports (LTSS). The 2017 scorecard produced by a cooperative effort of AARP and two other partners has Colorado ranking 8th in the nation for performance of LTSS. The dimensions studied for ranking are:

  • Affordability and access
  • Choice of setting and provider
  • Quality of life and quality of care
  • Support for family caregivers
  • Effective transitions

Click here to see an analysis of Colorado’s LTSS 2017 scorecard from ColoradoHealthInstitute.org.


Q. Which Colorado state departments oversee service administration for Long Term Services and Supports (LTSS)?

A. The Colorado Department of Human Services (DHS) and Colorado’s Department of Health Care Policy and Financing (HCPF) oversee service administration of Colorado LTSS.


Q. If I am enrolled in an HCBS Waiver, which Long Term Services and Supports can I receive?

A. Each of Colorado’s 10 HCBS Waivers qualifies participants for varying Long Term Services and Supports (LTSS). There is no one size fits all. Colorado.gov website has snapshots of all available programs for individuals with physical or developmental disabilities. Additionally, a snapshot of available programs for veterans is found here.

In Home Support Services (IHSS) and the Paid Family and Friend Caregiver program are available on certain HCBS waivers.

Contact The Independence Center Home Health Office Administrator for help

Do you or a loved one need LTSS? Do you think you might qualify for an HCBS Waiver in Colorado but aren’t sure? Navigating the LTSS system in Colorado can be confusing. The Independence Center is here to help point you in the right direction. Contact our Home Health Office Administrator at 719-476-3107 for help getting started.