Now at Center Stage: Self-Direction Comes to Long-Term Services and Supports

<span class="paragraphSection">Long-term services and supports (LTSS) have long had a marginal place in American health and social policy. No clear consensus exists that provision of such services is principally a public responsibility. The interplay of chronic and acute health conditions has meant that there is no singular claim of professional responsibility for LTSS. The recipients of those services, long defined by their incapacities, have had little political or policy standing. And the grinding nature of long-term service delivery and receipt has been less politically attractive than the cash benefits of Social Security, the health care benefits of Medicare, or the community support services of the Older Americans Act. Much as a result, American LTSS policy has resided in the largely means-tested world of Medicaid.</span>

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