Medicare and medicaid in long-term care.

Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated. Gaps often exist in some services while there is overlap in others. This can lead to inefficient delivery of services and confusion among program recipients and providers alike. Spending on postacute services in Medicare and long-term care services in Medicaid has grown more rapidly than enrollment in either program since 1999. Although growing numbers of people receive home and community-based services paid for by the two programs, there are wide variations across states and among target groups. The system of long-term care is in need of structural reform.