Long-term services and supports (LTSS) for the elderly and younger populations with disabilities are a significant component of national health care spending. In 2012, spending for these services was $219.9 billion (9.3 percent of all U.S. personal health care spending), almost two-thirds of which was paid by the federal-state Medicaid program. Medicaid spending for LTSS has gradually shifted toward home- and community- based services in recent years. Various studies have estimated that the economic value of caregiving, the imputed “cost” of informal care ranges from tens to hundreds of billions of dollars.