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    Long-Term Services and Supports (LTSS) Financing and Affordability Initiative

    About California’s LTSS Initiative

    A key component of California’s Master Plan for Aging (MPA) is addressing Long-Term Services and Supports (LTSS) financing challenges, particularly for those who are not eligible for Medi-Cal, referred to here as the "Overlooked Middle."

    The Budget Act of 2022 AB 179 (Ting) included $5 million to support data and research of LTSS financing and services options for older adults and people with disabilities. In March 2024, the California Department of Aging (CDA) launched the Long-Term Services and Supports Financing and Affordability Initiative.


    The full body of research is listed below and available on the LeadingAge LTSS Center @UMass Boston Overlooked Middle webpage.

    Who Are the Overlooked Middle?

    The Overlooked Middle are a population of older adults and adults with disabilities who are unable to sustain the costs of LTSS when needed without jeopardizing their daily living expenses, and they are too wealthy to qualify for Medicaid/Medi-Cal coverage.

    Generally, the Overlooked Middle is a diverse group of adults ages 50 and older with incomes between 139% and 500% of the Federal Poverty Level (FPL). In 2024 dollars, this amount ranges from a low of about $21,000 to a high of $102,000, depending on household size.

    SIZE & GROWTH In 2024, there were 5.5 million Californians ages 50 and older in the Overlooked Middle. By 2050, this population is projected to grow to 6.9 million, and those 75 years older will nearly double.
    AFFORDABILITY RISK Roughly half of California's Overlook Middle cannot fully afford to pay for their basic living needs if moderate LTSS costs arise (i.e., about 4 hours of paid care per day, every day). The risk is higher for women, black and Hispanic, older adults, and those at lower income levels.
    LTSS NEEDS GROWTH There were 571,000 people in California's Overlooked Middle who had LTSS needs in 2024. By 2050, this number is projected to reach 1.08 million - an 89% increase.
    HOUSING & HOME EQUITY About two thirds of households in California's Overlook Middle own a home. Their median home equity that could be tapped while remaining in their home is about $350,000. However, many worry that using their homes equity will limit future housing and LTSS choices later, and they do not see tapping home equity as a viable option to pay for LTSS should the need arise.
    CONSUMER PERSPECTIVE California's Overlook Middle prioritizes near term basic living needs over planning for future LTSS. They want programs that protect financial security, preserve choice and control, and help navigate systems.

    LTSS Initiative Webinars and Resources

    July 31, 2025

    August 28, 2024