Medicaid today pays for 41% of the nation’s long term care bill. Most of that spending (85%) is on institutions. As the Congress grapples with efforts to reduce Federal expenditures and balance the budget, the Medicaid program and its investment in long term care are particularly vulnerable to cuts. Indeed, Medicaid comprises nearly half of the total Federal government spending on entitlement programs for the poor and therefore will likely see reductions no matter how Congress elects to deal with the program (e.g.: Federal cap, block grant, Federal “take over”).