The question about how long term care services would be covered by the federal government was answered by requiring the states to provide both medical home health and nursing home services to their poor elderly in order to receive a federal match for the costs of their Medicaid program. States also could optionally include people who did not qualify as "poor" based on their income or assets if they could not afford to pay for the medical care they needed (the medically-needy), so long as the recipients "spent down" their assets to pay for as much as they could before receiving Medicaid payments.