Medicaid is the primary payor of long term care services in the United States. Unfortuneately, the convergence of an aging population, financial strains placed on states by the current economic downturn, and health care reform's mandate for increased access to care will effectively overwhelm state-administered Medicaid long-term care programs. This is according to "Medicaid Long-term Care: The Ticking Time Bomb," a new paper by the Deloitte Center for Health Solutions, part of Deloitte LLP.