At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint

Today, AARP Public Policy Institute, ADvancing States and Health Management Associates (HMA) released a new report highlighting the challenges facing states in providing long-term services and supports (LTSS). Even as states begin to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS), most states did not increase funding for non-Medicaid services – including senior centers, information and referral, transportation and caregiver supports, such as those under the Older Americans Act.

As Americans age, the demand for long-term care, including home and community based services, only continues to grow; and it's happening at a time when state budgets are still strapped. The recent meeting of the federal Commission on Long-Term Care serves as a reminder that as a country we're at the crossroads when it comes to providing care for older adults and persons with disabilities.

The report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms underway and trends across the country. The report found that more states are increasing participation in HCBS options within the Affordable Care Act as well as initiatives for individuals who are dually eligible for Medicaid and Medicare. At the same time, they're seeing increased demand for non-Medicaid services; for example, the caseload for adult protective services – for victims of abuse or exploitation – has increased in the last two years without increased funding in many states.

"It's increasingly evident that we need to rethink how we address long-term services and supports in this country," said Susan Reinhard, Senior Vice President for the AARP Public Policy Institute. "Long-term services and supports are critical not only to the population they serve, but also to the family caregivers who support them."

"The decision by so many states to transform their Medicaid LTSS systems from fee-for-service to managed care ranks as the most significant byproduct of The Great Recession," observed Martha Roherty, Executive Director of ADvancing States. "But our report documents that other vital programs for seniors, reliant entirely on state revenues, still languish six years after the recession began. As their economies improve, states now must turn their attention to other state programs like Adult Protective Services, still struggling with reduced or flat funding, hiring freezes and staff reductions."

"This report illustrates how states are actively engaged in exploring ways to better serve individuals with ongoing health care and support needs," said Jenna Walls, senior consultant at HMA. "The overwhelming survey response rate indicates state policymakers are committed to advancing a national dialogue for how to best address the increasing demand for services."

Click here for the executive summary.

Click here for the full report.

News date: 
Tuesday, July 16, 2013