Long-Term Services and Supports
Currently, more than 10 million Americans rely on long-term services and supports for their health and well-being. And that number will only increase dramatically as Baby Boomers age. Yet the United States has never had a system that ensures access to affordable and appropriate long-term care.
Health reform lays the foundation for changing that. It provides new opportunities for states to expand and strengthen home- and community-based programs in Medicaid, the major payer for long-term services. Medicaid coverage for these critical services is optional and varies widely from state to state. Health reform also establishes a voluntary insurance program for long-term services, the Community Living Assistance Services and Supports program (CLASS).
This section of our website looks at current long-term services coverage, the new options and programs that are part of health reform, and how these new options can make a difference nationally and at the state level. Even though health reform lays a foundation for improving access to long-term services, much more needs to be done. Under “Other Issues,” you can find information on legislative proposals to improve long-term care, promising practices, and innovative ways to cover and provide care in the United States and internationally.
The American Tax Relief Act of 2012 (the legislation that came out of the fiscal cliff deal), signed into law on January 2, 2013, repealed the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was a voluntary, national long-term care insurance program created by the Affordable Care Act, which also established a Commission on Long-Term Care.
Implementation of the CLASS Act was suspended on October 12, 2011, in response to an actuarial and legal analysis of the program conducted by HHS. The new commission is responsible for conducting a comprehensive evaluation of current access to long-term care; examining workforce issues; and developing a comprehensive plan to establish, implement, and finance a coordinated long-term services and supports delivery system. The commission will be comprised of 15 members, appointed within 30 days of the enactment of the American Tax Relief Act.
State Studies Find Home and Community-Based Services to Be Cost Effective summarizes a wide variety of studies on the effectiveness of home and community-based services for long-term care. (March 2013)
From the Disability Rights Education and Defense Fund and the National Senior Citizens Law Center:
Identifying and Selecting Long-Term Services and Supports Outcome Measures explains the importance of developing robust quality measurement and improvement mechanisms in states that implement managed long-term services and supports (LTSS). It describes principles for quality measurement; current efforts to develop better quality measures; and qualitative methods, such as site visits and critical incident reporting, that can identify problems where quantitative measures fall short. (January 2013)
From the Kaiser Commission on Medicaid and the Uninsured:
Medicaid's Role in Meeting the Long-Term Care Needs of America's Seniors examines Medicaid's role as the nation's primary payer of long-term services and supports. It includes state-level data on Medicaid enrollment and expenditures for elderly beneficiaries. (February 2013)
Implementation of Affordable Care Act Provisions to Improve Nursing Home Transparency, Care Quality, and Abuse Prevention describes the new requirements that were included in the Affordable Care Act for nursing homes that participate in Medicare and Medicaid. It also explains the reasons for incorporating these requirements into the law and the progress that has been made in implementing them so far. (January 2013)
Medicaid Home and Community-Based Services Programs: 2009 Data Update summarizes the key trends in expenditures and participation in the three main Medicaid home and community-based services programs. It also highlights results from a 2011 survey on provider reimbursement policies and participant eligibility and enrollment. (December 2012)
From the National Association of State Units on Aging and Disability:
State Medicaid Integration Tracker: Review of State Medicaid Integration Plans describes state proposals to reform delivery systems for long-term services and supports (LTSS). These proposal include managed LTSS, dual eligible demonstration programs, Medicaid state plan home- and community-based services options, and rebalancing initiatives like the Balancing Incentive Program (BIP) and Money Follows the Person (MFP). The report includes maps and state-by-state summaries with target dates for implementation. (January 2013)
From the National Senior Citizens Law Center:
Medicaid Managed Long-Term Services and Supports: A Review and Analysis of Recent CMS Waiver Approvals in New Jersey and New York summarizes how each new waiver approaches key elements of a managed long-term care program, and it provides a brief analysis of these approaches. (March 2013)