6 States Taking A Multiyear Approach To LTC Costs

Facing mounting pressures on Medicaid budgets, some states are forging a vision for what is necessary to finance a growing need for long-term services and supports (LTSS). That’s according to new research prepared by the LeadingAge LTSS Center at UMass Boston and the Center for Consumer Engagement in Health Innovation, with funding from the Robert Wood Johnson Foundation.

LTSS are relied upon by people with functional limitations and chronic illnesses who need assistance to perform routine daily activities, such as bathing, dressing, preparing meals, and administering medications. As the number of older people in America grows, and more people need assistance with daily activities of living, experts say all states will need to discuss LTSS financing in the years ahead.

Interviews conducted with 42 stakeholders from six states that are actively investing in their LTSS infrastructure found a trifecta of common approaches for moving LTSS financing reforms forward: (1) developing effective coalitions, (2) deploying multiple strategies and multi-year tactics, and (3) forging a common understanding of what is realistic.

Policy experts in the six states where interviews were conducted are investing in a variety of legislative, payment, and social structural efforts, including:

1. California’s statewide Master Plan for Aging, designed to strengthen and reinforce the goals and directions for LTSS finance reform;  
2. Hawaii’s support for working caregivers by subsidizing paid care for their loved ones;  
3. Maine’s proposal to establish a social insurance program focused exclusively on in-home care to support the paid caregiving workforce;   
4. Michigan’s formation of a coalition representing home-care providers, disability rights groups, family caregivers, senior advocacy groups, and providers to seek input from stakeholders;  
5. Minnesota’s effort to enhance affordable private market solutions for middle-income families provides funding for actuarial analyses and research studying the impact on Medicaid; and  
6. Washington’s plan to establish a social insurance program for LTSS, funded through a mandatory employee payroll tax, while reimbursing expenses for care provided at home and in care facilities.  

“The pandemic threw into sharp relief the massive shortcomings of our under-financed system of long-term services and supports, but these problems are not new,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. “In this account of state efforts to provide more long-term care services to residents, we can see the depth of the need and the void created by an absence of federal policymaking.”