Long Term Health 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 Latest

Recent Developments

  • On April 27, 2012, CMS released the final rule for the Community First Choice (CFC) option, created by the Affordable Care Act, which provides a 6 percent enhanced federal match for states that offer home- and community-based personal attendant services and supports. Under the final rule, states must meet several specific requirements, including establishing and maintaining a quality assurance system for CFC services; and meeting or exceeding the state’s current level of expenditures for home- and community-based attendant services for the first 12 months of the program. States are also required to use a person-centered service plan that is based on an assessment of functional need and that allows for services to be self-directed. The final rule clarifies that people should be determined to need an institutional level of care to be eligible for CFC services.
  • On April 27, 2012, CMS released proposed rules for the Home and Community-Based Services 1915(i) State Plan Benefit, which was originally authorized in 2005 and later improved by the Affordable Care Act to make it easier for states to provide Medicaid coverage for home and community-based services (HCBS). These new rules allow states to offer and receive federal reimbursement for HCBS as part of the regular state Medicaid benefit without the use of a waiver so they can provide a full array of services and supports to people who do not qualify for  institutional care but who have significant service needs. The rule also proposes a definition of “home- and community-based” settings that will serve as a common definition for services offered through the Community First Choice option and the Section 1915(i) state plan benefit. The proposed rule will be open for comment for 30 days beginning on May 3, 2012.
  • On April 16, 2012, HHS Secretary Sebelius announced the creation of the new Administration for Community Living, which combines into a single agency the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities. This new agency will undertake initiatives to increase access to community-based services and supports and to achieve full community participation for seniors and people with disabilities.
  • Maryland is the second state to be awarded a grant under the Affordable Care Act’s State Balancing Incentive Payments Program. Beginning on April 1, 2012, CMS is providing the state with $106.34 million over three years to implement administrative changes that will increase access to home- and community-based services. Maryland has set a target to increase the share of its Medicaid spending on community-based long-term services and supports from 37 percent to 50 percent of the state’s total long-term services budget.
  • CMS has announced another round of planning grants of up to $200,000 each for states that are not yet participating in the Money Follows the Person (MFP) Rebalancing Demonstration Program. Enacted into law in 2006 as part of the Deficit Reduction Act, these demonstration programs provide states with 12 months of enhanced federal matching funds for Medicaid beneficiaries who are moved from institutional settings to community-based settings. The Affordable Care Act extended the program through 2016. Currently, 43 states and DC operate demonstrations. These grants are an opportunity for AL, AK, AZ, SD, UT, and WY to receive funding to participate in the program. The grants will help states prepare their applications, and recipients will be announced later this year. The deadline for applying is March 6, 2012.
  • On December 20, 2011, CMS released a solicitation for applications for the Independence at Home Demonstration that was created by the Affordable Care Act. The demonstration is a voluntary program for Medicare beneficiaries with multiple chronic conditions and functional limitations. It will test the effectiveness of giving incentive payments to health care providers for coordinating care by delivering a complete range of primary care services in a home setting. State applications and Letters of Intent, if applicable, are due on February 6, 2012. Applications and further information on the demonstration are available in the Medicare Demonstrations section of the CMS website.
    • On April 27, 2012, the first 16 organizations that will participate in the new demonstration were announced. The participating health care providers will test whether delivering primary care services in the home can improve the quality of care and reduce costs for patients with chronic illnesses. The demonstration is scheduled to begin on June 1, 2012, and will conclude on May 31, 2015.

From the Kaiser Commission on Medicaid and the Uninsured:

Medicaid Managed Care: Key Data, Trends, and Issues examines the prevalence of managed care in state Medicaid programs, the varied approaches states have used, managed care for long-term services and dual eligibles, and evidence of cost savings. (February 2012)

From the Kaiser Family Foundation:

Medicaid’s Role for Women across the Lifespan: Current Issues and the Impact of the Affordable Care Actdiscusses the importance of Medicaid for the 21 million women that it covers. With Medicaid, low-income women have access to reproductive health care, care for chronic conditions and disabilities, and long-term services. (January 2012)