Long Term Services and Supports

This issue brief from the MLTSS Institute focuses on aspects of delivering effective care to individuals eligible for both Medicare and Medicaid. Only about 2/3 of states have undertaken any activity to better integrate care for dually eligible beneficiaries; many have encountered a number of barriers in pursuing better integration of the Medicare and Medicaid programs. This issue brief identifies key questions that states should ask themselves before they design an integrated care program.

This AARP Public Policy Institute research report examines support for family caregivers in managed long-term services and supports. The report finds that states have made progress in this area, but have opportunity to continue improving support for family caregivers in their MLTSS programs. One potential solution suggested by the report is to ensure that MLTSS contracts between states and health plans include clearly defined requirements to identify and support family caregivers.

On March 3, 2020, the Government Accountability Office (GAO) released a report that details challenges the Department of Veterans Affairs (VA) faces in meeting growing demand for long-term care (LTC). Three major challenges the VA faces includes workforce shortages, ailing care geographically, and meeting needs for specialty care. The VA currently provides or pays for LTC for over 500,000 veterans in the U.S. in both institutional and HCBS settings.

This issue brief discusses state policy trends using data from KFF’s 18th annual 50-state survey. It discusses policy areas such as implementation of electronic visit verification and value based payment models. The brief highlights key findings across the topics areas of HCBS program flexibility, MLTSS, and response to federal regulations

This brief includes the latest (FY 2018) Medicaid HCBS enrollment and spending data from KFF’s 18th annual 50-state survey. It contains data about per-enrollee spending on HCBS by target population and HCBS waiver waiting lists. This issue brief also includes tables with detailed state-level data. One key finding analyzed here is that most HCBS enrollees receive services provided at the state option.

This brief highlights the efforts of states who implemented Value Based Payment initiatives within systems that support individuals with intellectual or developmental disabilities (I/DD). The brief emphasizes the importance of understanding the population and provides an overview of the population served and their length of engagement with the service system. It looks at the experiences of OH and WA in the Medicaid Innovation Accelerator Partnership program from April 2018 to September 2019.

This case study explores how health plans can help rebalance LTSS for dually eligible members. It looks at two California health plans who successfully transitioned dually eligible members from institutional to community settings. The case study uses these two examples to identify key elements for supporting dually eligible individuals with LTSS needs during the transition to living in the community.

This report is the fourth in a series of publications from the MLTSS Institute, which was established in 2016 to drive improvements in key MLTSS policy areas, facilitate sharing and learning among states, and provide direct and intensive technical assistance to states and health plans. This issue brief focuses on delivering effective care to individuals eligible for both Medicare and Medicaid and aims to lay out the case for state Medicaid agencies to invest in integrated care programs.

The latest report in the AARP Public Policy Institute’s Valuing the Invaluable series estimates the economic value of unpaid family caregiving at $470 billion in 2017. The report also explores family caregiving trends, highlights federal and state policy changes since the release of the previous Valuing the Invaluable report in 2015, and offers further policy recommendations to enhance the well-being of caregiving families.

The Financial Alignment Initiative (FAI) is intended to improve the quality of care and reduce spending for low-income people who are dually eligible. Mathematica researchers conducted a study to identify reasons for the varying participation rates across states. This brief explores the details of two major factors: passive enrollment and demonstration/MLTSS alignment.