Strengthening Systems Serving Older Adults: NAMD’s Comments on ACL’s National Plan on Aging

The Strategic Framework for a National Plan on Aging was developed by the Administration for Community Living to address the growing needs of America’s aging population. Its goal is to foster systems that allow older adults to age with dignity and remain connected to their communities. As Medicaid plays a critical role in long-term services and supports (LTSS)—covering 61% of all LTSS costs in the U.S. according to recent data from KFF—NAMD’s comments on the Strategic Framework reflect a commitment to sustainable, well-rounded supports for older adults. Our recommendations focus on expanding access to LTSS and strengthening partnerships between federal and state systems, closely aligning with the framework’s objectives of building robust support systems for aging Americans.

NAMD’s Key Recommendations

Expand Access to Long-Term Services and Supports (LTSS)

Expanding access to LTSS is essential to ensuring older adults have the option to age in place and remain in their communities. To support this goal, NAMD advocates for comprehensive funding models, elimination of institutional bias in Medicaid, workforce development, and integration of health and social services as part of a robust LTSS expansion strategy.

• Secure Comprehensive Funding for LTSS: NAMD supports a multi-payer approach to enhance LTSS access. This includes Medicaid Home and Community Based Services (HCBS) buy-in options for those who might not meet traditional eligibility criteria, making critical services more widely accessible.

• Eliminate Medicaid’s Institutional Bias: Medicaid statute makes coverage of nursing facility care a mandatory benefit, while HCBS is optional. Reversing this benefit structure would provide more equitable access to community-based care and allow older adults to age in place, avoiding institutional settings being the default option.

• Address Workforce Shortages: Federal initiatives are essential to address workforce shortages that limit LTSS availability for older adults. NAMD supports federal initiatives to improve pay, benefits, and career growth for direct care workers. Just as vital, family caregivers need expanded support, including respite services and adaptable training programs. Together, these efforts will create a stronger, more reliable caregiving network.

• Integrate Health and Social Services: NAMD advocates for Medicaid to work in tandem with essential social services, such as housing, transportation, and caregiver assistance. As part of this integration, Medicaid support for room and board in community settings would allow more older adults to live independently. This comprehensive approach addresses both health and social needs, aligning closely with the framework’s goal of supporting all aspects of well-being.

Sustain Federal-State Partnerships for Long-Term Stability

The long-term success of Medicaid’s support for older adults depends on solid federal-state partnerships. NAMD highlights the need for ongoing federal funding to strengthen infrastructure, such as IT improvements, beyond temporary funding sources like the American Rescue Plan. These permanent investments are essential for lasting stability in LTSS delivery.

NAMD also emphasizes the importance of giving states flexibility to design programs that meet their residents’ needs. Adapting LTSS at the state level enables programs to better address regional differences, in line with the framework’s vision of adaptable, resilient support systems for older adults.

NAMD is dedicated to working on a framework that builds accessible, supportive systems for older adults, helping them live with choice and dignity. For further details on these policy recommendations, readers are encouraged to refer to NAMD’s full comments.