How can Medicaid meet the moment to strengthen and transform long-term care?

Recent federal investments in long term supports and services for individuals who want to live independently in their own communities makes the current moment the best one yet for transforming these services. But pandemic set backs have created their own sets of challenges for expanding this access.

At the NAMD Fall Conference, Director of Medicaid Programming Lindsey Browning discusses this reality and the path forward with Catherine Ivy, Deputy Executive Director for Service Administration & Delivery at the Georgia Department of Community Health, Susan Reinhard, a Senior Vice President at AARP’s Public Policy Institute and Paul Saucier, Director of the Office of Aging & Disability Services at Maine’s Department of Health & Human Services.

What’s the context?

Panelists agreed that COVID-19 rebalanced people away from nursing home care and toward long term supports and services delivered in their homes. About 1 in 10 individuals living in nursing homes have died during the pandemic outbreak, a reality that has been far worse for people of color. Because Medicaid is the defacto payer of these services, the burden has fallen on the program to ensure that systems are in place to support these decisions on the parts of Medicaid members.

Where should the effort to meet the moment focus?

Panelists were clear that areas of focus for improving in-home supports and services require a focus in four areas:

1. Bolstering the home care workforce
2. Identifying and supporting natural supports
3. Expansion of the use of assistive technologies
4. Payments linked to quality outcomes

NAMD Released a report on these focus areas recent. You can read Medicaid Forward: Long-term Services and Supports.

Focus area snapshots

• Workforce: State’s are exploring how to support critical workforce efforts like career ladders allowing individuals to advance and be retained, increased payments to direct care workers, supports for additional career training and recruitment and retention bonuses to name a few.
• Natural Supports: States are working hard to create needs-based assessments that identify not only the needs of the individual in care, but the abilities and skills of their informal care givers. These efforts support identifying gaps as well as assembling a care team that can widen supports available while the workforce is limited.
• Assistive Technology: Currently, these types of technologies are both undefined and underutilized, but pandemic distancing and other public health precautions have begun to bring these opportunities into clearer view. States are working hard to identify appropriate payment structures for these services as well as policy barriers that prevent their use.
• Payment: Possibly the largest lever available to Medicaid programs but also one that needs focused attention on connecting payments to meaningful outcome measures and then connecting this effort to policy and process that will allow all this to happen.