Bipartisan Policy Center Recommends Expanding Medicaid Home- and Community-Based Services to Improve Long-Term Care
Recommendations seek to eliminate “Medicaid’s bias for institutional or facility-based care”
February 4, 2016 10:11 AM
The Bipartisan Policy Center’s (BPC) Long-Term Care Initiative has released a new report titled “Initial Recommendations to Improve the Financing of Long-Term Care,” which contains recommendations to provide states with more flexibility to offer home- and community based services under Medicaid. The report also recommends the establishment of a federal insurance program for catastrophic long-term care, as well as a more affordable option for private long-term care insurance.
BPC is a think tank led by four bipartisan former U.S. Senate Majority Leaders – Howard Baker, Tom Daschle, Bob Dole and George Mitchell. The report was developed by the co-chairs of BPC’s Long-Term Care Initiative, former Senate Majority Leaders Tom Daschle and Bill Frist, former Secretary of Health and Human Services and Wisconsin Governor Tommy Thompson, and former Congressional Budget Office Director Dr. Alice Rivlin.The consensus by BPC on these recommendations is noteworthy because it demonstrates growing bipartisan support for promoting the increased use of HCBS under Medicaid as a means of improving long-term care.
In a press release, the initiative co-chairs said the report was intended as a “first set of recommendations” to improve long-term care. “Our proposal includes policies that encourage states to expand care in the home,” said Secretary and Governor Tommy Thompson.
“Today families and caregivers are becoming impoverished by the financial demands of long-term care,” said Senator Tom Daschle. “Since there is no single, comprehensive solution to solve this unsustainable situation, our strategy calls for a combination of actions that could help ease the extraordinary financial burdens Americans are facing. We agree that private insurance and state programs can’t meet the needs of those with significant long-term care costs. Therefore, we are committed to pursuing strategies toward creating a public catastrophic program.”
Among the proposals contained in the report are the following:
Provide state incentives and streamline Medicaid waivers for HCBS. The report recommends streamlining and consolidating “existing waiver authority into a single state plan amendment (SPA) in order assist states seeking to expand the availability of HCBS. “Combining features of existing SPAs would permit states to offer HCBS in a way that moves toward eliminating Medicaid’s bias for institutional or facility-based care, give states the flexibility and predictability they need to expand services to best address the needs of varying populations, and maintain essential provisions of federal law that allow individuals to direct their own care. Specifically, the streamlined SPA would draw from features in existing law — sections 1915(i), (j), and (k) of the Social Security Act — to combine the best features of each option.” It also recommends incentives through an increased match for states to improve their eligibility and enrollment functions.
Develop a federal catastrophic long-term care program. The report recommends pursuing “a public insurance approach for catastrophic long-term costs that does not increase the deficit and protects Americans from ruinous out-of-pocket costs.”
Make private long-term care insurance more accessible and affordable “by designing a new benefit structure and giving Americans the opportunity to purchase coverage using retirement savings through their employers or state and federal insurance marketplaces. Provide incentives for employers to enroll in insurance with an employee opt-out.”
The National Association for Home Care & Hospice (NAHC) supports improving long-term care through a greater focus on HCBS. In its Legislative Blueprint for Action, NAHC recommended Congress require mandatory coverage of comprehensive home care, hospice, and personal care services and home care medical supplies to all populations receiving Medicaid coverage. These services should include all therapies and medical social work services. All home and community-based care services should be mandatory benefits, including those offered under current optional programs and through waiver authority. With regards to long-term care insurance, NAHC recommended that all long-term care insurance policies should be required to meet the most up-to-date federal minimum standards, which should include a requirement that all long-term care policies cover a full range of home care and hospice services.
To view the full report by BPC, click here.