Senior Groups Comment Regarding Long-Term Care Financing and Delivery to House Energy & Commerce Health Subcommittee
March 15, 2016 11:20 AM
The Leadership Council of Aging Organizations (LCAO) recently sent a letter to the U.S. House Energy & Commerce Subcommittee on Health commenting on a recent hearing by the Subcommittee on the topic of long-term services and supports (LTSS) financing and delivery. The LCAO comments noted the need to address the current lack of a comprehensive LTSS financing and delivery system, as well as the need to end the institutional bias in Medicaid by making it easier for people to receive home and community-based services. The National Association for Home Care & Hospice (NAHC) previously submitted its own separate comments to the Subcommittee on the topic (see previous NAHC Report coverage here and here).
NAHC is a member of LCAO, a 72-member coalition of the nation’s non-profit organizations serving older Americans. LCAO is dedicated to preserving and strengthening the well-being of America’s older population and provides a voice for seniors and their families in the ongoing debate on aging policy.
“The lack of a comprehensive LTSS finance and delivery system today translates into a crisis for American families that places enormous financial, emotional, and physical strain on family caregivers as well as the person needing assistance,” LCAO stated. “At present, Medicaid provides the majority of paid LTSS, but has strict means-testing requirements that conflict with other policies intended to encourage savings and economic independence. For example, persons with disabilities who would like to work more face an unacceptable choice between losing the assistance needed to survive or not working and keeping that assistance.”
“In addition, America does not fully deliver LTSS in the settings people want most, an inefficient use of resources,” LCAO continued. “While high quality care must be assured in all settings, virtually everyone desires to be at home and in their community. Yet, Medicaid still suffers from a ‘bias’ that places far too many in an institution when they could otherwise remain at home or in their community. Beyond, ending this bias, improving delivery also means ensuring an adequate workforce to provide these services and that family caregivers and workers alike have the supports they need to provide quality care in the community.”
LCAO included in its comments the following principles for LTSS financing:
National Problem, National Solution – Recognize that although states, communities, families, and individuals have important roles to play, financing for long-term services and supports is a national problem that requires a national solution.
Universality with Limited Opt-Out – Create a public program that allows all people, including individuals with disabilities and those near retirement, the opportunity to contribute to and prepare for the costs of long-term services and supports. Make participation as convenient as possible but give people the limited choice to opt out.
Public/Private Partnership – Provide a strong foundation of protection while providing opportunities for personal planning that include a role for private sector options.
Affordability and Risk Pooling – Provide for broad pooling of risk and appropriate low-income subsidies to make premiums affordable enough so that all people, regardless of income and health status, can participate. Ensure that a new program does not force people to impoverish themselves to qualify.
Fiscal Responsibility – Provide actuarially sound funding, such as through voluntary premiums that build reserves over time sufficient to pay for future needs in a way that is affordable to individuals and to society as a whole.
Relieve Pressure on Medicaid – Provide additional long-term services and supports funding mechanisms that will help take the pressure off of future Medicaid expenditures, while preserving the guaranteed safety net.
Consumer Choice and Control – Promote independence and dignity across the broad continuum of services and supports by ensuring beneficiaries the right to control and choose what services they receive, how and where they are delivered and who provides them.
Support Family Caregivers – Recognize and support the central role families and other informal caregivers play in planning for and providing long-term services and supports, including developing strategies to support working caregivers to maintain their financial security.
Invest in Quality Care and Quality of Life –Target additional funding to ensure sufficient training and compensation for the workforce and to strengthen oversight, enforcement, and advocacy programs that improve quality of life and quality of care in all settings.
The full LCAO letter is available here.