No one wants to accept that they are getting older, or face the possibility they may develop health conditions or functional impairments that require assistance from a family member, community caregiver, or a facility. The reality is that most, if not all of us, will be touched by a need for long-term care at some point in our lives.
Technological advances allowing people with disabilities to be more independent and live longer coupled with the aging Baby Boomer population is leading to an ever-growing demand for publicly funded Long-Term Services and Supports (LTSS).
What are LTSS?
LTSS encompass a spectrum of health and social services, which are primarily intended to serve older adults and individuals with disabilities who require support with daily living tasks. Services are provided either in the individual’s home, in the community, or in institutions (nursing facilities and intermediate care facilities for individuals with intellectual disabilities).
From the White Paper . . .
According to a 2016 report to Congress on Medicaid & CHIP, 43 percent of Medicaid expenditures ($169.2 billion) were spent on LTSS users, even though LTSS users comprised only six percent (4.3 million) of Medicaid beneficiaries.
Demand for these services is on the rise as the country’s population continues to age and as individuals (including children) live with more complex disabilities. As demand grows, state Medicaid programs have experimented with several different models of healthcare financing and delivery. One major change has been the gradual shift to providing services in the home or community, and away from an institutional setting, whenever possible.
What are HCBS?
Home and Community-Based Services (HCBS) include residential services, adult daytime healthcare programs, home health aide services, personal care services, and case management services. According to the Kaiser Family Foundation, these efforts are driven by beneficiary preferences for HCBS, the increased population of seniors and people with disabilities who need HCBS, and the fact that HCBS typically are less expensive than institutional care.
- Then: In the past, Medicaid only paid for institutional LTC.
- Now: The waiver program “waives” the institutional admission requirement in favor of Medicaid-funded HCBS.
As demand for LTSS/HCBS continues to grow, state Medicaid programs must strike the right balance between management, oversight, and care delivery. Telligen helps state Medicaid programs assess eligibility, administer services, and develop person-centered care plans that support unique situations and goals. Check out future posts in this series to learn why “person-centered” and “conflict-free” are vital components of our approach to LTSS.