As the challenges of long-term care loom over America's aging population, state Medicaid directors are sharing ideas with the federal government for fixing several financing and delivery problems.
Medicaid's long-term care programs need to be more flexible for states, the National Association of Medicaid Directors told the Commission on the Long-Term Care, which is preparing a comprehensive report for Congress this month.
Medicaid pays for about 40 percent of the nation's long-term care -- a number that may grow -- and in the short-term the federal government should consider expanding and streamlining existing policies, the NAMD said.
One suggestion is to reauthorize the Money Follows the Person demonstration program beyond 2016. Created in 2006, the grant program offers states matching funds for 12 months for each Medicaid beneficiary transitioned from an institutional to a community-based setting, and 46 states have participated.
And considering policies for the future, the NAMD said in comments to the commission, there is "widespread support" to prioritize home- and community-based long-term support services, and states "need flexibility and support in implementing and managing their LTSS programs in a manner that ensures resources are better allocated in accordance with needs and which allows them to stretch limited resources across more of the people who need care."
"One of the biggest barriers for states is that under regular authority they cannot use federal Medicaid funding for even limited room and board costs in a community-based residential alternative setting, including housing," wrote NAMD president Darin Gordon, the director of Tennessee's Medicaid program, and vice president Thomas Betlach, the director of Arizona's Medicaid program.
The NAMD is also asking the commission and Congress to seek value-based purchasing for acute care services, and to think of ways that policies could increase value for states, who share the costs, and consumers, who ultimately use the services (and also share the costs).
"For example, policymakers should continue to focus attention on the development and implementation of more robust quality metrics and continuous quality improvement initiatives that are responsive to the setting and type of delivery system and payment approach the state employs. In addition, states and beneficiaries should be able to act on this information to reward high quality providers," the NAMD said.
For Americans who qualify for both Medicare and Medicaid, the NAMD recommended using "existing pathways to integrate funding, benefits and coordination for full benefit dual eligible beneficiaries receiving LTSS."
All Medicare-Medicaid beneficiaries receiving long-term services "must be enrolled in integrated and coordinated programs of care (i.e., the Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) and Financial Alignment Demonstrations) that include LTSS and coordinate services across the continuum of care," the group said.