September is Healthy Aging Month, and perhaps appropriately, it is also when the federal Commission on Long-Term Care must wrap up hearings and develop final recommendations on how the United States cares for its aging population. The Commission has heard from state Medicaid directors, who urged the panel to support a shift in federal funding from institutional to home and community-based services.
In a letter to the commission, the National Association of Medicaid Directors encouraged the Commission to:
- Permanently reauthorize the Money Follows the Person program with further modifications based on state input and program evaluations data. Progress and evaluation reports about this program are available from from policy think tank Mathematica, which is working with CMS to assess results.
- Align payment with key measures of performance, including the member’s experience of care through value-based purchasing, which ties hospital payments to performance.
- Give states authority to prioritize Medicaid Home and Community Based Services programs to make sure they have flexibility and support in implementing and managing their long-term service and support 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.”
- Develop and implement more robust quality and outcome measures, which factor in the various settings and and payment approaches of a particular state. This will allow beneficiaries to act on data, reward quality providers, and reduce waste and fraud in the system.
- Enact policy changes to ensure that Federal Benefit dual-eligible beneficiaries receiving long-term support services enroll in integrated programs of care that coordinate care across the continuum.
State Medicaid directors struggle with a complicated and patchwork system of federal oversight and regulation. As they work to rebalance their Medicaid long-term care programs, the impact of the Affordable Care Act is not yet clear. However, there seems to be consensus on some of the best practices and technical assistance needed to ensure continued service delivery for current and future enrollees.
