State Perspectives on Medicaid Long-Term Care: Report from a July 2003 State Forum

States, through the Medicaid program, are major purchasers of long-term care. Financed by the federal and state governments and administered by the states, Medicaid pays for over 40 percent of long-term care services nationwide. At the same time, long-term care for the elderly and persons with disabilities is the largest single component of Medicaid, averaging 35 percent (or $76 billion) of the program’s total budget. Soaring health costs combined with plunging state revenues have forced states to take a number of actions to control the growth of Medicaid. And as our nation ages and the demand for long-term care services continues to grow, long-term care programs are facing increasingly close scrutiny at both the federal and state levels. In an effort to review Medicaid’s long-term care program and identify its goals, strengths, and weaknesses, the National Academy for State Health Policy (NASHP), with support from the Kaiser Commission on Medicaid and the Uninsured, convened a forum of officials from seven states (Idaho, Maryland, Minnesota, New York, Ohio, Washington, and Wisconsin). The group met July 15, 2003, in Washington, D.C., and was comprised of a cross-section of state officials that included governors’ policy staff, state budget officials, department directors, and program administrators. In addition, we have sought input from several other state officials who were unable to attend the meeting. This report summarizes the group’s discussions as well as follow-up deliberations. It first focuses on the current environment that states face, addressing such issues as Medicaid’s role in long-term care, state fiscal crises and cost-containment strategies, and how state long-term care programs are evolving. It then details seven goals identified by the states participating in the forum. Those goals include 1) expanding access to home and community-based services; 2) reducing institutional bias; 3) allowing for greater consumer choice of services and settings; 4) expanding eligibility for long-term care; 5) improving coordination of care; 6) stabilizing financing; and 7) improving the capacity for strategic planning and tools development. Additional resources are included and referenced where useful.    

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