Long-term care

This study presents a summary of each state’s regulatory, licensure, and payment policies for adult foster care within its array of long term services and supports.  It also examines the influence of state Nurse Practice Acts on the scope of services available in adult foster care and  identifies policy considerations for state officials who are developing or expanding the availability of adult foster care.   

Rising demand for a full array of service options and consumer preferences for home-like non-institutional settings is increasing the interest among state policy makers in adult foster care as a service for older adults. Although adult foster care may also serve individuals with developmental disabilities and other populations, the primary focus of this report is adults age 65 and older. State leaders are interested in the experience of states that developed adult foster care as part of their service array, trends in provider supply, regulations governing providers, and quality oversight practices. This report is based on the policies and practices in five states – Arizona, Maine, Oregon, Washington, and Wisconsin. The states were selected based on their approach to licensing and Medicaid coverage for this residential option.

This fact sheet briefly describes the rules governing the way income and resources are treated in determining financial eligibility for Medicaid for low-income individuals who qualify under one of the 25 eligibility groups or categories established by law.

This report identifies numerous opportunities for strengthening the Medicaid program and enabling it to continue to play a critical role in the country’s health care system. The report draws upon the work of a group of experts with a broad range of experience in the Medicaid program. The report’s detailed recommendations identify opportunities for improvement in all areas of the Medicaid program and include calls for simplifying and expanding eligibility; increasing program flexibility for optional populations; improving coordination and integration with the Medicare program and private insurance; adjusting current financing mechanisms; and providing states with tools to manage the long-term care system and, in the process, rebalance the institutional and home and community-based care systems.