Congress should increase funding for non-institutional care, link payment and performance, Medicaid directors tell LTC commission

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The U.S. system for providing long-term care should be changed to reduce the number of people living in facilities and better align spending with health outcomes, according to comments that state Medicaid directors sent to the Congressional Commission on Long-Term Care.

Congress should expand Medicaid funding for care in home- and community-based settings (HCBS), the National Association of Medicaid Directors stated in a letter dated Tuesday. The organization referred to “widespread support” for HCBS and said states need more “tools and resources” to shift seniors away from facility-based 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,” the letter stated.

The Medicaid directors also endorsed value-based purchasing, which involves paying providers based on performance measures, and incentivizing people to use efficient services and providers. Prominent long-term care provider groups, including the American Health Care Association/National Center for Assisted Living, have also supported value-based purchasing, with reservations. Issues such as how potential payment penalties could stifle innovation need to be worked out, AHCA said in recent recommendations to Congressional lawmakers.

Medicaid is administered at the state level with contributions from the federal government. This means states will need flexibility to individualize “pathways and timeframes” when it comes to changing Medicaid for long-term care, the directors noted.

Created after the repeal of the Community Living Assistance Services and Supports (CLASS) Act in January, the Commission on Long-Term Care will submit its recommendations for LTC reform to Congress by the end of September. The deadline for submitting comments to the committee was Tuesday.

Click here to access the NAMD letter.


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