New report explores Medicaid's challenges in providing long-term care

Medicaid has evolved to become the primary payer for long-term care (LTC) services and supports to low-income elderly and disabled individuals, financing nearly half (42 percent) of the nation's spending on long-term care services.

The structure and cost associated with the program's role are key considerations as states begin to implement some of the changes passed as part of the Deficit Reduction Act of 2005.

The Foundation's Kaiser Commission on Medicaid and the Uninsured has released a report that presents an overview of Medicaid as a provider of LTC and highlights policy challenges facing the Medicaid program today. Some of the issues addressed include:

• Integration of services for people who use long-term care, many who require substantial acute care, and needs beyond traditional health care;
• Varying disability criteria for Medicaid LTC coverage which can create potential inequalities across beneficiary groups and states;
• The relationship of means-testing benefits with other program goals such as community integration;
• Achieving a balance between institutional and community-based care, especially with the recent shift towards more community-based alternatives;
• Flexibility in benefit design which could accommodate more consumer preferences, but may create equity issues;
• Continued and improved focus on quality of care, especially with LTC provided in the community; and
• Future financing of the program's LTC services as the number of users is projected to grow in coming years and the nation has yet to develop major, viable alternatives to Medicaid as a payer of these services.

The report is based on a roundtable discussion of policymakers and experts and drawn from a body of health services research. By gathering evidence and presenting data to address key Medicaid policy issues, the report can serve as a foundation for the current and ongoing policy debate regarding Medicaid's future role as a provider of LTC services and supports for low-income elderly and disabled Americans.