How successful are state LTSS programs?
Spending on home- and community-based services (HCBS) is up. More than half of money spent on long-term services and supports (LTSS) is going to aging and disabled individuals living at home, according to the 2023 LTSS State Scorecard published by the AARP Foundation.
LTSS comprise home and facility care and are available through state Medicaid agencies and provide much-needed services for hundreds of thousands of beneficiaries. But, for the first time, the LTSS State Scorecard reported more than half of spending on LTSS went to HCBS, rather than supporting institutional care. According to the report, 12 states spent most of their Medicaid LTSS funding on older adults and those living with disabilities enrolled in HCBS waiver programs. That’s up from nine states in 2009.
The LTSS State Scorecard is published every three years and analyzes a host of data from a variety of sources to provide an assessment on the performance of state Medicaid LTSS programs. The goal, according to the AARP Foundation, is to help identify successes and needs for improvement among state programs to inform future program management.
“LTSS systems affect everyone. As the country ages and adults with physical disabilities seek more options to remain independent, the need for LTSS will continue to grow,” according to the 2023 report. “States have the opportunity to act now in strengthening LTSS systems and identifying new ways to maximize the use of limited resources to account for these demographic shifts.”
There are approximately six million individuals enrolled in state Medicaid LTSS, according to the Kaiser Family Foundation, an organization active in surveying Medicaid enrollment numbers and state programs. The KFF estimates roughly 4.2 million are receiving HCBS.
Overall, LTSS programs across the country have seen improvements. The greatest strides forward have been in the expansion of self-direction services, aging and disability resources and No Wrong Door systems.
Other key findings from the 2023 report include:
- There has been a slight decline in the employment rates for those with disabilities.
- More states are allowing registered nurses to delegate medical tasks to aides, lessening the burden on family caregivers.
- Program enrollment for low-income individuals with disabilities continues to rise at a steady pace.
The scorecard is not a perfect measure of how programs are performing and how well individuals are being cared for. LTSS State Scorecard writers stated, “We recognize that even a strong ‘average’ or ‘median’ LTSS experience may not be available to all communities—and that no LTSS system can really deliver strong results unless it can do so for people across populations.”
AARP first published a scorecard in 2011. The report is compiled with the help of The Commonwealth Fund, The John A. Hartford Foundation and The SCAN Foundation.
