The LTSS Center will study strategies behind LTSS financing efforts in Washington, Hawaii, Maine, California, Michigan, and Minnesota.
The LeadingAge LTSS Center @UMass Boston has been engaged by the Robert Wood Johnson Foundation to study activity across 6 states exploring social insurance initiatives to help finance long-term services and supports (LTSS).
The LTSS Center will work in partnership with Community Catalyst’s Center for Consumer Engagement in Health Innovation to examine the underlying reasons why individual states took certain action, the coalitions that came together to support that action, and the factors associated with decisions about strategies and approaches.
GROWING LTSS NEED PUTS FINANCIAL PRESSURE ON STATES
Medicaid is the largest public payer for LTSS, and roughly half that money is contributed by states. As an aging population increases demand for LTSS, pressure on the financial system will continue to mount.
“States feel the pain most acutely and this pressure has led a number of them to consider new ways to address the challenge,” said LTSS Center Co-Director Marc Cohen, a leader of the study. “We need to develop foundational information about those initiatives. We want to determine what solutions, under which conditions, may have the best chance for success in other states.”
A CLOSER LOOK AT STATES TAKING ACTION
To date, 2 states have enacted laws that provide some kind of financial support for meeting LTSS needs. Other states are actively studying the issue and 1 state proposed a universal home care ballot question that was defeated in 2018.
The study will look at efforts in 6 states:
- Washington passed a law in May that will provide a $100 daily allowance and will cover up to 1 year of long-term care for all workers who contribute to the program through a payroll tax. The state will begin providing benefits in 2025. A similar proposal stalled in the legislature last year.
- Hawaii passed the Kapuna Caregivers Act in 2017. The measure pays caregivers who want to remain in the workforce $70 per day to buy care for loved ones. An earlier legislative proposal to create a mandatory social insurance program in Hawaii was unsuccessful.
- Maine voters defeated a Universal Home Care ballot initiative last November. The proposal would have provided in-home assistance to state residents age 65 or older and to people with disabilities.
- California has dedicated $3 million to add LTSS screening questions to a statewide health interview survey that could lay the groundwork for a feasibility study exploring a state-based LTSS financing program.
- Michigan is another state in an early study phase. Its current budget includes funding to conduct a needs assessment and actuarial analysis exploring LTSS funding options for state residents who do not qualify for Medicaid.
- Minnesota convened an advisory panel of stakeholders to explore options for private LTSS financing vehicles to better meet the needs of the middle-income market.
COMPARING PLAN DETAILS DEVELOPED BY STATES
The LTSS Center study will feature comparative qualitative research across all 6 states. Researchers will examine a variety of program elements, including eligible populations, timing and duration of coverage, benefit structures, financing approaches, and strategies for moving the issue forward in each state.
Researchers intend to address a number of specific questions related to state-based LTSS financing initiatives, including:
- What was the underlying rationale for action?
- What set of problems was each state trying to solve?
- How did a call for policy change develop and who were the key actors responsible?
- To what extent was the aging network involved in the development of initiatives?
- How much support exists for initiatives and what strategies were employed to facilitate support?
- Why was one approach chosen over others, and which ideas were considered but later eliminated?
- Do any of the approaches address the issue of whether and how new programs integrate with Medicaid?
“The overarching objective is to help state officials understand some of the different approaches that other states—which may be further along in their thinking and development—are taking in the area of LTSS financing,” said Cohen.
The LTSS Center is expected to deliver its project results in mid-2020. The study is being led by Cohen; Ann Hwang, director of the Center for Consumer Engagement in Health Innovation; and Michael Miller, director of strategy policy at Community Catalyst.