The Bipartisan Policy Center (BPC), a nonprofit organization founded by Senators Howard Baker, Tom Daschle, Bob Dole, and George Mitchell to promote bipartisan collaboration, recently released a report, Initial Recommendations to Improve the Financing of Long-Term Care, which makes policy recommendations for how to improve the availability and financing of long-term services and supports (LTSS). LTSS are, according to the BPC’s definition, the wide variety of “clinical and social services” (including medical services, vocational services like supported employment, benefits planning, transportation, personal care, and many others) that assist those who have functional limitations in one or more activities of daily living. People who meet this definition, according to BPC, include those with physical, cognitive, developmental, or other chronic health conditions. LTSS are provided for a longer period of time than traditional clinical or medical services, and they are typically not covered by private health insurance plans. The report discusses several possible approaches to decreasing costs and increasing access to LTSS, under the backdrop of anticipated demand for LTSS doubling over the next 35 years. The report proposes both private and public sector changes that would either reduce the cost of LTSS for consumers or improve the delivery and integration of care for persons who need LTSS.
For example, working-age Americans with disabilities who require LTSS to work may be able to access LTSS only through means-tested programs, such as Medicaid waivers. In many states, individuals working full-time may no longer qualify for these Medicaid waivers, a policy that creates barriers to employment. The report therefore proposes an Enhanced Medicaid Buy-In option. Under this option, the states would provide LTSS using Medicaid funding and would charge a sliding-scale premium based on income. The report notes that such a program would be costly, but it would decrease out-of-pocket spending by $130 billion and Medicaid spending by $154 billion.