With healthcare and long-term care costs rising at much higher rates than wages or salaries, it is becoming more difficult for Americans to afford the costs of long- term care. These unpredictable costs, combined with low levels of savings, mean many older American families find themselves forced to spend down their assets so they are eligible for long-term care coverage under Medicaid.

At the same time, the rules governing access to long-term care coverage through Medicaid are complex and vary widely from state-to-state. For most families, navigating this process is complicated and burdensome at a time when they likely are experiencing a health crisis.

This new report, Accessing Long-Term Care Coverage Through Medicaid: The Safety Net For Seniors Facing Unmanageable Costs, examines the complex rules and multiple pathways for receiving Medicaid coverage across the nation. The report focuses on the long-term care needs of older Americans and their options for accessing care. It also reviews an innovative long-term care social insurance program in Washington State that is projected to reduce Medicaid expenses and offers policy solutions to address the rising costs of long- term care.

The report offers four policies to address the unpredictable yet potentially catastrophic costs of long- term care needs:

  1. Long-term care proposals should provide universal coverage based on need. Washington State is piloting a social insurance program to provide coverage for long-term care costs, and this could serve as an example for other states or even a federal program.
  2. The programmatic bias toward institutional care over home or community-based care should be eliminated. HCBS costs less than institutional care and is generally preferred by beneficiaries and their caregivers.
  3. A stronger focus on healthy aging for all should include the integration of healthcare and social services and accountable care systems focused on long-term health.
  4. The ability of older adults to remain in their communities and live independently should be facilitated by public policy.