March 2013 — President Obama has recently appointed the final members of the Commission on Long Term Care. Over the next six months the Commission must accomplish one objective: develop a plan for the establishment, implementation and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports (LTSS) for individuals who need LTSS.
We believe that this plan must address the current imbalance that exists in payment for much of LTSS. Unfortunately, Medicaid, the nation’s largest payer of LTSS, continues to give preference to the provision of LTSS in institutions such as nursing homes instead of at home and in the community. As a result, many low-income older adults who could be receiving care at home are unnecessarily moved into institutions.
We believe that the foundation of a comprehensive LTSS system should be a high quality, accessible network of home and community-based services that supports individuals so that they may live with dignity and independence at home and in the community. Over a decade ago, the Supreme Court clarified the civil right of integrated, community living in its landmark Olmstead decision; subsequent to that decision, much has changed in how the nation perceives and provides LTSS.
However, Medicaid’s emphasis on institutional care remains. The time is now to correct this imbalance and finally shift the delivery of Medicaid-funded long-term services and supports away from institutions and into the community.