Coordination of Long-Term Services and Supports

Medicaid is the single largest public funding source for long-term services and supports (LTSS). It is a combined federal-state program. Some Medicaid services are federally mandated. Others are optional at the states' discretion. Thus, state Medicaid programs can vary considerably regarding the services covered and how the program is administered. Many states also operate LTSS programs for individuals who need services but do not meet Medicaid's stringent eligibility criteria. States also operate programs with federal grant funding, for example, through the Older Americans Act. Consequently, in many states, LTSS program administration is dispersed across several agencies and departments. As a result, consumers frequently have difficulty identifying the programs for which they are eligible and obtaining the services they need. 

Many policymakers and state officials believe that strategies to improve coordination between and among LTSS programs should begin with the consolidation of LTSS program administration, policies, and budgets within one state agency. Using a global budget for all publicly funded LTSS would allow individuals a choice of where to receive services. Another strategy to improve coordination is to establish single-entry points for all LTSS. The term means that an individual seeking LTSS can obtain comprehensive information and apply for services through multiple programs at the same time. 

All states have a single-entry point for people seeking publicly or privately funded LTSS, such as an Aging and Disability Resource Center (ADRC) or a No Wrong Door system. Single-entry points enable individuals to obtain information about all LTSS in a given geographic area. They can have their needs assessed and their eligibility for public programs determined. Some states have set up their systems to authorize services as well. ADRCs can also provide information about affordable housing options. 

States often use different assessment instruments to determine eligibility for each LTSS program and develop service plans. When this is the case, individuals applying to several programs are assessed multiple times. A comprehensive uniform assessment instrument would eliminate this costly and time-consuming process. It would streamline eligibility determinations for multiple programs. Some states have developed such instruments. 
 
Conflict-free care management can also improve service coordination. In conflict-free care management, the person providing service assessment, making decisions about which services will be provided and by whom, and providing service coordination is not affiliated with a service provider. The goal of conflict-free care management is to promote individual choice and independence. Many publicly funded state programs use care managers or care coordinators to assess a person's need for LTSS and organize service delivery. Evidence shows that people with multiple chronic conditions and those who have both LTSS and health care needs benefit from the services of care coordinators/care managers. These professionals can help them coordinate their care across multiple settings and providers.