Home- and Community-Based Services

Background

In 1999, the U.S. Supreme Court ruled in Olmstead vs. L.C. that unjustified institutionalization and segregation of people with disabilities violates the Americans with Disabilities ActLegislation that prohibits discrimination against people with disabilities in employment, public services, public accommodations, transportation, and telecommunications.. The Court said that people with disabilities have a right to live in the most integrated setting possible. Thus, the Department of Justice requires states to develop and implement what is called an Olmstead State Plan to fully integrate people with disabilities into community settings.

As a result, since 2013, the majority of MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. long-term services and supportsLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. (LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ) spending has been for home and community-based services (HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.). Prior to this, the majority of funds went to institutional care. As of fiscal year (FY) 2016, 57 percent of MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. dollars were spent on HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.. However, for older adults and people with physical disabilities, only 45 percent of these dollars were spent on HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.. MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. spending totaled $92 billion in FY 2018. However, MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. retains an institutional bias because it is required by law to cover services provided in institutional care settings while most HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. are optional.

As part of the 2010 Affordable Care Act (ACAThe ACA—the shortened abbreviation for the Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. ), Congress established new financial initiatives to facilitate states' expansion of their HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. programs and provided additional funding for several existing programs.

Several programs and policies are aimed at better balancing MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. spending on institutional and HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. services:

  • providing person-centered counseling through Aging and Disability Resource CenterState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. /No Wrong Door systems to people at risk of nursing home placement to provide information about publicly and privately funded HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. options;
  • the Money Follows the Person demonstration program, which encourages states to identify people in institutions who want to return to their communities and facilitates their return; and
  • rules requiring states to protect assets for individuals whose spouses receive MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. rather than only for those receiving institutional care.

The ACAThe ACA—the shortened abbreviation for the Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. established the "Community First Choice Option" under the 1915(k) authority. This option allows states to provide home and community-based attendant services and supports to eligible MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. enrollees under their state plan. States that use this option receive a six percent higher federal match. Individuals must be eligible for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. under the state plan and have an income that does not exceed 150 percent of the Federal PovertyThe federal government defines “poverty” as income below specific thresholds. These thresholds are adjusted annually for inflation and vary according to family size and the age of the head of the family. Level to receive service. Or, if their income is greater, they must meet institutional level-of-care criteria.

The ACAThe ACA—the shortened abbreviation for the Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. also strengthened the Money Follows the Person (MFP) Rebalancing Demonstration program, which encourages states to identify people in institutions who want to return to their communities. When a state transitions such people, it receives an enhanced Federal Medical Assistance Percentage match for the MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.-funded HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. that they receive in the first year after relocation.

From the start of the program in 2008 through the end of 2019, states transitioned more than 100,000 people to community living under MFP. On September 23, 2020, the Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services (CMS) announced a supplemental funding opportunity available to the 33 MFP demonstration states currently operating MFP-funded transition programs. Its purpose is to increase rebalancing efforts in the states participating in the MFP demonstration. MFP is currently authorized through September 30, 2023.

In addition, the ACAThe ACA—the shortened abbreviation for the Patient Protection and Affordable Care Act— is comprehensive health care reform legislation enacted by Congress and signed into law on March 23, 2010. modified the existing 1915(i) MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. State Plan option to make it easier for states to use this authority to expand HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.. The 1915(i) authority provides states an opportunity to offer services and supports before individuals need institutional care. It also required all states to apply spousal impoverishment protection rules to HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. for five years (2014–2019). States already are required to do this for the spouses of MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. participants who reside in nursing facilities. MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. spousal impoverishment protections are currently extended through September 30, 2023.

In 2014, CMS issued a final rule giving states additional flexibility and responsibility for paying for HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. through MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.. The rule provides a new definition of HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. settings. It emphasizes an outcomes-oriented approach so that older adults and people with disabilities can make an informed choice about care settings and service options. The new rule emphasizes person-centered planning focused on meeting an individual's goals and preferences. It also acknowledges that family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. play a vital role in enabling an individual to continue living at home or in the community. The rule also allows states to combine multiple MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. waivers to cover HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. based on functional need rather than age or diagnosis and to serve more than one population.

States have implemented numerous changes in their LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. systems in order to expand HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. and reduce reliance on nursing facilities. And some states have undertaken major re-designs of their MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. program. For example, in 2017, Washington State began implementation of a five-year MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. demonstration program, the MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Transformation Project, in accordance with section 1115Under Section 1115 of the Social Security Act, the Secretary of the Department of Health and Human Services can waive certain federal Medicaid requirements in the context of research and demonstration projects that promote program objectives.(a) of the Social Security Act. Under this 1115 waiver, Washington State will provide supports that family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. need to continue providing care and to protect their own health and well-being (see also Support For Family Caregivers).

States that have achieved success in transforming their LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. systems to give people choices and reduce their reliance on nursing facilities share certain characteristics, including the following:

Philosophy: The most important factor in creating a balanced LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. system may be a state's determination to promote quality of life for older adults and people with disabilities. Also important is a dedication to allow participants to choose how they will obtain their services.

All decisions are based on a commitment to:

  • deliver services to older adults and people with disabilities and their family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. in the most independent setting possible;
  • expand cost-effective HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. options; and
  • identify and provide the services people need using person- and family-centered planning.

Comprehensive array of services: States that provide a comprehensive array of culturally appropriate services designed to meet the needs of each individual, regardless of income, and his or her family caregiver People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. , are less likely to channel people into institutions.

Single administration: Assigning responsibility for the state's LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. system to a single administrative agency is a key factor in some of the most successful states.

Coordinated funding sources: Coordination of multiple funding sources can maximize a state's ability to meet the needs of older adults and people with disabilities.

Single appropriation: This approach, sometimes called global budgetingA payment model that some states use to create an incentive to use resources efficiently by paying a prospectively-set fixed amount for all the service provided during a given period of time. , allows states to transfer funds among programs and, therefore, make more timely decisions to serve people in their preferred settings.

Timely eligibility determination: Hospital discharges account for nearly half of all nursing facility admissions. When decisions must be made quickly at a time of crisis, state MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. programs need to arrange for HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. in a timely manner. Delays in eligibility decisions often result in unnecessary placement in nursing facilities. Successful states either presume financial eligibility for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. or fast-track the eligibility determination process for people being discharged from hospitals.

Standardized assessment tool: Some states use a single tool to assess functional eligibility and service needs for multiple programs. They then develop a person- and family-centered plan of services and supports. Such tools can be used to collect consistent data, leading to better system management. In states where people are disproportionately institutionalized, these data can be used to develop policies to reduce institutionalization.

Single-entry point: Research demonstrates the need for a single access point to a comprehensive array of LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. for older adults and people with disabilities. Effective systems that determine eligibility, arrange and coordinate services, and monitor quality can support people who have their own resources to pay for services, as well as those who qualify for public programs. A robust system of information and assistance is critical because most older adults, people with disabilities, and their families have difficulty negotiating complex systems. Administration for Community Living and CMS have funded Aging and Disability Resource CenterState-operated organizations that provide information about and access to all of the long-term services and supports available to older adults and people with disabilities. Also known as Single Point of Entry and No Wrong Door systems. /No Wrong Door systems in every state to provide single-entry point functions.

Participant direction: This is a service model that allows public program participants a greater role in determining who will provide their services, as well as when, where, and how they are delivered. It addresses the desire of individuals who need LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. to maximize their choices and control over their lives.

Transition from nursing facilities: Some states regularly assess the possibility of transitioning people from nursing facilities to their own homes or home-like residential care settings. States may assign staff to visit nursing facilities to identify, assess, and help people to relocate. MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. payment for transition services is critical to the success of these efforts.

Quality improvement: States are incorporating participant-defined measures of success in their quality improvement plans.

HOME- AND COMMUNITY-BASED SERVICES: Policy

HOME- AND COMMUNITY-BASED SERVICES: Policy

Medicaid's institutional bias

The federal government should eliminate MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.'s bias favoring nursing facilities. It should mandate the provision of home and community-based services (HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.) for everyone who meets MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. eligibility criteria and chooses to receive services in HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. settings.

Individuals who qualify for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. should have a choice between HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. or nursing facility care and have a choice of providers.

The federal government should give states more flexibility to set separate eligibility criteria for nursing facility care and HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. waiver services. Only people who cannot be safely, adequately, appropriately, and cost-effectively served in the community should be admitted to nursing facilities unless they choose to receive services in that setting. Uniform and independent assessments should be used in making the determination.

The federal government should provide federal matching funds to reimburse states for erroneous presumptive eligibility determinations regarding consumers who receive MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. and nursing facility services but are ultimately found to be ineligible for these services.

Expansion of HCBS

Congress and the states should expand funding for a wide range of HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. through MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets., the Older Americans Act (OAA), the Social Services Block GrantA fixed federal appropriation that states may use at their discretion within broad federal guidelines. program, and other programs that offer long-term services and supportsLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. (LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ).

States should fund sufficient HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. waiver slots to eliminate waiting lists.

Federal and state governments should allocate a greater proportion of MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. funding for HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. instead of nursing facility care.

Nursing facility transition programs

The federal government should convert the Money Follows the Person (MFP) demonstration program into a permanent state option with increased Federal Medical Assistance Percentage—either through a waiver program or the state plan. State diversion and transition programs should have sufficient capacity to assist any person who can be served in HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. settings rather than nursing facilities.

Until the MFP demonstration program becomes a permanent option, its funding should be continued and expanded.

Comprehensive range of HCBS

States should fund the services needed to meet individuals' LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. needs and allow them to remain in the community. At a minimum, these services should include personal care, conflict-free care management, adult day services, home modifications, assistive technologies, respite care, and other caregiver support services, such as education and training. Services should be offered in a range of settings. This includes supportive housing A setting for long-term services and supports that includes board and care homes, assisted living facilities, and group homes that provide or arrange for services and help with activities of daily living (see separate entry) in a residential setting. and adult day centers. These services should be offered through MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets., state-funded LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs, the Social Services Block GrantA fixed federal appropriation that states may use at their discretion within broad federal guidelines., and OAA programs.

States should expand HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. options to include a range of residential choices as well as home modifications and assistive technologies.

This can be done through waivers and other processes such as state plan amendments, Administration for Community Living funding, or state-only funding sources. Particularly important are programs that provide LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. for low-income residents of assisted living and other residential care settings and those at risk of entering a nursing facility. However, current MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. participants should not have to move to a residential care setting or nursing facility to receive services or have their current benefits reduced by the implementation of a waiver or other program.

States should expand the requirement to assess the needs of family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. under the 1915(i) HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. state plan option to all assessment tools to all MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. authorities. Such assessments will identify at-risk family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. before they burn out or compromise their own physical and mental health and support them in their caregiving roles.

States should support family caregiver People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. services that can delay or decrease the likelihood of needing to enter a nursing facility. These can include education and training, counseling, legal consultations, and respite care.

Coordinating administration of LTSS programs

States should coordinate LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting.  programs, policies, and budgets, whether in one state agency or across state agencies. This would promote efficiency, create single points of entry for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , and implement the data collection necessary to manage LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting.  strategically.

States should:

  • develop the capacity for prompt financial and functional MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. eligibility determinations for applicants who need and want HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings., and use presumptive eligibility for people who are at risk of nursing facility placement without MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets.-funded HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.;
  • use a unified global budget for publicly funded LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. , so they have flexibility in allocating expenditures and utilize the money saved through reduced nursing facility use for increased coverage of HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings.;
  • consolidate or effectively coordinate LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. programs policies and budgets within one state agency or across state agencies, to promote efficiency and create single points of entry for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. ;
  • ensure that Olmstead plans include specific action steps, timelines, and strategies for securing necessary HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. funding;
  • ensure that consumers fully participate in implementing and monitoring state Olmstead plans and waivers at the state and local levels, including serving on advisory committees and governing boards;
  • continue to monitor and revise, as needed, their Olmstead implementation plans;
  • establish policies to pay relatives and friends who care for people with LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. needs as part of a service plan, design programs and policies to protect consumers and avoid the erosion of family-care networks, guard against fraud and abuse, and avoid disincentives for unpaid caregiving;
  • identify barriers that unintentionally curtail consumer ability to direct their services or to arrange to have certain nursing tasks provided by unlicensed direct-care staff authorized and trained to do so by a registered nurse;
  • ensure that registered nurses are protected from liability if they have followed the prescribed protocols for delegation, training, and supervision outlined in their states' Nurse Practice Acts;
  • ensure that states with a formal process for allocating the number of nursing facility beds—such as a certificate of need—base decisions on the number of people who require a specific level of care and on data projecting the need for LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. in different areas of the state;
  • provide data on nursing facilities and HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. service use by age and geographic region, as well as per capita and aggregate cost of services, including MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. services in nursing facilities and HCBSLong-term services and supports provided in individuals’ homes or in community settings, including adult day services, assisted living and other residential care settings. to the extent possible;
  • provide data on the range of the level-of-care scores of people age 85 and older who are in nursing facilities;
  • preserve and expand funding for respite care services in a range of settings, such as personal care servicesServices that help individuals who have functional limitations with daily tasks, including bathing, dressing, eating, mobility, managing medications, light housekeeping, and laundry. in the home or adult day services, to ensure that more family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. can have a break from their caregiving duties;
  • preserve and expand funding for respite care services for all caregivers whether or not the individuals they are assisting are eligible for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. or another publicly funded program; and
  • allow family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. who are assisting individuals with moderate incomes, and who would not otherwise qualify for publicly funded respite services, to buy into or otherwise obtain these services.