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When economic conditions permit, states should accumulate budget reserves adequate to maintain services during recessions.
Deficit-reduction efforts should avoid cuts in programs that serve low- and moderate-income populations.
States should not tie essential spending programs to unstable revenue sources.
Federal policymakers should develop a comprehensive system for financing Long-Term Services and Supports (LTSS) that includes a new social insurance program to provide a basic level of LTSS.
Ideally, the federal government should finance LTSS through a universal, comprehensive, and publicly administered program such as Medicare or similar social insurance program of shared risk.
Program participant cost-sharing for either community or institutional services should be modest. It should not favor one type of service over another.
Some tax revenues for a new LTSS program should be earmarked to an LTSS trust fund. This would build adequate reserves to cover later generations.
The federal government should create a public social insurance benefit that provides coverage for LTSS. It should be within Medicare or in a new public program.
Until a comprehensive national LTSS program is implemented, the following intermediate steps should be taken:
The federal and state government should conduct regular, thorough, and consistent oversight.