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Passing responsibilities down to lower levels of government should be undertaken primarily to place services closer to the people being served and to maximize administrative

Public retirement systems should establish a maximum vesting period of five years for DB plans and one year for employers’ matching contributions to defined contribution or hybrid plans. 

States and localities should move toward full funding of their retirement systems. 

Deficit-reduction efforts should avoid cuts in programs that serve low- and moderate-income populations. 

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. <

Congress and the states should ensure adequate Medicaid funding and maintain existing guarantees for Medicaid long-term services and supports (LTSS). 

Federal and state governments should ensure that Medicaid reimbursement is sufficient to guarantee access to the full range of high-quality long-term services and supports in all service settings.

All individuals with incomes at or below 100 percent of the poverty line ($14,580 per year in 2023) should be considered categorically eligible for Medicaid.