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.
The federal government must strive for long-term fiscal balance.
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.
Defined contribution plan account holders should have to obtain written spousal consent to take payment from the account in a form other than a joint-and-survivor annuity.
States should require that all beds in a nursing facility be certified for Medicaid and Medicare as a condition for the facility’s participation in Medicaid.
States should require adequate numbers of appropriately trained staff to ensure a high quality of care.
Quality measures: Participant preferences and satisfaction should be used as key quality measures.