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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.
At the federal level, the two categories of budgetary expenditures are entitlement and discretionary spending.
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: