States should be incentivized to expand the availability of and access to home- and community-based services, the American Medical Association House of Delegates said in a policy it adopted at its recent annual meeting.

The policy also calls for innovations in the design of long-term care insurance products, including the insurance of HCBS.

Many assisted living communities deliver HCBS to Medicaid beneficiaries through waivers.

“Rising costs of everything from home ownership to higher education are making it harder than ever for Americans to save for retirement and the long-services and supports that more and more people require,” AMA Board Member Stephen R. Permut, M.D., J.D., said in a statement. “Our hope is that the policies and recommendations we are making today will provide feasible steps forward to alleviating the financial strain on families and Medicaid of providing LTSS. With demand for LTSS likely doubling over the next 30 years, the time for action and forward-facing reforms is now.”

The policy adopted by the delegates, announced June 11, supports standardizing and simplifying private long-term care insurance to increase coverage and improve affordability. Transferable and portable long-term care insurance coverage could be added as part of workplace automatic enrollment plans, the AMA said, with an opt-out provision potentially available to  both current employees and retirees.

The delegates also said they support allowing penalty-free withdrawals from employer-based retirement savings to be used for long-term care insurance premiums and LTSS expenses.

The policy also advocates:

  • Permitting Medigap plans to offer a limited LTSS benefit as an optional supplemental benefit or as separate insurance policy.
  • Allowing Medicare Advantage plans to offer LTSS in their benefit packages.
  • Permitting Medigap and Medicare Advantage plans to offer a respite care benefit as an optional benefit.
  • Offering a back-end public catastrophic long-term care insurance program.
  • Integrating health and social services and supports better, including the Program of All-Inclusive Care for the Elderly.