Address LTSS needs to avoid costly institutional care: authors

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When state and federal policymakers and other stakeholders do not consider ways to meet the long-term services and supports needs of low-income older adults, they risk necessitating more expensive, long-term institutional care or services for these people. That's one of the points made in a new issue brief by the Henry J. Kaiser Family Foundation.

The risk occurs, according to the authors, because low-income older adults, especially those who do not quality for Medicaid, may find institutions the only place where their LTSS needs can be met, because of Medicare and Medicaid coverage differences. Or older adults may develop more costly needs over time because their needs are not being met outside of an institution. Ironically, once living in a more expensive nursing setting, they may qualify for Medicaid.

"Providing LTSS to meet this population's needs may be cost-effective over the long-term as unmet needs may worsen and require more costly services to address in the future," the authors state, noting that several options exist—for example, through the Affordable Care Act or home- and community-based waiver programs—for states to expand Medicaid eligibility to offer services to those who need LTSS for medical reasons.

Even among older adults who do qualify for Medicaid, however, the authors' analysis shows a high need for services. "It also finds a need for social supports such as efforts to improve housing conditions, reduce fall risk, and, in some cases, address social isolation," they write.

As of October 2014, 19 states had waivers to offer capitated managed LTSS programs for Medicaid beneficiaries, and many of these programs are designed to improve access to services, according to the authors. And as of July, 12 states had demonstration projects aiming to better coordinate services and financing for those eligible for both Medicare and Medicaid.

States can limit Medicaid HCBS waivers, the authors note. In 2013, they write, more than 27,000 people were waiting for Medicaid waiver services for older adults, and they had an average wait of 13 months. Also at that time, more than 127,000 people were waiting for waiver services targeted to older adults and others with physical disabilities, and they had an average wait of 10 months.

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