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Advisory Council November 2020 Meeting Presentation: New State Initiatives

Tuesday, November 10, 2020

Printer Friendly Version in PDF Format (4 PDF pages)


Learning from New State Initiatives in Financing Long-Term Services and Supports

Marc A. Cohen, Ph.D.

Full Report:
Exec. Summary:

Presentation Outline

  • About the study
    • Objectives
    • Methods
    • Study states
  • Findings
    • Brief description of state efforts
    • Rationales for reform efforts and obstacles
    • Selected High Level Lessons learned

About the study

  • Qualitative case-study of 6 states in process of initiating LTSS financing reforms
    • All in varying stages of a LTSS financing reform
  • Objectives
    • Describe current status of financing reforms across states
      • History and evolution of their efforts
    • Common themes and lessons learned about how reforms move forward
    • Identify challenges or obstacles
  • Methods
    • Hour-long structured interviews with 42 stakeholders
    • 4-8 in each state
    • Advocates, legislature, providers, labor, state officials, consumer organizations

Summary of State-based Activity in Study States

  • Social Insurance program enacted (State LTC Trust Act of 2019)
    • Washington
  • States in process of coalition building and reform effort
    • California -- Studying social insurance proposal, actuarial modeling and state Master Plan on Aging
    • Hawaii -- Long history of LTSS reform attempts. Kapuna Caregiver Program and Kapuna Care Program
    • Michigan -- Feasibility study social insurance and workforce issues
    • Minnesota -- Support development of new private LTSS product options -- life insurance and LTC added to Medicare supplemental coverage
    • Maine -- Ballot initiative for comprehensive home-care social insurance program rejected 63% vs 37%.

Why are states embarking on reform efforts?

  • Try to control state Medicaid expenditures; move financing away from Medicaid.
  • Inject new resources into the system to help caregivers and help assure people do not bankrupt themselves -- middle class relief
  • Move from a welfare/Medicaid basis to a social insurance basis;
Bar Chart: Improve Support for Paid Workforce 2%; Failure of private market 4%; Improve access to LTSS 7%; Financial help for middle class 22%; Ease caregiver burden 22%; Medicaid budget relief 42%.

What are some of the most common obstacles to making changes to the system?

Bar Chart: Consumer Apathy 14%; Disagreement within Coalition 21%; Securing Legislative Support 26%; Proposal Cost 38%.

Selected High Level Lessons

  • Develop stakeholder coalitions that are broad with formalized processes and structures.
  • Identify legislative champions.
  • This is a marathon and not a sprint.
  • Conduct actuarial studies and invest in data acquisition, knowledge generation, and intellectual infrastructure development.
  • Have a policy framework within which efforts can occur
    • Try to establish linkages between stakeholders, legislators and when possible, executive agency personnel (e.g. Master Plan on Aging)
  • Support for public education campaigns are a very helpful way to help move the issues into greater public consciousness.

What’s Next?

  • Then came COVID-19....
  • Unclear which competing force will prevail:
    • Initiatives put on hold due to fiscal situation of states
    • Increased demand for policy change because implications of underfunded system clear to see