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New Report Highlights Need to Address Long-Term Care Demands

States Struggling With High Demand and Limited Resources to Provide Non-Medicaid Long-Term Services and Supports

July 16, 2013

AARP: Allyson Funk - or 202-434-2560
NASUAD: Kelsey Walter – or 202-898-2581
Health Management Associates: Kelly Niebel – or 517-482-9236

New Report Highlights Need to Address Long-Term Care Demands
States Struggling With High Demand and Limited Resources to Provide Non-Medicaid Long-Term Services and Supports

Washington, DC – Today, AARP Public Policy Institute, National Association of States United for Aging and Disabilities (NASUAD) and Health Management Associates (HMA) released a new report highlighting the challenges facing states in providing long-term services and supports (LTSS). Even as states begin to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS), most states did not increase funding for non-Medicaid services – including senior centers, information and referral, transportation and caregiver supports, such as those under the Older Americans Act.

As Americans age, the demand for long-term care, including home and community based services, only continues to grow; and it’s happening at a time when state budgets are still strapped. The recent meeting of the federal Commission on Long-Term Care serves as a reminder that as a country we’re at the crossroads when it comes to providing care for older adults and persons with disabilities.

The report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms underway and trends across the country. The report found that more states are increasing participation in HCBS options within the Affordable Care Act as well as initiatives for individuals who are dually eligible for Medicaid and Medicare. At the same time, they’re seeing increased demand for non-Medicaid services; for example, the caseload for adult protective services – for victims of abuse or exploitation – has increased in the last two years without increased funding in many states.

“It’s increasingly evident that we need to rethink how we address long-term services and supports in this country,” said Susan Reinhard, Senior Vice President for the AARP Public Policy Institute. “Long-term services and supports are critical not only to the population they serve, but also to the family caregivers who support them.”

“The decision by so many states to transform their Medicaid LTSS systems from fee-for-service to managed care ranks as the most significant byproduct of The Great Recession,” observed Martha Roherty, Executive Director of NASUAD.  “But our report documents that other vital programs for seniors, reliant entirely on state revenues, still languish six years after the recession began. As their economies improve, states now must turn their attention to other state programs like Adult Protective Services, still struggling with reduced or flat funding, hiring freezes and staff reductions.”

“This report illustrates how states are actively engaged in exploring ways to better serve individuals with ongoing health care and support needs,” said Jenna Walls, senior consultant at HMA. “The overwhelming survey response rate indicates state policymakers are committed to advancing a national dialogue for how to best address the increasing demand for services.”

The new report, “At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint” is available here:

About AARP
AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment security and retirement planning. We advocate for consumers in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.  A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world's largest circulation magazine; AARP Bulletin;; AARP TV & Radio; AARP Books; and AARP en Español, a bilingual news source.  AARP does not endorse candidates for public office or make contributions to political campaigns or candidates.  The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at

The National Association of States United for Aging and Disabilities (NASUAD) was founded in 1964 under the name National Association of State Units on Aging (NASUA).  In 2010, the organization changed its name to NASUAD in an effort to formally recognize the work that the state agencies were undertaking in the field of disability policy and advocacy.  Today, NASUAD represents the nation’s 56 state and territorial agencies on aging and disabilities and supports visionary state leadership, the advancement of state systems innovation and the articulation of national policies that support home and community based services for older adults and individuals with disabilities.

About Health Management Associates
Health Management Associates (HMA) is an independent, national research and consulting firm specializing in publicly financed health care reform, policy and programs. We serve government, public and private providers, health systems, health plans, institutional investors, foundations and associations. Every client matters. Every client gets our best. With 15 offices and more than 125 multidisciplinary consultants coast to coast, our expertise, our services and our team are always within client reach. For more information, visit


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