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In Brief: Pulling Together: Administrative and Budget Consolidation of State Long-Term Care Services

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3. Consolidation into one administration could include the following components:

  • A single budget with flexibility and authority to fund an array of LTC services and supports;
  • A single point of entry that does a timely and standardized assessment of financial and functional eligibility that is also used to gather hard data to manage the LTC system;
  • Case management capacity to provide assistance and oversight for consumers;
  • A process for resource development that meets consumer demand for services and supports;
  • A fair rate setting and contracting processes for providers of service;
  • A structure and process for ensuring regulatory oversight and quality management throughout the system; and
  • Integration of programs supported by Older Americans Act funds.

4. Barriers to consolidation can include the difficulty of serving multiple populations with different issues and funding streams, agency turf battles, fear of big government, and some resistance from some consumer groups.

5. Major state LTC system change generally requires two key elements: (1) leadership and vision reflecting core values on the part of top state policymakers; and (2) participation of major stakeholders, including consumers, providers, state officials, and representatives of persons with disabilities and the groups that represent them.

6. All agency directors who were interviewed for this paper agreed that it would be much more difficult to shift more funding to home and community-based services without the consolidated structure but that many LTC reforms can be accomplished without the consolidation of individual agencies.


A consolidated agency can bring about consistent policymaking and focus the system on persons rather than on program providers. Although many LTC reforms can occur in states without a single, consolidated agency and are being developed in many states today, compre-hensive system reform is much more likely to happen in states with consolidated agencies.



1Fox-Grage, Wendy, Barbara Coleman, and Dann Milne, PPI Issue Paper #2006-05. February 2006

Written by Wendy Fox-Grage, AARP Public Policy Institute
February 2006
©2006 AARP
All rights are reserved and content may be reproduced, downloaded, disseminated, or transferred, for single use, or by nonprofit organizations for educational purposes, if correct attribution is made to AARP.
Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049

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