LeadingAge: A New Vision for Long-Term Services and Supports
Overview
Type of Reform: Creating a New Program
Description: Goals to develop a fairer and more rational financing system to ensure access to quality LTSS. Recommends a flexible and universal LTSS insurance program grounded in the principles of shared risk and consumer flexibility. Re-directs health and LTC dollars already in the system and creates new funding that relies on a universal public catastrophic insurance program that insures against the risk of long periods of high need.
Sponsoring Organization and Key Author(s):
Sponsoring Organization: LeadingAge is an association of not-for-profit and mission-driven organizations dedicated to delivering high-quality LTSS. Members include providers, state partners, consumer group, research partners, and foundations. LeadingAge is a 501(c)(3) tax-exempt charitable organization focused on education, advocacy, and research.
Key Author: Lead by Pathways Task Force, overseen by Olivia Mastry, with expertise from a panel of policy, academic, research, advocacy, and practice professionals and experts. Actuarial analysis and modeling provided by Milliman, Urban Institute, and ATI.
Impact and Action:
Represents provider association, in collaboration with policy and advocacy experts, proposing finance reform and offering options and solutions.
Program Details
Participation Criteria
Universal and mandatory enrollment.
Conditions for Receiving Benefits Scope of Services
Not specified.
Scope of Services
Not specified.
Amount of Services
Not specified; recommends benefits be paid based on a “managed cash” benefit structure, provides individuals with flexibility to use a mix of LTSS that best meet their needs (similar to Medicaid’s Cash and Counseling program).
Participant Financial Responsibility
Eligible individuals are responsible for LTSS expenses (or care) during an initial two-year elimination period.
Elimination Period
Benefits begin after the individual has met the functional or cognitive criteria for benefit eligibility for at least two years.
Provider Requirements
Not specified.
Provider Payment Levels
Not specified.
Inflation Adjustments
Not specified.
Financing & Implementation
Revenue Source(s)
Not specified.
Total Program Costs
None estimated.
Program Administration
Not specified.
Private Sector Role
- Recommends that private LTC insurance be used to finance care during the two-year elimination period.
- Views presence of a public insurance program as a catalyst for innovation in a reinvigorated private LTC insurance market.
A New Vision for Long-Term Services and Supports
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