Long-Term Care Reform

Passage of any long-term care reform legislation is merely the first step in a long journey toward meeting the nation's long-term care needs. Knowledge about determining long-term care needs and services, derived largely from the experience of innovative states, suggests that state flexibility is the best way to meet the diverse needs of individuals and communities. This flexibility requires a new, different federal role, largely one of partnership with the states in the design and management of programs. The administration's proposal would give states $38 billion in federal funding each year for a new federal-state program of home and community-based services, to be phased in from 1996 to 2003. States will be given wide latitude to design and run programs to serve persons of all income ranges. The proposal would also liberalize Medicaid nursing home eligibility, provide tax credits to defray the costs of personal assistance for working persons with disabilities, and encourage and regulate private long-term care insurance. If the administration's proposal is to be the blueprint for long-term care reform, the new federal role should be spelled out more clearly. More thought should also be given to developing state guidance on determining eligibility and to helping states with less capacity to use program funds wisely.