Home-based care advocacy comes from both sides of the aisle in Washington, D.C., these days. Now, a new report from the Bipartisan Policy Center (BPC) is shining further light on the need for the delivery of health care in the home.
The Bipartisan Policy Center is a think tank that promotes bipartisan solutions to the country’s biggest issues. The group specifically laid out five specific recommendations to improve the availability of long-term care in one of its latest reports.
“For decades, policymakers have sought to improve access to long-term services and supports (LTSS) and to strengthen these services’ financing,” the report read. “Today, about half of 65-year-olds will need LTSS at some point in their life. This need will grow as baby boomers age and require more care.”
The first recommendation BPC made in its report was expanding access to home- and community-based services (HCBS).
“Congress should make HCBS available for individuals with long-term care needs who are ineligible for Medicaid,” the report noted.
Those services should be available through fully integrated care models, including fully integrated dual-eligible special needs plans (FIDE-SNPs), Programs of All-Inclusive Care for the Elderly (PACE), and other models with sliding-scale subsidies that could be approved by the secretary of the U.S. Department of Health and Human Services (HHS).
There are currently 140 PACE programs that serve around 55,000 patients across 30 states, according to the National PACE Association. Yet over 2 million Americans qualify for the program, leaving the penetration rate at only about 3%.
“Congress should develop a transitional program to support the expansion and development of integrated delivery models where they are unavailable, and should build caregiver capacity until the new HCBS program is fully implemented,” the report read.
In 2018, an estimated 14 million adults in the U.S. reported a need for LTSS, a range of unpaid and paid non-medical and medical services, according to the American Association of Retired Persons (AARP).
There are currently more than 800,000 American seniors and disabled people on waiting lists to gain access to HCBS. The number is likely even higher than that, and the wait time averages tends to be about three years.
“HCBS would be available through fully integrated health plans and providers,” the report continued. “BPC issued a 2020 report recommending that Congress require states to integrate Medicare and Medicaid services for dual eligible individuals. If adopted, all Medicare beneficiaries would have access to integrated plans, including Medicare Advantage, PACE, or other integrated medical home models.”
Access to HCBS, and wait lists, vary greatly based on the state and a number of other factors. But there is currently no data that “comprehensively captures disparities” in the delivery of HCBS, according to the BPC.
“Although all states cover HCBS to some extent, the services covered, access to services, and HCBS spending vary significantly by state,” the report read. “HCBS expenditures as a portion of total LTSS spending differs widely across the country, making it easier to receive HCBS in some states than others. “
Those disparities in the delivery of HCBS also need to be addressed in order to create greater access overall, according to the BPC, which listed that as its second recommendation.
“Congress should direct the secretary of HHS to collect data and issue an annual report on disparities in access to HCBS and make recommendations to Congress to address inequities,” the report read.
Improving access to HCBS not only helps address LTSS needed for seniors, but it is also a much cheaper option, especially compared to nursing home care.
BPC’s other recommendations included creating a caregiver tax credit to ease the out-of-pocket costs associated with LTSS-related care, improving the viability of private long-term care insurance and standardizing and simplifying long-term care insurance to find a balance between coverage and affordability.
But for the entire system to realize those savings tied to HCBS, investment in the space is well overdue. And that investment needs to come in a variety of forms to fix the access issue.
“No single politically viable solution exists to address the nation’s LTSS needs,” the report read. “BPC’s recommendations have the potential to expand access to LTSS for individuals with long-term care needs across a range of income levels, through public and private health insurance programs.”
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