Though the vast majority of seniors are living in their communities, as opposed to assisted living or nursing homes, only a third of these individuals are receiving financial support or assistance from Medicaid to pay for home- and community-based services.
That’s one takeaway from a recent Kaiser Family Foundation (KFF) webinar.
Seniors that aren’t getting financial support or assistance from Medicaid are either paying out of pocket or relying on support from informal or family caregivers, according to Anne Tumlinson, founder and CEO of the research and advisory firm ATI Advisory.
“Of that remaining two thirds, half of them live under 200% of poverty,” Tumlinson said during the webinar presentation. “We have a lot of older adults living in the community today, without any kind of Medicaid assistance, who can not afford home care, assisted living, who do not have long-term care insurance policies. Those people are 100% reliant on family caregivers, if they even have them. If they don’t, it’s a very dire situation. Those are often the people most at risk of spinning down into a Medicaid nursing home.”
These facts underscore how underfunded long-term care services and supports are in the U.S., Tumlinson noted.
“We don’t have enough money flowing into the system to attach to all of the people who have these needs,” she said. “If it’s a system where every single family is developing their own solution, one family at a time, one household at a time, of course we don’t have an infrastructure.”
A recent analysis found that while the majority of seniors will need some sort of in-home care support, the vast majority of them cannot afford that care.
Tumlinson doesn’t believe that this is an issue that the private market can solve on its own.
“This is just not an insurable risk that is possible to address through a private market,” she said. “This is not car insurance. This is not even health insurance.”
Instead, Tumlinson called for government solutions, specifically putting a new public program in place created from tax dollars.
In the meantime, there are various programs in place across different states. For example, Washington funds public insurance for its residents based on tax dollars.
States like California and Minnesota are considering similar programs, Tumlinson noted.
“We’ve seen states and state legislatures really sitting up and realizing the federal government is not going to solve this problem,” she said. “Medicaid is a liability on their books, and they need to start looking at other options for paying for it.”
States such as Vermont, Wyoming and Washington are also working to address these issues through Medicaid demonstration programs.
Ultimately, Tumlinson believes that collective action will be key to activating change.
“As families, we can not solve this problem by ourselves,” she said. “We are going to have to collectively solve it. States are going to be part of the solution. Hospitals and health systems are going to be part of the solution. CMS is going to be behind the scenes helping to facilitate all of those solutions, while we wait for Congress, hopefully, to act on something more universal and national.”