Health and Home: The Role of Medicaid and Managed Care in HCBS and LTSS
Generations Journal, vol. 49, no. 4 (Winter 2025-26 Issue)
Guest Editor: Orion Bell
CEO of Benjamin Rose in Cleveland, OH
Health and Home
When my bones are stiff and aching,And my feet won’t climb the stair,I will only ask one favor:Don’t bring me no rocking chair. Excerpt from On Aging by Maya Angelou, 1978 The Benjamin Rose Institute, established in 1908, is one of the oldest charitable organizations in the United States dedicated to serving older adults. Rose made a fortune in the...
Maybe Elephants Can Dance
Abstract The United States initially developed a long-term care system that prioritized nursing home care over in-home care, particularly for those supported by the Medicaid program. Legislation in 1981 attempted to change that strategy, but progress was slow. Today, however, the long-term services system has been altered in most states to emphasize home-...
Medicaid at 60: Its Essential Role for Older Adults
Abstract Medicaid has played a vital role in supporting the U.S.’s older population for more than 60 years. It funds essential health and long-term care for nearly 80 million people, including millions of older adults and caregivers. As the primary funder of home- and community-based services (HCBS), Medicaid has shifted from a focus on institutional care...
Expanding Medicare’s Ability to Provide Home-Based Care
Abstract As the U.S. population ages, the demand for care allowing older adults to remain at home is growing rapidly, exposing long-standing gaps. Acute medical care is universally available but long-term home- and community-based services (HCBS) are chronically under-resourced. Medicare only covers short-term home health and select demonstration models,...
AddnAide: Lessons from the National Home-Care Workforce Shortage
Abstract Faced with long wait times to connect individuals with essential in-home care services, Council on Aging of Southwestern Ohio (COA), the Area Agency on Aging (AAA) serving five counties in southwest Ohio, decided to take a pioneering approach to connecting clients with care providers. Through its wholly owned subsidiary and innovation incubator,...
Ten Years of NCI-AD
Abstract National Core Indicators–Aging and Disabilities (NCI-AD) is a national initiative that measures and strengthens long-term services and supports (LTSS) systems for older adults and people with disabilities. NCI-AD uses standardized, person-centered surveys to hear directly from people using LTSS and provider agencies, capturing outcomes related to...
Older Americans Act Revisions: Enhancing Community Supports for HCBS
Abstract Older Americans Act (OAA) requirements require states to monitor service quality across nutrition, caregiving, emergency preparedness, and service delivery. This article highlights how the National Core Indicators–Aging and Disabilities (NCI-AD) Adult Consumer Survey (ACS) can support OAA compliance and program improvement using 2023–2024 data...
Person-Centered Supports for Older Adults: How Paid Family Caregiving Measures Up
Abstract As the demand for home- and community-based services increases, many are turning to family caregivers to provide support. We look at how outcomes vary for older adults, with a focus on understanding the experiences of older adults who report they get the most help from paid staff, paid family, or unpaid volunteers. The results show that older...
The Role of Area Agencies on Aging in Medicaid Waivers and Medicaid Managed Care
Abstract Ohio’s Area Agencies on Aging (AAAs) have become national leaders in integrating health and social care through Medicaid waivers and managed care. Their long-standing role in Ohio Medicaid programs like PASSPORT and MyCare Ohio demonstrates how community-based organizations can improve care coordination, outcomes, and cost-effectiveness. Uniquely,...
Aging-in-Place Villages and the Promise of Artificial Intelligence
Abstract Older adults, their families, their communities, and public health and social services agencies share the desire to enable individuals to age in place (Malani et al, 2024). Over the past 25 years, nonprofit virtual villages have emerged as important contributors to this goal. However, they are under-resourced to meet their potential, lack data...
Beyond Home Care—What Now?
“The true measure of any society can be found in how it treats its most vulnerable members.”—attributed to Mahatma Gandhi In introducing this issue of Generations Journal, I began with a note about Benjamin Rose and his desire to help older adults maintain their “comfort and dignity.” Comfort and dignity included the ability to remain at home. Medicaid and...
Staff
Editor-in-Chief: Leanne Clark-Shirley, PhD
Senior Editor: Alison Biggar
Issue Contents
Caring About the Care Workforce and Families
Health and Home By Orion Bell
Maybe Elephants Can Dance By Bob Applebaum, Matt Nelson, Bailee Brekke, and John R. Bowblis
Medicaid at 60: Its Essential Role for Older Adults By Amber Christ
Expanding Medicare’s Ability to Provide Home-Based Care By Laura Borth
AddnAide: Lessons from the National Home-Care Workforce Shortage By Paula Reichle Smith
NCI-AD and the Quest for Quality Long Term Services and Supports
Ten Years of NCI-AD By Stephanie Giordano, Lindsay DuBois, Rosa Plasencia, and Courtney Priebe
Older Americans Act Revisions: Enhancing Community Supports for HCBS By Courtney Priebe, Kendall Lynch, Stephanie Giordano, Lindsay DuBois, and Rosa Plasencia
Person-Centered Supports for Older Adults: How Paid Family Caregiving Measures Up By Lindsay DuBois, Stephanie Giordana, Courtney Priebe, and Rosa Plasencia
Aging-in-Place Villages and the Promise of Artificial Intelligence By Mary Jo Deering
Beyond Home Care—What Now? By Orion Bell
Editorial Advisory Board
Ruth E. Katz, Chair
Wendy Lustbader, Immediate Past Chair
Tobi Abramson
Orion Bell
Mary L. Flett
Sarah Galvan
Robyn L. Golden
Donna M. Lisi
Najja Orr
Winifred V. Quinn
Laura Trejo
ISSN 2694-5126
Suggested citation for articles in this issue: [Last Name(s), First Name(s)]. “Article Title.”
About Generations Journal
Generations Journal is the quarterly journal of the American Society on Aging. Each issue is devoted to bringing together the most useful and current knowledge about a specific topic in the field of aging, with emphasis on practice, research, and policy.