States That Lead in Transforming Long-Term Services and Supports

Many of us were happy to wave goodbye to 2020, a year fraught with challenges in our nation and across the globe. As the pandemic continues into 2021, states will be addressing the short-term health impact of COVID-19 as well as its long-term economic impact. The pandemic illuminated challenges within long-term services and supports (LTSS) systems as states and providers shifted gears to safely support people in their homes. These same services are a significant component of state Medicaid budgets. States will be looking for ways to improve LTSS access and quality while managing costs, so some leading states have solutions to offer.

Setting the Pace for Change

The SCAN Foundation recently announced its 2020 Pacesetter Prize, which uses data from the AARP LTSS State Scorecard to recognize states that are making significant progress in achieving a high-performing system of care.

The Foundation awarded four leading states—Connecticut, New Jersey, New York, and Ohio—for their innovative efforts and improvements in providing quality services and supports to their residents. The Pacesetter Prize highlights examples of state best practices to maximize learning and adoption by other states.

Connecticut, recognized for improving Affordability and Access, uses a data-driven approach to communicate with the public about LTSS programs. It collects robust data to monitor access, including trends in personal preferences, population demographics, rationale for why certain programs work and cost comparisons between institutional care and home- and community-based settings. Connecticut ranked No. 4 in Affordability and Access in 2014 and moved to No. 2 in 2017, where it remains today. Its overall State Scorecard rank rose from No. 10 in 2017 to No. 6 in 2020.

New Jersey, recognized for improving Choice of Setting and Provider, is a national leader in using managed care to give people who need LTSS more choices of care providers and settings for receiving support. Its unique managed long-term services and supports (MLTSS) program greatly increased access to home- and community-based settings for Medicaid-eligible adults with complex care needs. New Jersey improved its rank in this category from No. 36 in 2017 to No. 19 in 2020. Its overall State Scorecard rank rose from No. 17 to No. 12 during the same period.

‘States must prioritize providing adequate LTSS for older adults and people with disabilities.’

New York, recognized for improving Support for Family Caregivers, significantly strengthened its laws to support family caregivers. It is increasing paid family leave between 2018 and 2021 from eight to 12 weeks per year, while also expanding guaranteed job protections. Its comprehensive approach to empowering family caregivers across government programs and agencies is the reason New York jumped from No. 11 in Support for Family Caregivers in 2017 to No. 5 in 2020. Its overall State Scorecard rank rose from No. 20 to No. 11 during the same period.

Ohio, recognized for improving Effective Transitions, is a national leader in improving transitions for people who need LTSS and are moving out of institutions and back into the community. It works across different types of insurance—commercial and Medicaid—to integrate LTSS services with health plans, which have brought relief to thousands of residents. Ohio improved its rank in the Effective Transitions category from No. 31 in 2017 to No. 18 in 2020. Its overall State Scorecard rank rose from No. 34 to No. 19 during the same period.

The 2020 Pacesetter Prize paints a picture of comprehensive LTSS system performance before the COVID-19 outbreak began. Yet, if we have learned anything in the past year, it is that states must prioritize providing adequate LTSS for older adults and people with disabilities. By highlighting state improvements, the Pacesetter Prize points to opportunities where all states can do better, no matter their ranking in the LTSS State Scorecard.

Develop a Plan to Set the Pace for Change

Our analysis of leading states over several rounds of the AARP LTSS State Scorecard indicates that those committed to an overarching plan to guide policy choices and investments perform higher on average than their counterparts. Leaders seeking to transform their LTSS systems can look to Pacesetter states to identify levers for change that can address priorities within a broader strategic plan. With multiple demands on both state staff and fiscal resources during these challenging times, it may seem counterintuitive to embark upon a strategic planning process. However, a plan with a clear focus can help a state to embrace opportunities and navigate competing priorities more successfully when budgets are tight. States can start by building on existing efforts or initiating new strategic planning capacities to guide decisions over time.

The following are examples of strategic planning activities underway in several states:

  • Master Plans for AgingA Master Plan for Aging is a blueprint developed to guide the restructuring of state and local policy, programs and funding geared toward aging well in the community (e.g., California, Colorado, Massachusetts, Texas).
  • State Long-Term Care Plans—A plan used to outline a state’s vision for LTSS, and educate and provide recommendations to policymakers (e.g., Connecticut).
  • Age-Friendly Initiatives—A network of states or communities working to implement changes that make communities more livable for people of all ages (e.g., New York, Washington, DC, Maine).
  • Issue-Specific Task Forces/Workgroups—Groups of stakeholders brought together by state leadership to develop recommendations on specified issues.

Making LTSS programs more affordable, accessible and of higher quality is essential for becoming a state that supports a positive aging experience. Pacesetter Prize winners offer policy ideas and best practices that can help states to achieve high performance as they rebuild and reimagine their LTSS systems.

Learn more from the Pacesetter Prize states in a webinar on January 22, 2021.

Megan Burke is the policy analyst at The SCAN Foundation, in Long Beach, Calif.