Long-term care in the United States is government-controlled, welfare-financed, centrally-planned and highly dysfunctional. Means-tested Medicaid funds 61% of all long-term services and supports but pays too little to supply quality care profitably. For decades, institutional bias left generations languishing in nursing homes unnecessarily.
Now, 700,000 people wait in long lines, hoping eventually to receive strictly controlled home- and community-based services. Few people plan ahead for LTC, so if and when they need expensive care over an extended period, they rely on Medicaid. Of all the government programs under scrutiny by budget cutters today, Medicaid is the most vulnerable. This house of cards is on the verge of collapse. There must be a better way.
There is no reason for Medicaid to dominate LTC funding and service delivery. The current system evolved like Topsy over decades of tension between competing political ideologies.
Some on the left expanded Medicaid to cover more people and more services more generously. Spousal impoverishment protections, medically needy expansion, and rebalancing from institutional to home care are examples.
The full article can be found in McKinght’s Long-Term Care News.
