Long-Term Care Reform: Program Eligibility, States' Service Capacity, and Federal Role in Reform Need More Consideration

Pursuant to a congressional request, GAO discussed long-term health care reform, focusing on: (1) eligibility determinations; (2) service capacity; and (3) the federal role in implementing long-term care reform. GAO noted that: (1) long-term health care reform is needed because of changing demography, rising costs, and dissatisfaction with current services; (2) the principles of long-term care reform include emphasizing home- and community-based services, assessing an individual's ability to carry out everyday activities, permitting flexibility in the services provided to individuals, and controlling costs; (3) in addition, the reform proposal would liberalize Medicaid nursing home eligibility, provide tax credits to defray health care costs for disabled persons, and encourage and regulate private long-term care insurance; (4) one of the most challenging elements of the long-term care proposal is eligibility determination; (5) the proposal specifies that persons of all income levels and ages will be eligible for long-term care services; (6) giving states more latitude in eligibility determination could help compensate for limited knowledge on how best to weigh individual needs; (7) information dissemination and technical assistance could help states with less capacity; (8) continuous monitoring and feedback could provide needed data on the best health care practices; and (9) the government's role in long-term care reform should be more clearly articulated and requires cooperation with states in the design, administration, and monitoring of long-term care programs.