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The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis on topics important to state health policymakers, particularly on issues related to state leadership, primary care, aging, and health care costs.
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The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a nonpartisan foundation focused on improving the health of communities and entire populations.
July 11, 2018
The Health of Aging Populations The Center for Evidence-based Policy
Curtis S. Harrod
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As the US population ages, the demand for long-term care options has grown. Special focus has been on Medicaid programs, which pay for most long-term services and supports (LTSS) in this country. But as public policy has shifted LTSS from institutional settings to home- and community-based settings, new questions arise for policymakers who want to know how Medicaid agencies measure the quality of home- and community-based services (HCBS), how they pay for them, and how to encourage more cost-effective services.
One alternative payment model for HCBS that has attracted attention is “bundled payments,” a package of health care services paid for as a set. They are currently used in Arkansas and Colorado, where assisted-living facilities or contracted home health agencies receive a daily rate to provide HCBS.
To help state policymakers address the challenges of developing HCBS, the Medicaid Evidence-based Decisions Project (MED) commissioned a report focused on alternative payment methods and quality metrics for HCBS. MED is a self-governing collaboration of state Medicaid agencies, based at the Center for Evidence-based Policy (CEBP) at Oregon Health & Science University.
This report, adapted from the MED report, is also authored by CEBP staff and addresses the same questions for a broader audience. It offers tools, resources, and examples for policymakers as they look for innovative ways to reimburse for and assess quality in Medicaid HCBS, a challenge that will grow in the future as Medicaid enrolls more elderly Americans.
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