The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
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 to advance state health leadership, strong primary care, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest posts from our staff and guest authors.
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 foundation that works to improve population health and health equity.
August 19, 2026
Quarterly Article
Pamela Herd
Aug 19, 2026
Jun 1, 2026
June 2026
Back to The Milbank Quarterly
Policy Points:
Context: America’s long-term care policy approach is poverty-based, requiring most older adults to spend down their assets to qualify for limited, Medicaid-funded support, which is biased toward institutional care and plagued by bureaucratic complexity and enrollment hurdles.
Methods: I conduct a review of long-term care policy developments since the 1980s, as well as related research on the impacts of these varying policy approaches on access to services.
Findings: While Medicaid-funding long-term care remains plagued by complexity and access issues, there have been promising changes. Use of home and community-based services has increased substantially for Medicaid beneficiaries since the early 1980s due in large part to activism on the part of disability rights movement. Though new and still relatively limited in scope, the most promising change has been the recent adoption of a universal long-term care policy in Washington State.
Conclusions: As the population ages and care needs grow more urgent, the United States faces a critical choice—cling to a piecemeal, confusing, and impoverishing long-term care system or embrace universalism to ensure meaningful access to needed community-based long-term care supports.
