America should have a coherent and comprehensive framework for its LTSS policies, programs, and funding. NCD offers the following recommendations:
- Decouple eligibility for Home- and Community-Based Services (HCBS) under an HCBS waiver from a determination of nursing home eligibility. Remove the institutional bias in the Medicaid program to give Medicaid beneficiaries greater choice in where they live and how financial assistance is provided to cover a range of LTSS.
- Increase support for families and significant others in their role as informal and unpaid caregivers.
- Improve the supply, retention, and performance of direct support workers to meet increasing demand. Funding should be authorized for collaborative demonstration projects between the U.S. Departments of Labor and Health and Human Services that promote collaboration between community colleges and disability-related organizations to develop a high-quality set of competencies to be taught in a new support worker certificate program that expands supplies of quality workers to meet market demand in home- and community-based settings.
- Mandate coordination and collaboration among federal agencies to align public policy and transform infrastructure to be responsive to consumer needs and preferences for a comprehensive system of LTSS.