Financing Long-Term Services and Supports: Opportunities for Overcoming Historical Roadblocks to Reform

Abstract This presentation documents the continuing failure to tackle the problem of financing long-term services and supports (LTSS)—a failure most recently seen in the only national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was included in the Affordable Care Act, but was repealed in 2013. Subsequently, policy experts and some Democrats have made proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window open once again for addressing the problem of LTSS financing nationally.

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Stepping into the Breach of Federal Inaction: Reforming the Financing of Long-Term Services and Supports in the Post-CLASS Era

Journal of Health Politics Policy and Law ◽

10.1215/03616878-8543310 ◽

2020 ◽

Vol 45 (5) ◽

pp. 847-861

Author(s):

Edward Alan Miller ◽

Pamela Nadash ◽

Marc A. Cohen

Keyword(s):

Policy Development ◽

National Level ◽

State Level ◽

Policy Window ◽

Adoption And Implementation ◽

Single Piece ◽

Opportunities For Learning ◽

Post Class ◽

Services And Supports

Abstract The growing need for long-term services and supports (LTSS) poses significant challenges to both individuals and government. This article documents the continuing failure to tackle this problem at the national level—a failure that was most recently seen in the fallout from the Affordable Care Act (ACA), which included the single piece of national legislation ever enacted to comprehensively address LTSS costs: the Community Living Assistance Services and Supports (CLASS) Act. The CLASS Act was passed as part of the ACA (Title 8) but was repealed in 2013. Following its demise, policy experts and some Democrats have made additional proposals for addressing the LTSS financing crisis. Moreover, significant government action is taking place at the state level, both to relieve financial and emotional burdens on LTSS recipients and their families and to ease pressure on state Medicaid budgets. Lessons from these initiatives could serve as opportunities for learning how to overcome roadblocks to successful policy development, adoption, and implementation across states and for traversing the policy and political tradeoffs should a policy window once again open for addressing the problem of LTSS financing nationally.

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Opportunities in the Affordable Care Act to Advance Long-Term Services and Supports: The Role of Rehabilitation Counseling

Rehabilitation Research Policy and Education ◽

10.1891/216866512805000929 ◽

2012 ◽

Vol 26 (1) ◽

pp. 55-66

Author(s):

Joe Caldwell ◽

Reginald J. Alston

Keyword(s):

Affordable Care Act ◽

Rehabilitation Counseling ◽

The Affordable Care Act ◽

Services And Supports

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States of Reform

State and Local Government Review ◽

10.1177/0160323x17699526 ◽

2016 ◽

Vol 48 (4) ◽

pp. 246-258 ◽

Cited By ~ 1

Author(s):

Phillip M. Singer

Keyword(s):

Logistic Regression ◽

Political Polarization ◽

State Budgets ◽

Services And Supports

A growing percentage of state budgets has been focused on caring for individuals who receive long-term services and supports (LTSS). States have an important tool to reduce the costs of caring for individuals with LTSS, Medicaid Section 1915(c) waivers. Using logistic regression, whether and when a state decides to apply for a waiver during the years 1993–2014 is tested. Wealthier, larger states are more likely to apply for waivers, while previous waiver applications are related to fewer applications. The role of political polarization within the legislature has mixed results on whether a state decides to apply for a waiver.

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How The Affordable Care Act Can Help Move States Toward A High-Performing System Of Long-Term Services And Supports

Health Affairs ◽

10.1377/hlthaff.2011.0099 ◽

2011 ◽

Vol 30 (3) ◽

pp. 447-453 ◽

Cited By ~ 16

Author(s):

Susan C. Reinhard ◽

Enid Kassner ◽

Ari Houser

Keyword(s):

Affordable Care Act ◽

High Performing ◽

The Affordable Care Act ◽

Services And Supports

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A Multiple Streams Analysis of Recent Changes to State-Level Dyslexia Education Law

Educational Policy ◽

10.1177/0895904818807328 ◽

2018 ◽

Vol 34 (7) ◽

pp. 1036-1068

Author(s):

Brian Gearin ◽

Jessica Turtura ◽

Edward J. Kame’enui ◽

Nancy J. Nelson ◽

Hank Fien

Keyword(s):

Explicit Instruction ◽

State Level ◽

Long Term Effects ◽

Multiple Streams ◽

Short Term ◽

School Practice ◽

Policy Window ◽

Multiple Streams Approach ◽

And Training

This article provides an overview of recent changes to state-level dyslexia legislation. It begins by applying a variant of Kingdon’s multiple streams approach to explain how the dyslexia education “policy window” came to be opened. The article then describes the most likely effects and side effects of the new laws. Likely short-term effects include (a) a greater focus in schools on dyslexia screening and intervention, (b) greater use of multitiered systems of support and explicit instruction, and (c) changes in teacher preparation and training. Possible long-term effects include a reconceptualization of what constitutes “normal” school practice.

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Opportunities in the Affordable Care Act to Advance Long-Term Services and Supports: The Role of Rehabilitation Counseling

Rehabilitation Research Policy and Education ◽

10.1891/2168-6653.26.1.55 ◽

2012 ◽

Vol 26 (1) ◽

pp. 55-66

Author(s):

Caldwell Joe ◽

J. Alston Reginald

Keyword(s):

Affordable Care Act ◽

Rehabilitation Counseling ◽

Rehabilitation Counselors ◽

Term Care ◽

Persons With Disabilities ◽

Long Term Care Insurance ◽

The Affordable Care Act ◽

Services And Supports

The Affordable Care Act includes many new provisions for long-term services and supports (LTSS). Among these are several new options, improvements, and incentives within Medicaid to balance service systems and expand access to home and community-based services. In addition, the Affordable Care Act authorizes the establishment of a new voluntary national long-term care insurance program, the Community Living Assistance Services and Supports (CLASS) Program. This article discusses some of the major provisions and implementation. It also examines how the major principles of rehabilitation counseling are central to advancing LTSS policy and how rehabilitation counselors can play a key role in ensuring quality LTSS services for persons with disabilities.

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Tennessee Education Savings Account: Tipping the Scales From Equity to Choice

Iris Journal of Scholarship ◽

10.15695/iris.v2i0.4771 ◽

2020 ◽

Vol 2 ◽

pp. 98-110

Author(s):

Erin Curtin

Keyword(s):

School District ◽

School Choice ◽

State Level ◽

Poverty Line ◽

Comprehensive Education ◽

Policy Window ◽

Federal Poverty Line ◽

Scholarship Program ◽

Shelby County ◽

K 12

This article provides an analysis of Tennessee’s newly signed Education Savings Account policy, a school choice initiative. The policy provides vouchers, in the form of a debit card, to students in grades K-12 who are at or below 200% of the federal poverty line and are zoned to attend a Nashville, Shelby County, or Achievement School District school. Using the Policy Window Framework the author uncovers that the policy was created in a federal and state-level political convergence, which attempted to place equity at the forefront of the issue. However, using Levin's Comprehensive Education Privatization Framework, we can see that neoliberal ideals of choice and efficiency conquer equity in the finalized policy. The author predicts the outcomes of this new policy using this framework in tandem with 3 case studies: Louisiana Scholarship Program, DC Opportunity Scholarship Program, and Tennessee’s Individualized Education Accounts.

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