Forum Session

State Variation in Long-Term Services and Supports: Location, Location, Location
July 19, 2013


Carol V. O'Shaughnessy, MA


Where people live affects the opportunities available to them and, ultimately, their quality of life. People with limited income and assets who need long-term services and supports (LTSS) beyond services provided by family caregivers depend on the services systems in their communities and states of residence. Because state LTSS programs are primarily financed by the federal-state Medicaid program, they do have some common features. At the same time, programs vary substantially by state. State-specific factors, including state leadership and vision, state responses to federal policy, consumer demand and advocacy, and provider supply and political strength, among other things, affect programs and services. State variation in LTSS has been discussed for many years, and much research has been devoted to describing individual state approaches that are believed to show positive effects on care recipients, quality of services, and costs. But certain state-specific circumstances may be barriers to replication of practices that another state has found successful. Given the substantial federal investment in LTSS, some believe that ensuring equitable access to services as well as achieving comparability and choice of services for people with LTSS needs across, and even within, states is warranted, and that consumers should expect some measure of equity regardless of where they live. At this Forum session, speakers described how Medicaid policies and programs have influenced state LTSS programs, discussed variation in state characteristics that affect service delivery, and explored state experiences in managing LTSS programs.


Erica L. Reaves, MPP (bio)
Policy Analyst
Commission on Medicaid and the Uninsured (KCMU)
Henry J. Kaiser Family Foundation

Lisa Alecxih, MPA (bio)
Senior Vice President
Center for Aging & Disability Policy
The Lewin Group

John Michael (Mike) Hall, MA, JD (bio)
Senior Director of Medicaid Policy and Planning
National Association of States United for Aging and Disabilities

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