Long-term care for the elderly and disabled is driving up Medicaid costs, and states should take notice. That was the message of speakers at the 2015 CSG Medicaid Policy Academy held June 17-19 in Washington, D.C. “In nine states, at least 30 percent of Medicaid enrollees are elderly or disabled,” explained Matt McKillop, an officer for the State Health Care Spending division of The Pew Charitable Trusts. The main source of funding to provide long-term care and support for these individuals streams from Medicaid through state budgets. McKillop highlighted national data from the Centers for Medicare and Medicaid Services that showed the elderly and disabled individuals comprised 24 percent of Medicaid enrollees in 2010, but accounted for 64 percent of total Medicaid expenditures in the states.

Long-term care and supports were the focus of the 2015 CSG Medicaid Policy Academy, held in Washington, D.C., June 17-19, 2015. The 30 registered CSG members came from 19 states. Home states are marked in purple in the map below. Over the four years CSG has convened the Medicaid Policy Academy, legislators from 42 states have participated. 

The program concluded with a plenary session featuring Dr. Jeffrey Brenner, medical director of the Urban Health Institute at the Cooper University Healthcare as well as the founder and executive director of Camden (N.J.)  Coalition of Healthcare Providers. In 2013, Dr. Brenner was named a MacArthur Fellow for his work on addressing the health care needs of the chronically ill in impoverished neighborhoods. 

Top Five 2015 Health Issues: A Further Examination

A flurry of state governors - in the 24 states that have not yet expanded Medicaid - are talking about expanding Medicaid eligibility as allowed under the Affordable Care Act. Many of these governors are offering up solutions that they say are designed uniquely for their state, carefully differentiating the new proposals from “traditional” Medicaid. This activity is likely to continue throughout 2015. Outside ACA issues, states will consider a number of health delivery issues. These include how to match the workforce to the need for professionals and how to expand some service areas such as mental health and substance abuse.

CSG Director of Health Policy Debra Miller outlines the top five issues in health policy for 2015, including Medicaid expansion, growing the health workforce, integrating health and human services, long-term care, and mental health and substance abuse. 

This week I was privileged to join with 40 experts in the field of elder justice gathered in Washington, D.C. to put the finishing touches on a national road map to guide programs and services to address elder justice issues – preventing elder abuse, providing services for victims of elder abuse in all its forms, and building systems for prosecution of abuse, sexual assault and financial exploitation.  CSG was invited to the meeting to bring the perspective of state level policy makers to the...

Health care spending is 18 percent of the national economy so it is no wonder that big health issues face the states in 2014. The all-consuming question for states is how to contain costs. The Affordable Care Act kicks in full force in 2014 and states that haven't already decided to expand Medicaid eligibility may take up the question. The health marketplaces, while slow to start in October, were making more headway as 2014 began. Nearly 4 million (3.9) individuals had been deemed Medicaid or CHIP eligible and another 2.1 million selected private health insurance policies through the federal or state marketplaces by the end of December 2013. States will look at systems and delivery methods, including mental health, aging and professional scope of practice issues. 

Family caregivers are the backbone of our nation’s system of long-term services and supports for older adults and people with disabilities. The economic value of their contributions is estimated at $450 billion per year. It is critical that states support the efforts of these caregivers, to help them avoid burn out and protect their own health.

A high-performing system of long-term care services and supports must address four critical dimensions: affordability/access; choice of setting/provider; quality of life and care; and support for family caregivers. A recent scorecard assessed the states on 25 indicators within these dimensions and found marked differences in performance. States can use these findings to target system improvements.

Chapter 9 of the 2012 Book of the States contains the following articles and tables:

Book of the States 2012

Chapter 9: Selected State Policies and Programs


  1. Elections, Greater Federal Grant Scrutiny and Ongoing Disasters Continue to Test Management System
  2. ...

Three out of four people with Alzheimer's disease will end up in a nursing home unless better systems of community care and support are built in states. Even without robust systems, today, nearly 15 million caregivers provide care valued at $202 billion.