COVID-19 State Resource Guide: Leveraging Federal and State Authorities to Ensure LTSS Access

COVID-19 Update

Populations who use long-term services and supports (LTSS) are particularly vulnerable to contracting COVID-19 and experiencing severe cases due to their age or because they are living with one or more chronic conditions. Roughly 2.5 million older adults and other individuals with complex care needs receive care in nursing homes and other congregate care settings, which have been particularly susceptible to COVID-19 outbreaks. Another 10 million individuals receive assistance at home or in their communities, which in many cases has been disrupted due to caregivers:

  • Being subject to stay-at-home orders
  • Having no access to childcare as schools shut down
  • Lacking the personal protective equipment (PPE) needed to provide care safely
  • Entering isolation after becoming sick or being exposed to COVID-19

In a new resource guide supported by a grant from The SCAN Foundation, Manatt Health provides a tool to help state officials and other stakeholders understand how temporary federal and state Medicaid flexibilities are being deployed during COVID-19 to ensure access to LTSS. The resource guide highlights state policy goals for implementing regulatory flexibilities available during the COVID-19 public health emergency. It also provides specific examples of how states are ensuring continued access to LTSS, such as by expanding the types of settings in which services can be delivered, bolstering pay and other supports for LTSS providers, and addressing barriers to care created by the COVID-19 pandemic.

The guide includes policy goals—along with related actions and flexibilities, state implementation examples, and authorities—across five critical categories:

  1. Eligibility and Enrollment—flexibilities seeking to expedite or expand access to LTSS for beneficiaries by easing financial and clinical eligibility requirements for LTSS and removing barriers that could jeopardize beneficiaries’ eligibility for services.
  2. Benefits and Care Management—flexibilities seeking to ensure beneficiaries can easily access services during the pandemic, by expanding self-direction opportunities, covering new services, removing prior-authorization requirements, and easing administrative requirements related to care management assessments and person-centered care plan development.
  3. Alternate Care Sites—flexibilities seeking to protect high-risk beneficiaries and workers from contracting COVID-19, or mitigating the spread of COVID-19, by authorizing states to cohort COVID-19-positive beneficiaries in separate care sites from beneficiaries without COVID-19, and authorizing expanding allowable settings where home- and community-based services (HCBS) may be provided.
  4. Telehealth—flexibilities seeking to protect beneficiaries from contracting COVID-19 by expanding and supporting the use of telehealth, in place of in-person visits, for care management and care delivery activities.
  5. Provider Capacity and Workforce—flexibilities seeking to expand the pool of and financially support LTSS providers and workers to ensure beneficiaries can receive the services to which they are entitled during the COVID-19 pandemic.

To download the full resource guide and view the five tables, click here.

Moving Forward

Several states are now turning their attention to considering which flexibilities they want to be able to “toggle on and off” during future COVID-19 outbreaks or other public health emergencies (such as the ability to quickly establish alternate care sites), and which flexibilities they want to retain permanently to strengthen and improve LTSS care delivery (such as expanded use of telehealth). Manatt Health will continue to monitor states’ actions and decisions and keep you up to date on the latest developments.



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