Long-Term Services and Supports in Massachusetts: Coverage, Access, Affordability, and Future Reform

Health Highlights

This is an excerpt of a recent report prepared by the Blue Cross Blue Shield of Massachusetts Foundation and Manatt. Click here to read the full report and opportunities.

Why Focus on Long-Term Services and Supports (LTSS) in Massachusetts?

  • Long-term services and supports (LTSS) are the critical medical and nonmedical services and supports that people with disabilities and chronic conditions of all ages use to meet their daily living needs, remain independent, and participate in their communities. LTSS include nursing facility care, home health care, personal care, physical/occupational/speech therapies, durable medical equipment (e.g., wheelchairs), care management, and more.
  • Private commercial health insurance coverage and Medicare cover only a subset of LTSS for a limited duration of time, whereas Medicaid typically covers more comprehensive LTSS for a longer duration. Therefore, most people who need LTSS consistently rely on Medicaid (known as MassHealth in Massachusetts) or self-pay to cover these services. Some Massachusetts residents (approximately eight percent) have private long-term care insurance to cover some LTSS costs, but insurance policies must be purchased well in advance of anticipated needs and policyholders often experience significant premium increases. In order to qualify for MassHealth, people who need LTSS and their families often need to exhaust personal resources, resulting in impoverishment in order to be eligible for coverage and access to care.
  • The COVID-19 pandemic’s significant impact on nursing facility residents and staff nationally and in Massachusetts underscored several vulnerabilities in our LTSS system. It heightened public awareness about long-standing LTSS workforce shortages and the low wages, limited benefits, and lack of career mobility for these in-demand workers; the significant pressures on unpaid family caregivers who provide the majority of LTSS; racial and ethnic disparities in LTSS care; and the lack of affordable LTSS financing options other than Medicaid. These challenges are expected to worsen with a growing demand for LTSS as the population ages. In MA, over 23,000 new LTSS direct care jobs will be needed by 2030 to meet this demand, but many could be left unfilled due to workforce shortages. Federal and state policymakers have responded to these challenges with a renewed focus on strengthening and improving the LTSS system.

Massachusetts has made significant investments to strengthen its LTSS system, including expanding access to community-based LTSS, improving care provided in nursing homes and other residential settings, and enhancing care coordination for people who use LTSS. Recent initiatives include:

  • Funding new home- and community-based services (HCBS) initiatives. HCBS are a subset of LTSS delivered in people’s homes and communities; these services can help people stay out of institutional care. Leveraging $526 million in federal COVID-19 relief dollars, Massachusetts is promoting access to HCBS in various ways, including implementing time-limited worker wage increases, grant and training programs, loan reimbursement, and retention bonuses focused on workforce recruitment and retention. In 2023, MassHealth also relaunched Money Follows the Person, a federal program for rebalancing LTSS spending from institutional to home- and community-based settings.
  • Pursuing innovative care at home models. Massachusetts is exploring various care-at-home models, including by studying the cost and clinical outcomes of providing post-hospital care at home rather than in a skilled nursing facility.
  • Enhancing its integrated care programs — One Care and Senior Care Options (SCO) — that serve people enrolled in both Medicare and Medicaid. People enrolled in both Medicare and Medicaid tend to have significant LTSS needs. Massachusetts is working with stakeholders to strengthen member protections, improve the care model, and advance health equity in One Care and SCO.

Through these and other initiatives, Massachusetts is recognized as a national leader in LTSS system performance. However, certain areas such as LTSS affordability, quality, and caregiver supports require more attention to meet the growing need for LTSS and ensure equitable and affordable access to LTSS for all Massachusetts residents.

To learn more about LTSS in Massachusetts, register for the upcoming webinar on June 10, 2024 from 12-1 PM ET. 



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