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Health Policy

Medicare Benefit Design And Long-term Services And Supports: Gaps, Opportunities, And Implications For Beneficiaries

Despite the increasing number of adults with functional disabilities and cognitive impairments, financing for long-term services and supports (LTSS) has made little policy progress in the past few decades. One possible reason for the impasse is policymakers’ concern about the cost of undertaking such an initiative. This work will inform Medicare reform policy proposals to restructure Medicare benefits and cost-sharing, as well as longer term understanding of the implications of an aging population on access to and cost of long-term services and supports.

One of the study goals is to analyze trends in paid and unpaid personal care and expenditures under a model Medicaid Community First Choice (CFC) program in Maryland using Maryland Medicaid claims data, as well as observed longitudinal variation in participants’ informal supports using interRAI assessments. Quantitative analysis will be supplemented by interviews with Maryland officials and experts.


Karen Davis, Amber Willink, Ian Stockwell, Kaitlyn Whiton, Julia Burgdorf, and Cynthia Woodcock. Designing a Medicare Help at Home Benefit: Lessons from Maryland’s Community First Choice Program. June 27, 2018 

"Maryland’s experience with the Medicaid Community First Choice benefit design and care model is encouraging. The benefit has supplemented— rather than substituted for — informal support from family and other caregivers and has resulted in stable per-person spending since it was launched in 2014."

Amber Willink, Karen Davis, John Mulcahy, and Jennifer L. Wolff. Use of Paid and Unpaid Personal Help by Medicare Beneficiaries Needing Long-Term Services and Supports. November 15, 2017.

"This analysis shows that the amount of unpaid care provided varies little between those who receive both paid and unpaid support and those who receive unpaid support only, suggesting that paid care does not replace unpaid care, but supplements it. Addressing and supporting the need for LTSS can result in savings to individuals and the government through delayed nursing home and Medicaid entry."