Navigating Tradeoffs in Building an Equitable LTSS Social Insurance Program
Executive Summary
The American long-term services and supports (LTSS) system exacerbates existing inequities and does not meet the needs of many groups, including direct care workers, older adults, people with disabilities, and family caregivers. With growing and unsustainable Medicaid budgets and the inaccessibility of private LTSS insurance for all but high earners, some states are exploring establishing LTSS social insurance programs as a more sustainable way to provide coverage to a broader swath of the population. Creating a new LTSS social insurance program is a viable approach for many states, but stakeholders must confront many important tradeoffs as they design this new program. To help with those decisions, they should first identify a guiding framework to navigate decision points, including: the program goal, key political considerations, coordination with the care ecosystem, and workforce objectives. They can then refer to this guiding framework to navigate decision points. This report identifies key tradeoffs associated with an LTSS social insurance program and provides helpful tips and examples around navigating each tradeoff.