Long Term Care: State and Local Programs
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Different states assign aspects of long-term care to different agencies. Finding the right state agency for the information you need can be challenging.
For example, Medicare is Medicare wherever you are (although there are some local variations in determining payment to providers) and Social Security is one system, but Medicaid in Florida is the Florida Agency for Health Care Administration, and in Wisconsin it is ForwardHealth. More important than the name is the variation in Medicaid from state to state.
After you have located the right agency (and if possible, the right person in the agency), make sure to keep a record of how to find it again. Check out the following list for state agencies that are relevant for long-term care planning:
Departments of aging: Every state has an agency devoted to services for older adults, often linked to services for people with disabilities. Like Medicaid, however, what the agency is named varies, although not as much.
Although the most common name is Department (Office Division, Commission) of (for, on) Aging, other variations include: Office of Elder Services (Maine) and Aging Long-Term Support Administration (Washington).
The National Association of States United for Aging and Disabilities has a state-by-state listing of offices. These agencies have information about senior centers, food programs, counseling, and other services, both state-funded and in partnership with federal agencies.
County and city departments of aging: Many counties and cities also have departments of aging that contract with local community agencies to provide services. It may be easier to get information from a local agency than from the state, although that may depend on the level of staffing. These are the same agencies described in the Federal Program section as Area Agencies on Aging.
Advance directives: The Federal Patient Self Determination Act, enacted in 1990, requires hospitals and other providers (including psychiatric hospitals and other mental-health providers) and health plans to maintain written policies and procedures with respect to advance directives — documents that spell out what kinds of treatments you do or do not want if you are not able to speak for yourself.
The providers must ask whether a patient has an advance directive; in practice this means that if you’re admitted to a hospital, someone (probably the admitting clerk) will ask you if you have an advance directive. If you do, that information should go in your medical record.
The federal law does not specify what form the advance directive should take; that’s up to states. The advance directive usually includes the name of the person you have chosen to speak on your behalf if you are unable to express your wishes.
Medicaid: Every state has a Medicaid program for low-income people that provides a basic package of services as defined by federal law. Each state, however, determines its own optional services and criteria for eligibility for different types of services.
Home- and community-based services are optional and may be covered under a waiver from the federal government that allows states to spend their funds for these services or through other approaches. Some programs have long waiting lists.