Functional Assessments for Long-Term Services and Supports

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June 2016

Chapter 4 takes a focused look at the tools used by state Medicaid programs to assess applicants’ health conditions and functional needs when determining eligibility for LTSS and creating specific care plans for eligible individuals. The movement to home and community-based services and managed LTSS, as well as interest in better understanding the substantial costs of providing LTSS, highlights the role of functional assessments in evaluating different program designs, access, and quality of LTSS across states.

The federal government does not require states to use a particular functional assessment tool; MACPAC’s inventory of state practices found that there are at least 124 tools currently in use. The chapter discusses the relative merits and drawbacks of moving toward a single national tool to assess functional status. It concludes that moving to a single national tool now would be premature given rapid changes in the delivery of LTSS and federal efforts to develop more standardized measures for assessing functional status.

Publication Type: Reports to Congress

From: June 2016 Report to Congress on Medicaid and CHIP

Tags: benefits, elderly, eligibility determination, functional status, home and community-based services (HCBS), long-term services and supports, managed care, people with disabilities