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Long Term Care Database

This database contains summaries of major long-term care legislation enacted between 2000 and 2007 in all 50 states.  It is searchable by state, topic and year.  This database was prepared through a partnership with Rutgers University.

View the database here

NCSL Analysis of Findings from the Long-Term Care Database:

Significant Reform

As Long-Term Care services increasingly move into community settings and become more person-centered, states are in the forefront of testing new approaches.  In many states, innovative laws, reinforced by budget authority, administrative rules, or provider standards, are shaping policy.  This website highlights significant state Long-Term Care legislation enacted between 2000 and 2007.

A number of states had significant enactments in several topic areas.

• Rhode Island ratified multiple laws encompassing financing, assessment practices and specialty disease care for aged and disabled populations, including authorization for a PACE program.  The combined influence of these new laws provide a framework for person-centered, community-based care. 
• Vermont established a commission to determine the viability of nursing homes and identify and address unmet needs of Vermont elders.  Vermont also took many steps through H.B. 735 (2003) and H.B. 543 (2005) to support future development of home and community-based services by advocating for the use of Section 1115 waivers. 
• An established leader in LTC reform efforts, Wisconsin passed S.B. 653 in 2005,  a law that eliminated waiting lists for Family Care, the state’s successful Long-Term Care program.  Other laws reduced the number of nursing home beds and increased funding for community-based care.  Wisconsin also enacted the Community Relocation Initiative which allows any resident of a nursing home to move into the community if he chooses. 
• Iowa attempted to spur change through a single multi-faceted law, H.B. 841 (2005), which established the IowaCare Act.  This measure includes efforts to improve access, expand Long-Term Care choices and foster an environment emphasizing community living for the aged and disabled populations.

Emerging Themes

Themes emerging from state long-term care legislation reflect the nationwide movement toward person-centered, community-based care.   New laws aim to improve access, expand the range of service options, assure a workforce of high quality, and reorient financing toward community services.   

• Consumer-Directed Care
  Increasingly, consumers seek a greater role in managing their own care.  Several new laws reinforce the option of consumer direction and support its implementation within Medicaid or other publicly-funded programs.  Examples include  New Mexico S.B. 839 (2003), Oklahoma H.B. 2300 (2003), and North Dakota H.B. 1148 (2005), all of which mandate the inclusion of a consumer-direction option as part of waiver/personal assistance programs. Indiana S.B. 493 (2003) requires a self-direction option to be available through both a state-funded program for the elderly and the state’s Medicaid HCBS waiver.
• Assisted Living
  Creating supportive residential environments is essential for advancing community care.  States view assisted living as an important housing option and several states created or altered licensing requirements for assisted living facilities through legislation.  In Nevada,  A.B. 248 (2005) links assisted living and Medicaid support for low-income persons by setting up individualized supportive services in assisted living facilities and funding them through a Medicaid waiver.   
• Workforce
  Of particular interest and difficulty for states is the recruitment and retention of direct care workers for publicly-funded home and community long-term care programs.  Shortages experienced by many states have spurred legislation aimed at bolstering the supply of quality direct care workers.  Some state legislation gives attention to expanding the pool of providers. For example,  Delaware S.B. 261 (2004) allows a long-term care recipient to delegate some simple services to unlicensed individuals.  Illinois S.B. 1489 (2005) permits qualified volunteers to provide companion-type services to older adults after undergoing training.
• Financing
  To support individuals who choose a community long-term care setting, several states  enacted legislation to make funding, especially Medicaid dollars, more flexible.  One category of reform, “money follows the person”, enables funds to move with the individual to the appropriate long-term care setting.  For example, North Dakota S.B. 2330 (2005) requires that Medicaid waiver funds pay for services wherever the individual chooses to receive their care.  

Glossary of Terms

Want to know more?  This glossary defines the 15 topic areas within long-term care into which the state laws are categorized.