An Updated Policy Roadmap: Caring for Individuals with Complex Needs

Lisa Harootunian
Katherine Hayes
G. William Hoagland
Brian O’Gara
Kamryn Perry
March 2022


Recommendations for federal policymakers to improve Medicaid for adults with complex needs and improve long-term services and supports for individuals not eligible for Medicaid.


The Bipartisan Policy Center has released more than a dozen reports on policy recommendations to improve complex care. Some of these recommendations, such as those related to dual-eligible special needs plans (D-SNPs), have been enacted into law or incorporated into agency guidance. Given the complicated systems related to home- and community-based services (HCBS) authorities and Medicare and Medicaid coverage, this report identifies recommendations for future action.


Policy recommendations include proposals to improve health and long-term services and supports through the Medicaid program, as well as recommendations for those not eligible for Medicaid who may also experience catastrophic long-term care costs before they become eligible for Medicaid. Recommendations cover simplifying and streamlining Medicaid HCBS authorities, integrating Medicare and Medicaid for dually eligible individuals, addressing barriers to Medicaid buy-in programs, establishing an HCBS buy-in, improving chronic care, creating a caregiver tax credit, and improving private long-term care insurance.


Federal policymakers can apply these recommendations and related information to improve care for adults with complex needs, especially for dually eligible individuals and individuals requiring long-term services and supports.

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