Reductions in the growth of Medicare and Medicaid figure prominently in federal budget debates. Federal policy changes not withstanding, it falls increasingly to state and county governments to pay for long term care. Currently, acute health services and long term care are financed and delivered through sharply separated systems. Medicare and the federal government dominate acute care while Medicaid and the state government take the lion's share of responsibility for long term care. As a consequence, services that are highly related from the consumer's perspective are provided in a fragmented, uncoordinated way.
Consumers suffer from the effects of fragmented care.
At the same time, public spending for both health and long term care services increase steadily with little accountability for their effectiveness. Integrating health and long term care depends as much upon restructuring service delivery systems as it does on the ability to combine diverse funding streams. DHHS has identified several basic features that need to be considered when developing integrated systems that span both health and long term care. Streamlined access, referral arrangements, and a single portal of entry for Medicaid and other state funded home and community based services and nursing facility placement. Formal referral procedures should exist for all institutional providers, primary care physicians, and agencies offering social, aging, mental health, and other related services.