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![handle is hein.crs/goveggd0001 and id is 1 raw text is: Congressional Research Service
nforming the Iegislitive debate since 1914
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Updated March 22, 2022
Connecting Older Adults and Individuals with Disabilities to
Health Services: Resources for Constituents
Overview
Navigating the U.S. health and long-term care systems can
be confusing and complex for some constituents. Older
adults and individuals with disabilities may face additional
challenges in identifying and accessing needed health care
and long-term services and supports (LTSS), such as home
and community-based services that can assist individuals in
maintaining their quality of life and living independently.
Decisions about rehabilitative services or LTSS may be
made in response to an emergency or crisis. Older adults
and individuals with disabilities, as well as their family
members, may have limited understanding of available
options for home care versus institutional care, either for
short-term rehabilitation or extended care needs. Moreover,
public programs may be financed through different funding
streams (e.g., Medicare, Medicaid, Older Americans Act
[OAA]), and some are state or locally administered. As a
result, eligibility for certain public programs can vary by
state or local entity and may be limited only to individuals
with low-incomes or high levels of care need. Private
funding, such as long-term care insurance, for example,
may be one option for individuals to offset the potential
high costs associated with needed long-term care.
In an effort to simplify access to information about health
care and LTSS options for older adults and individuals with
disabilities, many states have developed No Wrong Door
(NWD) systems, which are collaborations between the
Administration for Community Living (ACL), the Centers
for Medicare & Medicaid Services (CMS) within the
Department of Health and Human Services (HHS), and the
Veterans Health Administration (VHA) within the
Department of Veterans Affairs. State-administered NWD
systems assist individuals and families needing information
about public programs or private resources and can assist
with counseling and future planning for LTSS options.
NWD systems also serve as the entry point to publicly
financed LTSS, including programs and services funded
under Medicaid, OAA, and VHA, as well as other state or
locally funded programs.
This In Focus describes federally funded resources that
provide information, outreach, and assistance for
constituents to find, navigate, and access available public
and private health care and LTSS. It is organized into three
groups of resources: (1) health programs and benefits, (2)
home and community-based services, and (3) health care
providers and facilities. Table 1 lists the websites and
contact information for the various resources described.
Connect to Health Programns
and Benefits
ACL funds and administers grants for the following
activities which facilitate connections to programs and
benefits:
Aging and Disability Resource Centers
Local Aging and Disability Resource Centers (ADRCs)
provide one-on-one options counseling and assistance with
accessing a wide range of publicly and privately financed
LTSS and caregiver supports. Examples of ADRC services
include application assistance, screenings and needs
assessments, care coordination, support services for
individuals transitioning from hospital-to-home and nursing
home-to-home, and services to mitigate social isolation.
ADRCs are part of the NWD system, which aims to
streamline and make seamless the navigation of LTSS.
State Health Insurance Assistance Programs
State Health Insurance Assistance Programs (SHIPs) offer
one-on-one health insurance counseling to Medicare
beneficiaries. SHIPs assist constituents with joining,
leaving, or switching their Medicare Advantage health
plans and/or Medicare Part D Prescription Drug Plans.
SHIPs assist Medicare beneficiaries with issues related to
their other health coverage, such as retiree health benefits,
Medicaid, long-term care insurance, and Medigap
(Medicare supplemental insurance). SHIPs answer
constituents' questions about covered benefits, premiums,
cost-sharing (such as deductibles and coinsurance), and
complaints and appeals (e.g., about denials of coverage).
Benefits Enrollment Centers
Benefits Enrollment Centers (BECs) assist Medicare
beneficiaries, including older adults and younger
individuals with disabilities, to identify and apply for
programs for which they may be eligible. Such programs
may include Medicaid, the Supplemental Nutrition
Assistance Program (SNAP), the Low-Income Home
Energy Assistance Program, Supplemental Security
Income, and pharmaceutical assistance programs. BECs are
supported in part by the National Council on Aging's
Center for Benefits Access.
BenefitsCheckUp
BenefitsCheckUp is an online tool and hotline that assists
older adults in identifying benefit programs for which they
may be eligible. Constituents answer a confidential
questionnaire, then they receive a contact list for potential
programs. These programs may address issues such as tax
relief, food, housing, utilities, discounts, employment,
prescription drugs, and health care. The site is operated by
National Council on Aging.](ViewImageLocal?handle=hein.crs/goveggd0001&div=1&collection=&method=preview&ext=.png&size=3)