This resource guide is a tool to help state officials and other stakeholders understand how temporary federal and state Medicaid flexibilities are being deployed during COVID 19 to help ensure access to LTSS.2 Populations who use LTSS are particularly vulnerable to contracting COVID-19 and experiencing severe cases due to their age or because they often live with one or more chronic conditions. Roughly 2.5 million older adults and other individuals with complex care needs receive care in nursing homes and other congregate care settings, which have been particularly susceptible to COVID-19 outbreaks. Another 10 million individuals receive assistance at home or in their communities, which in many cases has been disrupted due to caregivers being subject to stay-at-home orders, having no access to childcare as schools shut down, not having adequate access to PPE needed to provide care safely, and, in some cases, caregivers entering isolation after becoming sick or being exposed to COVID-19.

The tables below highlight state policy goals in implementing regulatory flexibilities and administrative actions available during the COVID-19 public health emergency, as well as specific examples of how states are ensuring continued access to LTSS by expanding the types of settings in which services can be delivered, bolstering pay and other supports for LTSS providers, and addressing barriers to care created by the COVID-19 pandemic. Several states are turning their attention to considering which flexibilities they want to be able to “toggle on and off” during future COVID-19 outbreaks or other public health emergencies, such as the ability to quickly establish alternate care sites, and which flexibilities they want to retain permanently to strengthen and improve LTSS care delivery, such as expanded use of telehealth.