Healthcare Equity

The Rural Health Transformation Program is a once-in-a-generation opportunity for states to reshape rural healthcare delivery. By aligning with HHS’s strategic goals and investing in sustainable infrastructure, states can achieve measurable improvements in population health and strengthen their healthcare workforce.

The One Big Beautiful Bill Act (OBBBA) requires certain Medicaid beneficiaries to complete at least 80 hours per month of employment, training, or other activities to maintain coverage. While the law does not appear intended to impose these requirements on family caregivers, the way it is implemented could inadvertently do so if details are not addressed carefully. Unless federal and state regulators act thoughtfully and carefully, unpaid family caregivers -- who are already propping up a fragile healthcare system -- may find that the implementation of this new law penalizes them for the very work that keeps their loved ones out of costly hospitals and nursing homes.

This compendium summarizes the findings and recommendations of our work exploring how to improve equity in long-term services and supports (LTSS). We conducted quantitative and qualitative research to better understand the differences in LTSS needs and access to services by race, ethnicity, language, disability, sexual orientation, gender identity, and geography. This compendium outlines those findings, in addition to policy recommendations for stakeholders, including federal and state policymakers, and community leaders.

Approximately 14 million adults in the United States need long-term services and supports (LTSS) to help with their cognitive and functional needs. How many of these individuals have access to LTSS? What are their experiences like? What are the disparities by race and ethnicity, gender, age, and sexual identity?

ATI Advisory’s qualitative research highlights the experiences of individuals with long-term services and supports (LTSS) needs and their caregivers in requesting, receiving, and providing LTSS. Using a community-based participatory framework in partnership with local organizations, ATI conducted six focus groups interviewing individuals and caregivers from key populations across race, ethnicity, language ability, gender identity, sexual orientation, and disability status about their experiences with LTSS. Discussions generated themes around barriers to accessing LTSS, insights on family and professional caregiving across cultures, financial constraints, the value of social community for individuals and their caregivers, and the impacts of equitable and inequitable LTSS. This work was supported by the Robert Wood Johnson Foundation.

ATI Advisory research highlights demographic differences in supportive resources, including social supports and Medicaid coverage, among older LGBQ+ adults. This research also notes differences in supportive resources between older LGBQ+ and non-LGBQ+ individuals. Relationships with children, co-residents in the home, and the prevalence of having a partner in the home are common forms of unpaid in-home support and caregiving for older adults. This data spotlight analyzes the differences in these supports and additionally discusses differences in Medicaid coverage since Medicaid is the primary payer for long-term services and supports. In addition to this data spotlight, a brief highlights recommendations from advocacy groups, community-based organizations, and health plans who serve LGBTQ+ adults.