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Note: Improving the Long-Term Care Landscape for LGBTQ+ Adults Through Home- and Community-Based Care Reform


Across the country, Medicaid-eligible individuals face widespread challenges in accessing appropriate long-term care, but LGBTQ+ elders face unique barriers to care and are especially vulnerable to discrimination, making this issue particularly pressing. In light of historical and continued discrimination against LGBTQ+ individuals across the country, home- and community-based services present a safer option for LGBTQ+ adults to receive long-term care. However, home- and community-based care is administered through Medicaid waivers that present state-specific barriers to desired care. First, not all states allow legally responsible individuals, such as spouses, to be paid caregivers for their family members. Second, states can implement waiting lists or other restrictions on waiver services that prevent eligible individuals from accessing care. Third, there are no explicit protections in place under federal Medicaid rules to protect LGBTQ+ individuals from discrimination and states have not adopted protective policies.

Establishing home- and community-based services as mandatory benefits under Medicaid would circumvent waiting lists. Allowing all family members to be paid caregivers would increase caregiver options for beneficiaries. Implementing cultural competency trainings would strengthen the caregiver workforce to better meet the needs of LGBTQ+ adults without access to family caregivers. Finally, improving data collection among Medicaid recipients with long-term care needs to gather information on gender and sexual orientation will allow Medicaid programs to better understand and serve their beneficiaries.