State Medicaid agencies and their contractors rely on functional assessment tools to make coverage and eligibility decisions for long-term services and supports (LTSS). Many states use tools developed and licensed by private entities, while others have developed and implemented their own tools. The variety of tools is staggering. One national survey identified 124 different functional assessment tools in current use across the 50 states. States use assessments for eligibility determinations, service planning, and, increasingly, to inform resource allocation and quality measurement.
In this paper, Senior Policy Analyst David Machledt, explores the terms, techniques, and procedures that states and other tool developers use to validate tools and to link assessment results to resource allocation for long-term care. The paper identifies key features advocates should understand to better advocate for an allocation process that is properly vetted, independent, accurate, and flexible enough to meet the needs of all Medicaid beneficiaries.