Abstract
Creating a national long-term care (LTC) delivery “infrastructure”—one that would make home-based care more accessible to people with extensive needs—will be a major undertaking. It will require new service organizations that have the authority to provide and coordinate an appropriate array of services. Medicaid Managed Long-Term Care (MLTC) and the Programs of All-Inclusive Care for the Elderly (PACE) offer two promising examples of what the service organizations of the future might look like. The history of how these plans developed illuminates challenges that others will encounter. Further expansion of these types of organizations requires resolution of resource, staffing, and operational issues.
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