Oregon: Strategies and outcomes for integrating long-term care services

Publicly funded Medicaid long-term care in the U.S. is undergoing a slow transition as it begins to include more home and community based services along with nursing home care. One state, Oregon, is much further along than others as it provides 70% of its long-term care services in community settings. Oregon recognized this need in the mid 1970s and developed strategies to offer integrated services to its Medicaid population in an attempt to satisfy consumer preferences for this type of care and to contain rapidly rising Medicaid costs. This paper presents data on Medicaid-related long-term care costs in Oregon over the last twenty-five years and discusses the strategies Oregon used to achieve a more balanced approach for integrating long-term care. Included is a discussion of how these strategies contribute to cost containment, efficiency and consumer satisfaction for Oregon and lessons for other states to consider as they attempt to offer more integrated services.