Even as states begin to implement long-term services and supports options in the Affordable Care Act that increase access to Medicaid home and community based services, most states didn't increase funding for non-Medicaid services, says a report released last month by the AARP Public Policy Institute and others.

Such non-Medicaid services include senior centers, information and referral, transportation, and caregiver supports, such as those under the Older Americans Act.

In addition to AARP, the Washington, D.C.-based National Association of States United for Aging and Disabilities, and Naples, Fla.-based Health Management Associates contributed to the report.

As Americans age, the demand for long-term care, including home and community based services, continues to grow, and it's happening at a time when state budgets are still strapped, the report says. It asserts the recent meeting of the federal Commission on Long-Term Care serves as a reminder that as a country we're at the crossroads when it comes to providing care for older adults and persons with disabilities.

The report examines findings of the third annual survey of long-term services systems across 49 states and the District of Columbia, highlighting transformations and reforms under way and trends across the country. The report found that more states are increasing participation in home and community based options within the Affordable Care Act, as well as initiatives for individuals who are dually eligible for Medicaid and Medicare.

At the same time, they're seeing increased demand for non-Medicaid services; for example, the caseload for adult protective services—for victims of abuse or exploitation—has increased in the last two years without increased funding in many states.

"It's increasingly evident that we need to rethink how we address long-term services and supports in this country," says Susan Reinhard, senior vice president for the AARP Public Policy Institute. "Long-term services and supports are critical not only to the population they serve, but also to the family caregivers who support them."

Martha Roherty, executive director of the National Association of States United for Aging and Disabilities, says, "The decision by so many states to transform their MedicaidLTSS systems from fee-for-service to managed care ranks as the most significant by-product of The Great Recession. But our report documents that other vital programs for seniors, reliant entirely on state revenues, still languish six years after the recession began. As their economies improve, states now must turn their attention to other state programs like adult protective services, still struggling with reduced or flat funding, hiring freezes, and staff reductions."

Jenna Walls, senior consultant at Health Management Associates, says, "This report illustrates how states are actively engaged in exploring ways to better serve individuals with ongoing health care and support needs. The overwhelming survey response rate indicates state policymakers are committed to advancing a national dialogue for how to best address the increasing demand for services."

The new report,"At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint"is available on the AARP website, at www.aarp.org.

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million. A source for lifestyle tips, news, and educational information for baby boomers and seniors, AARP produces AARP The Magazine, the world's largest circulation magazine; AARP Bulletin; www.aarp.org; AARP TV & Radio; AARP Books; and AARP en Espanol, a bilingual news source. The organization has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.

The National Association of States United for Aging and Disabilities was founded in 1964 under the name National Association of State Units on Aging. In 2010, the organization changed its name to NASUAD in an effort to recognize formally the work that the state agencies were undertaking in the field of disability policy and advocacy. Today, NASUAD represents the nation's 56 state and territorial agencies on aging and disabilities and supports the advancement of state systems innovation and the articulation of national policies that support home and community based services for older adults and individuals with disabilities.

Health Management Associates is an independent, national research and consulting firm specializing in publicly financed health care reform, policy, and programs. It serves government, public and private providers, health systems, health plans, institutional investors, foundations and associations. The organization has 15 offices and more than 125 multidisciplinary consultants nationwide.