Ohio’s Long-Term Care Crisis: What Other States Can Teach Us

The result, analysts say, is a system that too often forces families into crisis, spending down assets to qualify for Medicaid or settling for institutional care when home-based options would be less expensive and more humane.

The Scope of the Problem

Ohio’s 85-plus population is growing faster than any other age group, yet the state still relies heavily on Medicaid-funded nursing homes and a limited number of home- and community-based services (HCBS) slots.

“Ohio has a patchwork of programs and pilots, but no integrated strategy,” said one senior care advocate. “Your ZIP code often determines the quality and type of care you can get.”

Missed Opportunities

• No public long-term care (LTC) insurance program to provide a baseline safety net for middle-income residents.
• Limited reach of the Program of All-Inclusive Care for the Elderly (PACE), which other states use to reduce hospitalizations and extend independence.
• Workforce shortages in home care driven by low wages and high turnover.
• Inconsistent planning and transparency, with no statewide dashboard to track rebalancing goals.

Learning From Success

“Each of the six states was able to expand community-based care services without generating runaway costs in total long-term care spending.”

— U.S. Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE),
State Long-Term Care Reform

• Washington: WA Cares Fund provides a universal LTC benefit funded by a 0.58% payroll contribution, with an initial lifetime benefit of $36,500 indexed to inflation.
• California: Expanded PACE through day centers, telehealth, and mobile teams; research links PACE to fewer hospitalizations and better quality of life.
• Minnesota and New York: Used American Rescue Plan Act (ARPA) Section 9817 HCBS funds to raise wages, train caregivers, and modernize HCBS. New York implemented staged
  home care minimum wage increases.
• Oregon: Allows nursing task delegation in assisted living, supported by
  Oregon Health Authority (OHA) guidance, to lower costs while maintaining safety.
• Wisconsin and Maryland: Identified by HHS ASPE as states that expanded community care without runaway costs, using master plans and public-facing metrics.

Solutions for Ohio

• Establish a public LTC trust fund to protect middle-income families from financial ruin.
• Expand PACE to every major metro and rural service area.
• Launch a statewide workforce plan to raise wages, create career ladders, and improve retention.
• Implement managed long-term services and supports (MLTSS) with strong quality guardrails.
• Build a statewide LTC master plan with a public dashboard to track progress and ensure accountability.

A Question of Will

The question is not whether Ohio can fix its long-term care system — it is whether there is the political will to act before the demographic curve becomes a budget-breaking wave. Other states have shown you can control costs and improve care at the same time. Ohio just needs to move.