Neoliberal Long-Term Care in the U.S. and the Future of Public Programs

Until 2013 the home and community-based services part of Florida’s public long-term care (LTC) system was administered by the Area Agencies on Aging and non-profit service providers. In 2013, however, most of the publicly funded HCBS programs were privatized through contracts with HMOs run by large insurance companies such as United Health Care. These contracts gave the HMOs the power to administer all Medicaid funded LTC programs including the nursing home program. This paper includes a description of the political (ideological and corporate) forces at both the state and federal levels that played major roles in the transition to a full scale for-profit managed LTC system in Florida, an analysis of the major problems encountered during the transition from both consumer and organizational perspectives, the impact of the new system on costs and quality of care outcomes through 2017, and the impact of MLTC on the Florida Aging Network, non-profit organizations in terms of their role(s) in the state’s public LTC system and in other aging services. Finally, the paper will address the implications of this neoliberal approach to the administration of public LTC programs for a wider range publicly funded programs from educational and health care (Medicare, etc.) to corrections and public utilities (water). More broadly the paper will address the future of the state and public sector if the current neoliberal policy trajectories are sustained over the next several years. We will use Wolfgang Streeck’s concept of the Hayekian state dominated by corporate, especially financial, interests and the five crises of neoliberalism as a framework for this analysis of current policy trajectories.