The LeadingAge national-state network delivered significant results for the aging services sector in 2023—from substantial increases in public funding to innovative professional development models—all in support of our mission-driven provider members.

Here’s how LeadingAge leveraged the collective voice of our national experts, 36 state partners in 41 states, and more than 5,400 members to move the sector forward. This is only half of the great news. Read about advances in strengthening leaders and organizations in Part One of the series.

Asserted our expertise and amplified the voice of aging services providers

In states and “inside the Beltway,” LeadingAge representatives used targeted tactics to inform law and policy makers about the realities of providing aging services and advise them on the most effective approach to laws and regulations. Whether mobilizing grassroots support or meeting with federal Cabinet Secretaries, LeadingAge carried our members’ messages forward.

Collaboration between LeadingAge and our state associations generated sustained and loud opposition to federal staffing mandates for nursing homes, through the Get Real on Ratios and Let’s Get It Right! campaigns.

LeadingAge mobilization generated more than 1,000 comments from across the nation to the Centers for Medicare and Medicaid Services (CMS), and LeadingAge leaders met with Department of Health and Human Services Secretary Xavier Becerra to voice the detrimental impact of the unattainable mandate.

One example of why direct advocacy matters: LeadingAge South Carolina members traveled to Washington, DC, for Capitol Hill visits that influenced four South Carolina Representatives to co-sponsor the bill to halt the proposed staffing mandates.

LeadingAge members are a regular sight in state houses, illustrating the real-world impact of aging services policy. LeadingAge Maryland testified on more than 25 bills and LeadingAge Nebraska more than 20, while LeadingAge Minnesota drove more than 12,000 connections with state and federal lawmakers, LeadingAge Pennsylvania held more than 125 meetings with legislators and General Assembly staff, LeadingAge New York monitored 900+ pieces of legislation and took action on more than 50 bills, and LeadingAge DC’s executive director testified to the City Council’s Committee on Health highlighting shortages in the direct care workforce and advocating for equitable wages. To hear about advocacy in their own words, watch these short videos from LeadingAge state directors in Missouri and North Carolina.

LeadingAge experts also contributed to state commissions and working groups to ensure effective results for older adults.

• The Montana Hospital Association was appointed by the governor to the HB 29 Transition Review Committee, which monitors the need for and progress in developing community-based services for individuals who have been or are at risk of being involuntarily committed to the state hospital and who have a primary diagnosis of Alzheimer’s disease, other forms of dementia, or traumatic brain injury.
• Pennsylvania representatives participated in the state Master Plan for Older Adults and facilitated listening sessions at member communities to inform guidance.
• Texas peers expressed expertise on various workgroups and stakeholder meetings hosted by state agencies, including Quality Incentive Payment Program Year 8, the Nursing Facility Payment Methodology Advisory Committee, and the Housing & Health Collaborative.

Scored significant legislative victories to increase state and federal government funding to help providers cover their costs in delivering high quality care to an expanding number of older adults

LeadingAge experts’ full-court press to secure increased public funding for aging services succeeded in 2023: at least 16 state legislatures and Congress increased their appropriations for long-term care and housing for older adults. LeadingAge advocacy compelled state legislatures to add billions to budgets for long-term care. Several partners achieved victories to reduce costs or burdensome regulations.

In the U.S. Congress, where progress is scarce, LeadingAge delivered for our members. We helped secure:

• $285 million federal appropriation for apprenticeships.
• $160 million for U.S. Department of Housing and Urban Development (HUD) Section 202 housing.
• $40 million in HUD funding for 160 new service coordination programs—for the first time since 2013.

Thank you to all who sent messages to Congress through the LeadingAge Action Alerts.

Sixteen LeadingAge state associations also secured significant funding advances, particularly in closing the gap between costs of care and reimbursement for services for older adults covered by Medicaid. This is vital. The Medicaid and CHIP Access and Payment Commission released an analysis showing that, on average, reimbursements covered 86% of providers’ costs.

The following LeadingAge state associations (14) succeeded in increasing Medicaid reimbursement:

• Colorado (additional $62 million for Medicaid nursing homes and targeted rate increases for HCBS providers)
• Following a year in which 23 Iowa nursing homes closed, LeadingAge Iowa launched an advocacy effort highlighting the challenges facing providers, focusing on the shortfall in Medicaid reimbursement. The legislature allocated an additional $15 million for Medicaid reimbursement.
• Maryland
• LeadingAge Minnesota secured approximately $1 billion in historic investments and helped pass legislation that increased rates for care centers and Elderly Waiver rates for all services, including assisted living and adult day services.
• In Missouri, LeadingAge secured the largest increases for Medicaid reimbursements to nursing homes for two consecutive years ($10 per patient per day in 2023). Advocates also won an increase in home and community-based services (HCBS) reimbursement to $28.87 per hour!
• Montana
• Nebraska (3% increase)
• New York (7.5% for nursing homes and adult day health care, 6.5% for assisted living programs)
• LeadingAge Ohio won $1.374 billion in new funding for nursing homes over two years and $100 million (annually for four years) for a new state Low-Income Housing Tax Credit program. HCBS payment increases included:
  • 30% for PASSPORT adult day services
  • 47% for PASSPORT homemaker services
  • ~40% aide services, across multiple waivers and state plan home health
  • 80% for assisted living waiver, bringing the base payment to $130 per day and adding a new memory care tier at $155 per day
• Oklahoma
• Pennsylvania
• The state legislature approved funding nursing homes at 100% of methodology, in part due to the South Dakota Association of Healthcare Organizations’ efforts.
• Texas ($900 million for nursing homes)
• Wisconsin (establishment of a Medicaid payment standard for nursing home support services at the median organization cost, +25%)

Achieved funding for workforce initiatives

Despite economic challenges, LeadingAge California protected $70 million for nursing workforce development funding, added $4 million to the California Department of Social Services to reduce the background check delays in Residential Care Facilities for the Elderly (RCFE) settings, added $30 million to the California Department of Aging to advance older adult behavioral health, and passed a bill to allow nonprofit providers to access tax-exempt bonds to finance new construction or rehabilitation of RCFEs.

LeadingAge Kansas secured a record-breaking $160 million in new funding and millions more for workforce development programs.

LeadingAge Rhode Island supported members’ bottom lines by successfully advocating for legislation to cap the rates nursing staffing agencies can charge at 250% of the median wage to combat their predatory pricing to providers.  It also includes strong anti-poaching provisions.

Secured beneficial tax policy

Against an offensive from some local assessors, LeadingAge Indiana legislatively secured statewide property tax exempt status for its non-profit Continuing Care Retirement Communities (CCRCs), nursing homes, assisted living communities and other senior living providers for taxable years current to 2025. This victory provides temporary certainty and time to continue educating legislators.

Working with House lawmakers, LeadingAge Michigan secured introduction of legislation to further protect in law aging services providers’ property tax exemption from local re-interpretation.

After five years of persistent work, the North Carolina General Assembly approved language that exempts Life Plan Communities (LPCs) from charging sales and use tax on any items provided to residents. This major victory for member communities and LPC residents—estimated to save providers tens of millions of dollars—resulted from advocacy by LeadingAge North Carolina and its member communities and residents.

Passed legislation to advance availability of care models

Legislation to create a Continuing Care at Home program passed, with the advocacy efforts of LeadingAge Illinois.

LeadingAge Massachusetts’ work led to the House-passed nursing home omnibus legislation including a provision making it easier to develop and operate small house nursing homes, a model that consumers prefer and many members have sought to build.

Following years of LeadingAge Michigan advocacy, the Medication Aide Bill is law. It  frees nurses from tasks to allow better care planning and monitoring of residents.

LeadingAge Southeast passed its flagship legislation to bolster Florida’s CCRC/Life Plan Community model. The legislation modifies current laws affecting access to capital, expansions, and escrow requirements to reduce costs while streamlining reporting and the examination process, and increases transparency and notices to residents.

Advocacy from the South Dakota Association of Healthcare Organizations helped create a Long-Term Care Sustainability Legislative Study focusing on innovation, workforce, infrastructure, regulations, and home and community-based services with several recommendations coming out of that study for the 2024 legislature.

Generated media attention on cross-continuum aging services issues

Providers offer powerful public voice when they share the pressures and joys of serving older adults. Our experts elevated members’ messages in media outlets across the nation.

LeadingAge united the voices of our state partners in this national press release to convey the potential damage to aging services organizations from the proposed nursing home staffing mandate. President and CEO Katie Smith Sloan said, “No state will be immune from the harm.”

“What Biden gets wrong about nursing homes” headlined Sloan’s counterpoint op-ed in USA Today to President Biden’s on staffing mandates as she spoke for the sector in opposition.

As the national media exposed the complex and costly patchwork of long-term care services, Sloan urged action to fix the long-term care system in an op-ed in The Hill, a must-read publication among federal lawmakers.

LeadingAge connected national media with members to talk about homelessness among older adults for this Wall Street Journal article.

Our experts went on the record with national media in the powerful New York Times Dying Broke Series and with ProPublica in Pressure Mounts for Hospice Reform.

Here are just a handful of examples showing how media coverage raised visibility in states.

The Baltimore Sun carried a letter to the editor during Older Americans Month by LeadingAge Maryland (Maryland press room).

Efforts to educate the public and decision-makers through robust media outreach led to in-state TV and print stories, as well as trade publications coverage, for LeadingAge Nebraska, Pennsylvania, and Texas.

LeadingAge Pennsylvania representatives participated in the Shapiro Administration’s series of press conferences to celebrate the success of the Department of Health’s Long-Term Care Transformation Office’s partnership with providers. LeadingAge Pennsylvania Executive Director Gary Pezzano (at podium) spoke at a press conference to celebrate the efforts of the Department of Health’s Long-Term Care Transformation Office and their positive partnership with providers across Pennsylvania, at the Country Meadows Retirement Communities.

LeadingAge Southeast’s Senior Living won the 2023 Bronze Trendy award in the annual and quarterly magazine category, from among 250+ submissions. It was recognized for its quality and creativity.

Provider members can count on LeadingAge to elevate our views and advance policy

In Washington, DC, and states nationwide, LeadingAge has our members’ backs. Collaboration to get the right information to the right decision-makers at the right time is how we do it. Stay tuned in 2024 as we build on our success last year.