LTSS Newsletter—March 2019


Funding opportunities, news, events, and resources for tribal LTSS programs
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Upcoming webinar: Lifeline Internet and Telephone Discount Program—March 27, 2019
Long-Term Services and Supports

Technical assistance for culturally competent care
March 2019
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HCBS and the cost of LTSS

A new study from The Commonwealth Fund found that out-of-pocket costs for elders living at home who need long-term services and supports (LTSS) were at least double the costs of living for those who did not need LTSS.

Caregiver rests hand on shoulder of elder eating a meal of salmon, rice, and garden salad.

These costs can cause elders to skip meals, miss rent or utility bills, or experience other consequences. These problems can then lead to elders needing assisted living or nursing home care earlier than they would if they were receiving more home- and community-based services (HCBS), which include health and personal care services designed to help people stay in their homes instead of moving to a facility.


Cynthia LaCounte, Director of the Administration on Aging's Office for American Indians, Alaska Natives and Native Hawaiians Programs at the Administration for Community Living, says expanding HCBS can be difficult if tribes rely only on Older Americans Act Title VI funding.


LaCounte says some tribes are starting to fill the gap by seeking Medicaid reimbursement for HCBS. This funding helps them provide additional services to their Medicaid-eligible elders, including meals, transportation, and personal care.


"That seems to be our solution to building our aging programs and home- and community-based services to make sure our elders are well-cared for," she says.


LaCounte adds that her office is currently working on a guide to assist tribes looking to bill Medicaid for qualifying HCBS. We'll follow up with another story when that guide is available.


HCBS Resources


You can find an overview of Medicaid reimbursements for tribal LTSS programs, including home- and community-based services (HCBS), on the LTSS TA Center. Also, see information on working with your state to receive 100% federal reimbursement for eligible Medicaid services.


The TA Center has additional resources about HCBS, including information on different kinds of HCBS, benefits and challenges, eligibility, financing options, transitional care, and examples of HCBS in Indian Country.


Resources of note include:




New Medicare cards have arrived

Medicare has finished mailing new Medicare cards to all beneficiaries. If someone you care for has not received a new card, they can print it by signing in to or call 1-800-MEDICARE for assistance.


Once a person has the new card, they should destroy their old card. (If they have Medicare Advantage Plan or drug plan cards, they should keep those).

A Medicare card coming out of an envelope

To learn more about the new Medicare cards, watch a CMS webinar recording on what the new cards mean for Indian Country.


Vaccination: Our best shot at healthy aging

As we get older, our risk for shingles and pneumococcal infections increases. That's why elders should be vaccinated against both diseases.


Additionally, adults of all ages should be up to date on their seasonal influenza vaccine and their tetanus vaccine, which is typically administered every 10 years.

Close-up image of a health care professional vaccinating a patient

For more information on which vaccinations an adult in your care may need, refer to the 2019 recommended adult immunization schedule.


Funding opportunity: Alzheimer's Disease programs

Applications due: April 1, 2019

Under the Alzheimer's Disease Programs Initiative, the ACL will award cooperative agreements to help programs create home- and community-based services for people with dementia. These funds will promote person-centered care that helps elders with dementia stay in their homes and communities while living as independently as possible.


Weighing the benefits of congregate meal programs

Congregate meal programs, which serve meals to elders in group settings, provide healthy meals and social engagement for elders.


The Administration for Community Living analyzed the benefits for congregate meal participants under Title III-C services in the infographic, "Congregate Meal Programs: A Value Proposition" (PDF, 64 KB, 1 pg.). Most participants said they experienced improved health, and many participants expressed that congregate meals offered them more social opportunities.


Under Title VI, tribal organizations are eligible for grants to provide congregate meals, along with other nutrition services. During 2017, 269 3-year grants were awarded to tribes and tribal organizations for Title VI nutrition and supportive services. An analysis of 13 of these programs showed that more than half of the grantees served between 101–500 congregate meals in their first year.

Congregate Meal Programs: a value propsition

Interrupted sleep worsens pain


Helping elders sleep through the night may reduce their need for pain medications.


According to a study published in the Journal of Neuroscience, even subtle nightly changes in sleep quality can affect a person's day-to-day experience of pain.


Caregivers can help improve elders' sleep quality by:

  • encouraging them to limit fluid intake in the evening and use the toilet before bedtime,
  • replacing noisy medical equipment with quieter models whenever possible, and
  • seeking out professional help for elders with sleep difficulties caused by anxiety or depression.
Join the conversation on LinkedIn

Want to learn more about or discuss LTSS in Indian Country? Looking to connect with others working in the same field? Join the Tribal Affairs Group on LinkedIn and join the conversation.



Upcoming webinar

Lifeline Internet and Telephone Discount Program Overview

Wednesday, March 27

The federal Lifeline program provides internet and phone service discounts to qualifying low-income people. In this webinar, you will learn about the program, eligibility, and how to leverage the program to help low-income tribal consumers in your community connect to jobs, family, and emergency services.


The Universal Service Administration Company (USAC) administers the federal Lifeline program, which is available on tribal lands.


Participants in this webinar will learn:


  • how to inform eligible tribal consumers about the benefits of the Lifeline program and application process;
  • ways to leverage the federal Lifeline monthly subsidy to support job training and health care needs of low-income consumers in Native communities; and
  • how to identify opportunities to train tribal health officials to assist their communities with Lifeline benefit eligibility.

Have questions for our presenters? Let us know before the webinar by emailing


Jessica Zufolo
Senior Advisor, Strategic Partnerships

Leah Sorini
Communications Associate

Forrest Cox
Program Analyst, Data Reporting


Please note your
location's call-in time:

8 a.m. Hawaii
10 a.m. Alaska
11 a.m. Pacific
11 a.m. Arizona
12 p.m. Mountain
1 p.m. Central
2 p.m. Eastern






Send Us Your News
Do you have news to share about LTSS in Indian Country? Send it to, and we'll include it in a newsletter. Contact us with other comments or feedback, too.
About the Newsletter

Long-Term Services and Supports Solutions is published monthly by the CMS Division of Tribal Affairs to share information, funding opportunities, and resources with LTSS planners, tribal leaders, and supporters.

Centers for Medicare & Medicaid Services Indian Health Service Administration for Community Living