1. RCNAD
  2. Long-Term Care in Indian Country

Collaborative Partnerships Between Tribes and States for Long-Term Care

Collaborative partnerships between tribes and states are essential to strengthening long-term care systems. By working together, governments can coordinate funding, share data and expertise, reduce service gaps, and support culturally appropriate home and community-based care. These partnerships help ensure Elders receive timely, person-centered services close to home, honor tribal sovereignty, and build sustainable aging and long-term care infrastructure across communities.

  • Agreements
    Tribal programs may receive reimbursement for services provided to eligible Veterans
  • Medicaid State Plan Services
    In some states, personal care services or targeted case management can be reimbursed without a waiver
  • Philanthropic or Foundation-Based Funding
    Supports program startup, workforce development, and pilot projects

Older Americans Act: Title VI and Title III Coordination

The Older Americans Act (OAA) provides a foundational framework for coordination between Tribal and state aging systems:

  • Title VI provides funding to federally recognized Tribes and Native Hawaiian programs to support services that help Native Elders remain healthy, independent, and connected to their communities. Programs may include congregate and home-delivered meals, transportation, in-home assistance, information and referral, and caregiver support designed specifically for Native Elders
  • Title III provides federal funding to states and Area Agencies on Aging (AAAs) to provide community services for people 60 and older, such as support services, nutrition programs, and caregiver assistance.

Title III and Title VI programs are designed to work together to support older adults. Under the OAA, states and AAAs are required to coordinate with Tribes receiving Title VI funding. This collaboration:

  • Prevents duplicated service
  • Improves referrals and access across systems
  • Supports equitable access to nutrition services, transportation, caregiver supports, and other aging services.

Medicaid and Long-Term Services and Supports (LTSS)

  • Medicaid Home and Community-Based Services (HCBS) State Waivers allow states to use Medicaid funds to provide long-term services and supports (LTSS) in homes and communities rather than facility-based settings. States can tailor these waivers to meet local service needs like personal care, case management, transportation, home modifications, respite care, and supported employment. The waivers may target specific groups, such as older adults or people with disabilities.
  • Federal Medical Assistance Percentage (FMAP) is the formula that determines the federal government’s share of Medicaid spending. Because Medicaid is jointly funded, FMAP sets how much the federal government pays and how much states contribute, with lower-income states receiving a higher federal match. In all states, eligible services provided to Medicaid-eligible AI/AN patients in IHS or tribal facilities can be reimbursed at 100% FMAP. The availability of this 100% FMAP is an important resource that can help increase funding to support Native Elders.