Challenges and Opportunities for Improving Rural Long-Term Services and Supports under the Affordable Care Act

Research center:
Lead researcher:
Research staff:
Project funded:
September 2011
Project completed:
June 2013

Problem: Caring for an aging population is especially challenging in rural areas, where a limited long-term services and supports (LTSS) infrastructure strains the capacities of families and communities to care for those needing services. Emerging models of care coordination and financing reform offer promise for increasing access to needed services, improving quality, and potentially reducing costs. The Affordable Care Act (ACA) contains provisions for expanding care coordination, integration of medical and behavioral healthcare, health homes and Medicare/Medicaid coordination; yet, implementation in rural areas could be challenging given the limited capacity and infrastructure of many rural communities. This project aims to inform national and state policymakers' understanding of challenges and opportunities in rural LTSS, and how rural areas might implement components of the ACA to improve care across the continuum of primary, acute, and LTSS services. The project will focus on three issues: 1) options, strategies and models for building integrated care management; 2) policy and financing strategies and models for improving care for rural dual eligibles, and 3) provision of behavioral health services to the LTSS population.

Project Goals: This project has three goals: 1) to examine select rural LTSS issues and policy solutions; 2) to assess the implementation opportunities and barriers of ACA care coordination and LTSS provisions in rural areas; and 3) to identify policy options and service delivery models that hold promise to facilitate and enhance rural implementation of these provisions.

Methods: This policy analysis project will use secondary sources to describe current issues in rural long-term services and supports, and will examine policy and service strategies and models for building rural integrated care management, improving care for dual eligibles, and strengthening mental health systems. Secondary sources include: existing formal and informal literature, targeted analysis of data from relevant national surveys, and interviews with knowledgeable experts and key informants.

Anticipated Products/Products: The principal products will be three detailed policy briefs (6-8 pages). We will submit abstracts for presentation at meetings of the National Rural Health Association, AcademyHealth, and other organizations with an interest in rural LTSS.


  • Challenges and Opportunities for Improving Mental Health Services in Rural Long-Term Care
    Maine Rural Health Research Center
    Date: 06/2013
    This study explores practices for increasing the quality, quantity, and accessibility of mental health services in rural long-term care.
  • Integrated Care Management in Rural Communities
    Maine Rural Health Research Center
    Date: 05/2014
    This study reviews the opportunities and challenges reform initiatives under the Affordable Care Act present for rural communities. The study assesses four types of organizational models for delivering integrated care management. Each model has different strengths and drawbacks, weighing for and against implementation in rural areas.