State No Wrong Door Systems Continue to Improve in the LTSS Scorecard

State No Wrong Door (NWD) systems are critical toward ensuring people can access long-term services and supports (LTSS), which provide help with day-to-day tasks that support people with functional limitations and/or cognitive impairments. These systems, which include ADRCs (Aging and Disability Resource Centers), area agencies on aging, state and local agencies, providers, and more, can make the difference as to whether a person seeking LTSS is able to do so in a timely, appropriate manner. A 2017 AARP report described what could be considered an ideal NWD system: “if people contact any organization that is part of an NWD System, they are connected with what they need, resulting in “no wrong door” for access to services and supports regardless of their age, income, or disability.”

It is in that spirit that the LTSS State Scorecard measures the functionality of state ADRC/NWD systems. Across several editions, the Scorecard has compiled data by state on their progress toward developing fully operational NWD systems. Much of the data comes from state agencies themselves, often the entities responsible for designing and administering NWD networks. While not all states use the terminology ADRC or NWD, every state provides this functionality in some kind of single-entry point system that is evaluated in the Scorecard.

In recent years, states have shown improvement in this area. In 2017, the Scorecard found that ADRC/NWD systems across states on average performed only 60 percent of the functions that would be part of a fully operational system. In 2020, that increased to 67 percent and in the most recent edition published in 2023, the national score increased further to 72 percent. Relatedly, more than 30 states made significant improvement in their specific NWD system, the second highest frequency of improvement among 26 Scorecard indicators where change could be tracked. 

So, what drove this increase? The Scorecard ADRC/NWD functions indicator measures state systems across five components. The greatest improvement took place in the areas of streamlined eligibility for public programs, state governance and administration, and person-centered counseling. Full descriptions and criteria within each of the components are available on page 101 of the Scorecard report.  Component scores for every state are available on page 179 of the report.

This progress shows real promise of the capacity of state NWD systems to fully serve older adults, people with disabilities, and family caregivers seeking support. At the same time, opportunity for improvement remains as states continue to strive toward fully operational systems. 

While improving, “streamlined eligibility for public programs” continues to be the least functional of the five components the Scorecard measures. This component includes functions such as tracking applications, targeting people who are at high-risk for institutionalization, and taking steps to ease access to services and supports. The state governance and public outreach components also score below 70 percent functional. These components are critical toward developing the infrastructure NWD systems need to succeed and ensuring that both people seeking services and family caregivers know about and can find entry points to NWD networks where they live. 

Opportunities to improve exist within specific functions as well. Most states, for example, do not have presumptive eligibility (PE) policies for Medicaid home and community-based services (HCBS). This important policy can help people enroll in HCBS quickly while their full eligibility determination takes place. More states are adopting this policy and in January 2024, New Jersey enacted legislation that will create a permanent HCBS PE for its Medicaid programs. In addition, more than 10 states reported providing no or very limited person-centered counseling to individuals with intellectual/developmental disabilities and individuals with mental illness and behavioral health needs. 

Overall, the Scorecard demonstrates that states can and have improved how they design and deliver NWD system functions and provides a path forward for states to continue efforts toward fully operationalizing these critical networks.

On February 14, Susan Reinhard participated in a webinar hosted by the Administration for Community Living about the No Wrong Door System indicator. A recording of the webinar is available here.