ADRC/NWD Functions

Two-thirds of states made progress toward fully functional status with their ADRC/NWD systems—networks of organizations at the state and community levels that help consumers and family caregivers learn about, consider and navigate LTSS options, both public and private. High-performing states must have strong collaborative partnerships between state aging and disability and state Medicaid agencies. The greatest improvements were recorded in providing person-centered counseling and streamlining eligibility for public programs. 

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This composite indicator draws from a voluntary, self-reported survey fielded by AARP for each state’s Aging and Disability Resource Center/No Wrong Door (ADRC/NWD) System. Survey asked state administrators to describe their progress toward developing fully operational NWD Systems using 41 criteria across 5 dimensions:

  1. State Governance and Administration (10 criteria)
  2. Populations (5 criteria)
  3. Public Outreach and Coordination with Key Referral Sources (8 criteria)
  4. Person-Centered Counseling (9 criteria)
  5. Streamlined Eligibility for Public Programs (9 criteria)

States were awarded a point value on the functional status of each criterion. Each criterion received a maximum of 3 points, ranging from 0 (not in place) to 3 (fully operational statewide). Criteria that were informed by more than one question were scored based on the average of the individual questions. State scores were summed across all criteria to a total of 123 possible points from these functionality criteria. Scores are listed in the LTSS Scorecard as a percentage of total possible points, rounded to the nearest whole percent. List of 41 criteria by function and number of questions for each criterion:

I State Governance and Administration (10 criteria)

  1. Governor and/or State Legislature’s Support to Develop NWD System (1 question)
  2. Multistate Agency Coordinating Body (1 question)
  3. Formal Assessment of Access Programs and Functions (1 question)
  4. Multiyear Plan to Implement NWD System (1 question)
  5. External Stakeholder Involvement (1 question)
  6. State Funding (1 question)
  7. Designation of Entities (1 question)
  8. Continuous Quality Improvement (3 questions)
  9. Staff Capacity (2 questions)
  10. Information Technology (2 questions)

II Populations (5 criteria)

  1. Older Adult Population (1 question)
  2. People with Physical Disabilities (1 question)
  3. People with Intellectual and Developmental Disabilities (1 question)
  4. People with Mental Illness and Behavioral Health Needs (1 question)
  5. Family Caregiver Population (1 question)

III Public Outreach and Coordination with Key Referral Sources (8 criteria)

  1. Outreach and Marketing Plan (1 question)
  2. Searchable Website and 1-800 Phone Number (2 questions)
  3. Information and Referral and State Health Insurance Assistance Program (SHIP) (2 questions)
  4. Section Q – Local Contact Agencies (1 question)
  5. Transitions – Hospitals or Rehab Facilities to Facilitate Transition to Home (1 question)
  6. Transitions – Youth (1 question)
  7. Veterans Administration (VA) Medical Centers to Provide Veteran-Directed HCBS (1 question)
  8. Statewide Reach (1 question)

IV Person-Centered Counseling (PCC) (9 criteria)

  1. Standards are Used to Define PCC (1 question)
  2. Management Supports PCC and Planning (1 question)
  3. Basic Competencies to Conduct Person-Centered Planning (1 question)
  4. Specialized Competencies to Conduct Person-Centered Planning (4 questions)
  5. Established Protocols for Developing Person-Centered Plans (1 question)
  6. Variety of Organizations to Serve Different LTSS Populations (1 question)
  7. Future Planning Needs and Private Pay (2 questions)
  8. Follow-up (1 question)
  9. Statewide Reach (1 question)

V Streamlined Eligibility for Public Programs (9 criteria)

  1. Improving Efficiencies (1 question)
  2. NWD Protocols (1 question)
  3. Application Assistance (1 question)
  4. Tracking Procedures (1 question)
  5. Ease of Access (2 questions)
  6. Targeting People Who Are High Risk of Institutionalization (1 question)
  7. Diversion Protocol is in Place (2 questions)
  8. Presumptive Eligibility (1 question from a different survey source)
  9. Statewide Reach (1 question)

AARP PPI, ADRC/No Wrong Door state survey conducted in collaboration with The Lewin Group and US Administration for Community Living” (unpublished, Washington, DC: AARP Public Policy Institute, 2022). Reference data are from 2019 and come from the same source.


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