Final Assessment of the National Background Check Program for Long-Term Care Providers: Safeguarding Seniors Through Effective Screening

The National Background Check Program, established in 2010 under the Affordable Care Act, aimed to protect seniors in long-term care facilities by providing federal support to states in developing robust background check systems for prospective employees. With as many as 70% of seniors expected to require long-term care at some point and a reported 16% experiencing abuse, this program addressed critical safety concerns.

Over 14 years, the program helped 27 states establish systems to disqualify candidates with concerning criminal histories from working in these sensitive environments. By implementing automated background checks and monitoring ongoing status changes, states created efficient and reliable processes that balanced safety with workforce needs. While challenges included limited state legislative authority and inter-departmental coordination issues, the program achieved significant progress without substantial unintended workforce reductions.

With over $100 million invested, the program proved to be a meaningful advancement in safeguarding vulnerable populations in long-term care settings. OIG’s recommendations throughout the program supported these outcomes, and no further actions are currently recommended for CMS.