CHCS - Center for Health Care Strategies

Improving the quality and cost-effectiveness of publicly financed health care

Policy Brief - Medicaid-Funded Long-Term Care: Toward More Home- and Community-Based Options

Policy & Issue Briefs
Gretchen Engquist, PhD, and Cyndy Johnson, Independent Consultants; and Alice Lind and Lindsay Palmer Barnette, Center for Health Care Strategies
May 2010
Robert Wood Johnson Foundation and Aetna

National policymakers and state Medicaid leaders are paying greater attention to better management of long-term supports and services (LTSS).  The reasons are obvious: aging of the baby boom population; severe fiscal pressures; the disproportionate costs of those with serious long-term conditions; an ongoing over-reliance on institutional care; and the fact that LTSS remains almost entirely in the unmanaged fee-for-service system. Yet an array of financial, administrative, bureaucratic, and political obstacles impede states from rebalancing their LTSS programs toward greater emphasis on home-and community-based alternatives.

This brief outlines initial policy recommendations for reforming the nation's Medicaid-funded LTSS system to support more cost-effective and consumer-oriented long-term care options.

It provides a useful summary for understanding:

  • The current Medicaid long-term care environment;
  • Legal, regulatory, and bureaucratic barriers to rebalancing LTSS;
  • Promising solutions for rebalancing LTSS; and
  • Policy recommendations for improving the Medicaid LTSS system.

Innovations in the Medicaid Continuum of Care Series

This brief is part of CHCS' Innovations in the Medicaid Continuum of Care series, developed to help state and federal policymakers identify high-quality and cost-effective strategies for addressing the full range of clinical and long-term supports and services (LTSS) needs of Medicaid beneficiaries.


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