Start: June 2011

End: June 2013

Funder: The SCAN Foundation


The majority of Medicaid beneficiaries needing long-term supports and services (LTSS) are in unmanaged, fee-for-service programs, including many individuals in institutions versus home- and community-based options. Overhauling the delivery of Medicaid LTSS offers significant opportunities to improve health care quality, control costs, and enhance quality of life for millions of people. Particularly now, the Affordable Care Act offers new incentives for states to improve LTSS delivery.

Through support from The SCAN Foundation, CHCS provided targeted technical assistance (TA) to help 10 states — Arizona, Georgia, New Jersey, Nevada, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Virginia, and Washington — develop and test innovative models for better managing and rebalancing LTSS. Participating states focused on one, or in a few cases both, of the following priorities:

  • The Rebalancing Path (NJ, NV, OK, PA, RI, SD, VA) – States worked to rebalance their LTSS system away from institutional care toward home and community settings that maximize independence and are preferred by most beneficiaries. CHCS TA assisted states in expanding home and community-based services (HCBS), with a focus on leveraging enhanced federal funding.
  • The Managed LTSS Path (AZ, GA, NJ, NV, OK, PA, VA, WA) – States are seeking to better manage the full array of intensive supports and services required by beneficiaries with long-term care needs. CHCS TA helped states in addressing critical milestones for designing and implementing effective approaches for managing LTSS.

Specific TA focus areas for these LTSS “paths” included: (1) communicating the value of managed LTSS; (2) using the Affordable Care Act to support rebalancing; (3) financial incentives for managed LTSS; (4) assessment and care planning tools; and (5) managed LTSS benefit design and performance measures.

This TA initiative is a continuation of CHCS’ Profiles of State Innovation Roadmaps. Made possible by The SCAN Foundation, this set of national environmental scans published in December 2010 chronicled emerging state innovations and best practices for improving publicly financed long-term care programs. The TA helped states in achieving the critical milestones outlined in the State Innovation Roadmaps.