Strong commitment among advocates, the Olmstead decision, and states’ own recognition of the high rates of institutionalization among long-term services and supports (LTSS) beneficiaries, have spurred state investment in strategies to support the transition of nursing facility residents to the community. States recognize that successfully transitioning a person in need of LTSS from an institutional to a community setting requires the availability of and access to sufficient community-based services and an affordable and accessible place to live.

This strategy provides an overview of key supports that states can put in place to encourage successful transitions, along with program case studies:


  • Transition and tenancy-sustaining services (e.g., transition counselors, housing searches, rental security deposits, and home modifications)
  • Affordable housing options

 Implementation Mechanisms

  • Federal funding
  • Tax credits
  • Section 1915(c) waiver
  • Section 1115 waiver
  • State-based managed care contracting authority

State Case Studies

  • Diverting and transitioning Medicaid enrollees from nursing facilities (NY)
  • Enhancing benefits for people with serious mental illness to support their community transitions (TX)
  • Offering housing to individuals with disabilities exiting institutions (AZ, TX)
  • Transitioning individuals from nursing facilities to the community (TN)