States face multiple challenges as they consider whether to pursue opportunities in the Affordable Care Act (ACA) that would increase the community-based long-term services and supports (LTSS) available to Medicaid beneficiaries. In addition to the Money Follows the Person demonstration program, the ACA created the Balancing Incentive Payments program, the Community First Choice Options program, and the modified Home- and Community-Based State Plan option (1915(i)). States must determine the potential cost of these options and identify how these options may support each other and fit within their existing LTSS programs. In addition, each option has specific requirements for care coordination, data reporting and performance measurement, which sometimes differ or overlap across programs.

To help states better understand these program requirements, this technical assistance brief describes the different LTSS program options available with particular emphasis on their budget impacts; application processes; and requirements for participant eligibility, care coordination, and data reporting. It also discusses the ways in which the different options for providing LTSS interact with each other and with existing state LTSS structures.

This technical assistance brief was a product of CHCS’ Implementing the Roadmaps: Innovations in Long-Term Supports and Services program, made possible through The SCAN Foundation. Through this program, CHCS helped participating states to rebalance and better manage an array of long-term services and supports for Medicaid populations.