Medicaid currently covers more than 40 percent of the nation’s long-term care needs. Yet close to 95 percent of beneficiaries needing long-term care are in fragmented fee-for-service programs, including a disproportionate number in institutions versus consumer-preferred home- and community-based options. Overhauling the delivery of Medicaid long-term supports and services (LTSS) offers significant opportunities for states to improve health care quality, control costs, and enhance the quality of life for millions of Americans.

This roadmap is part of a series developed to help Medicaid stakeholders design more effective models for long-term care delivery, particularly in light of new opportunities in the Affordable Care Act. Through support from The SCAN Foundation, CHCS conducted an environmental scan to identify state best practices for:

1. Rebalancing programs to provide more home- and community-based options instead of institutional care;

2. Designing managed LTSS programs; and

3. Integrating care for adults who are dually eligible for Medicare and Medicaid.

For this Rebalancing Roadmap, CHCS identified four innovative states — Georgia, Oregon, Vermont, and Washington — with expertise in developing and implementing programs to help individuals with long-term care needs live in community settings. The resulting report culls from these states’ experiences to outline 10 critical mileposts for successfully achieving a more equitable balance between institutional and home- and community-based care. It also identifies key ACA provisions that support state efforts to improve long-term care delivery.

The four profiled states each have different approaches to rebalancing care toward greater use of community-based services. These state efforts illustrate how success can be achieved in both rural and urban settings, in dramatically different geographical and political environments, and in programs initiated in the 1980s as well as those launched in the new millennium.


Profiles of State Innovation Series

This roadmap is part of CHCS’ Profiles of State Innovation series, made possible through The SCAN Foundation to help Medicaid programs develop high-quality, cost-effective, and consumer-focused approaches for delivering long-term supports and services.