States continue to work on rebalancing their Medicaid long-term services and supports (LTSS) systems away from institutional settings and toward community-based care. They are using opportunities provided by the Affordable Care Act to develop their LTSS eligibility and delivery systems in a way that strengthens both access to and availability of community-based services. States also are migrating from fee-for-service delivery systems to managed care to better integrate LTSS with primary and acute care and behavioral health care.

This brief highlights states’ continued progress in: 1) rebalancing Medicaid LTSS options toward home- and community-based services; and 2) developing and implementing managed LTSS programs to better integrate care. It also describes states’ progress in improving quality of care for LTSS and the decision by some states to change program authority for LTSS services from 1915(c) waivers to comprehensive Section 1115(a) demonstration waivers.

This brief is part of CHCS’ Implementing the Profiles of State Innovation Roadmaps program, which is supported by a grant from The SCAN Foundation. Through this program, CHCS is helping participating states to rebalance and better manage an array of long-term services and supports for Medicaid populations.