CHCS: State Trends and Innovations in Medicaid LTSS

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

Federal Budget and Policy

State Medicaid programs have made great strides in rebalancing the provision of long-term services and supports (LTSS) from institutional settings to home- and community-based care. Increasing consumer demand for community-based options and the need to ensure optimal cost-effectiveness of publicly-financed care have driven this transformation of Medicaid LTSS delivery systems. States are pursuing opportunities made available in the Affordable Care Act (ACA) to expand the availability of home- and community-based services (HCBS) to Medicaid beneficiaries.