State Options That Expand Access to Medicaid Home and Community-Based Services

This background paper examines various aspects of the Medicaid program that can expand access to home and community-based services (HCBS) and rebalance long-term care spending in favor of HCBS.

As a result of the long-standing requirement that states cover facility-based care, the majority of Medicaid long-term care (LTC) expenditures historically have been for institutional, rather than home and community-based, services. Over the past two decades, major efforts have been undertaken by states and the Centers for Medicare and Medicaid Services (CMS) to expand access to Medicaid HCBS and the Medicaid program presently offers numerous options for states to do so. These initiatives stem from the growing demand by people with disabilities to receive health care services in their homes for as long as possible, rather than be institutionalized.

Report (.pdf)