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 (LTC) spending in favor of HCBS. First, the three major categories of Medicaid HCBS benefits available to states are described. Second, various measures of access to HCBS are discussed, and the states with the highest ratings on access to HCBS are identified. Third, the benefits and policies that appear to contribute to high HCBS access in states are identified and discussed. Finally, new options and incentives available to states to expand HCBS under the Patient Protection and Affordable Care ACT (ACA) (Public Law 111-148 of 2010), are described.
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