A Balancing Act: State Long-Term Care Reform

This AARP Public Policy Institute research paper examines the extent to which states have balanced the delivery of Medicaid-funded long-term care (LTC) services and supports to people in their homes (or in more home-like settings in their communities) and in institutions. What is unique about this report is its primary focus on older people and adults with physical disabilities separate from other LTC populations, such as people with developmental disabilities. The paper explores what states have been able to accomplish under current Medicaid law and addresses the impact that federal policies have on the states’ ability to balance service delivery.

This report is designed to stimulate LTC reform that will improve and increase options for older adults and people with disabilities. The ability of some states to accomplish substantial reforms for older people and adults with physical disabilities—as well as successes in the mental retardation/developmental disabilities movement, which have led to increased home and community-based services options for many—demonstrates that obstacles to change can be overcome. (193 pages)

To obtain printed copies of the full report, please call the AARP Public Policy Institute's Independent Living/Long-Term Care Team at (202) 434-3890 or send your request to the Public Policy Institute at ppi@aarp.org.

State Reports

To access a copy of this report for a single state, click on the state in the map below (PDF, approximately 50 KB).

Percent of Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities Going Toward Home and Community-Based Services