Get free help preparing your taxes from AARP Foundation Tax-Aide. Find a location


AARP Staying Sharp: Keep Your Brain Healthy
Bob Dylan Talks!


Military and Veterans Discount


You Could Choose Your Dream Vacation


Introducing RealPad by AARP


AARP Auto Buying Program


Piggy bank on the road - AARP Driver Safety

Take the new AARP Smart Driver Course!

Download the ipad App



AARP Games - Play Now!

AARP Books

Medicare for Dummies book cover

Get the answers you need, from Patricia Barry, AARP's Ask Ms. Medicare

Most Popular


share your Thoughts

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do

In Brief: A Balancing Act: State Long-Term Care Reform

This and Related Reports

Positive transformational change of Medicaid's LTSS system requires a philosophy that embraces the right of people with disabilities to live in the least restrictive environment; effective leadership; a creative problem-solving attitude that can find innovative ways to work within existing laws; and innovative ways to encourage federal policy makers to waive or overturn rules that hinder states' ability to balance their service delivery in favor of HCBS.


The ability of some states to accomplish substantial reforms demonstrates that obstacles to change can be overcome.

Change can be accelerated and supported by adopting federal and state policies that:

  • Allow consumers to receive services in the setting of their choice.
  • Adopt nursing home diversion programs that prevent people from ever entering a nursing home.
  • Eliminate waiting lists for HCBS.
  • Offer a range of residential choices.
  • Support family caregivers.
  • Facilitate states' ability to establish a unified global budget for funding LTC.
  • Consolidate LTC programs, policies, and budgets in one state agency.
  • Put a moratorium on Medicaid regulations that hinder states' ability to help individuals leave nursing homes and transition to HCBS.
  • Eliminate Medicaid's institutional bias.
  • Increase affordable public and private financing options to give people more choice and control over the services they need.
  • Explore offering states financial incentives to accelerate the pace of change in shifting more Medicaid spending to HCBS.


Written by Enid Kassner, Susan Reinhard, Wendy Fox-Grage, Ari Houser and Jean Accius, AARP Public Policy Institute; Barbara Coleman and Dann Milne, Consultants.
July 2008
©2008 AARP
All rights are reserved and content may be reproduced, downloaded, disseminated, or transferred, for single use, or by nonprofit organizations for educational purposes, if correct attribution is made to AARP.
Public Policy Institute, AARP, 601 E Street, NW, Washington, DC 20049

Topic Alerts

You can get weekly email alerts on the topics below. Just click “Follow.”

Manage Alerts


Please wait...

progress bar, please wait

Tell Us WhatYou Think

Please leave your comment below.

Discounts & Benefits

From companies that meet the high standards of service and quality set by AARP.

Walgreens 1 discount membership aarp

Members get exclusive points offers from Walgreens, Duane Reade and

member benefit aarp hear usa

Members can save 20% on hearing aids with the AARP® Hearing Care Program provided by HearUSA.

AARP membership discount Man trying on eyeglasses at optometrists smiling

Members save up to 60% on eye exams and 30% on glasses at LensCrafters.

Member Benefits

Join or renew today! AARP members receive exclusive member benefits & affect social change.