Rebalancing LTSS

ADvancing States is excited to offer intensive technical assistance to two states to implement strategies to improve HCBS rebalancing, with an emphasis on dual eligible integration and service coordination. This technical assistance is available at no cost to the selected states through the support of the Laura and John Arnold Foundation (LJAF).

The application for technical assistance is currently open! We are accepting applications through Friday, October 6, 2023.

Rebalancing LTSS

Rebalancing is an important mechanism for states to contain Medicaid expenditures and offer options for individuals who need LTSS to reside in the setting of their choice. Around 75 percent of individuals enrolled in Medicaid LTSS programs are also eligible for Medicare, making integration and coordination between the two programs a critical component of effective rebalancing strategies.

Promising Strategies

Using CMS’s LTSS Rebalancing Toolkit, input from a focus group of state leaders, and other resources, ADvancing States has identified five promising state strategies to support rebalancing:

  1. Invest in consumer education or “No Wrong Door” (NWD) infrastructure to promote awareness of HCBS options.
  2. Develop pre-Medicaid and/or pre-LTSS supports to delay the need for Medicaid LTSS.
  3. Improve the HCBS eligibility process so HCBS is a viable option in critical moments.
  4. Use data to find people during transitions so they can be diverted from long-term facility stays.
  5. Provide incentives for plans and/or providers to maximize access to HCBS.

Additional information about these strategies is available in a recent issue brief. Click here to read the brief.

Technical Assistance Opportunity

ADvancing States will provide technical assistance to two states over an 18-month period beginning in January 2024 to implement one or two of the five strategies above.

ADvancing States will engage with the designated state teams to identify goals and desired outcomes, build an implementation strategy and timeline, provide project management support, and assist with implementation activities. Technical assistance will be tailored to fit the state’s needs.

The technical assistance may include activities such as:

  • Developing project management plan with key timelines and milestones for implementation;
  • Researching and analyzing existing policies and identifying barriers;
  • Conducting gap analyses of current processes to identify needed intervention;
  • Engaging with stakeholders; and
  • Assisting with drafting proposed policy changes (i.e., providing guidance on waiver or state plan amendments) and
  • Assisting with drafting guidance and education for managed care plans, providers, and beneficiaries.

States must be able to commit considerable staff time to the project during the technical assistance period. It is expected that state staff will meet virtually with ADvancing States on a bi-weekly basis, and identify state resources to implement the necessary system and program changes to support the selected strategy. ADvancing States will also conduct up to three on-site visits to support the state’s progress. 

Additional information about the TA opportunity is available in the slide deck from our recent information session.

Application Process

To apply for Rebalancing LTSS Technical Assistance, states must complete the online application at this link:

The deadline to apply is Friday, October 6, 2023.


Please feel free to reach out to Camille Dobson ( or Rachel Neely ( with any questions.