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.


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