ADvancing States provides expert, customized technical assistance to state agencies navigating the complexities of Medicaid program design, implementation, and oversight. Our services are designed to strengthen state capacity and enhance the delivery of Medicaid-funded long-term services and supports (LTSS), including home and community-based services (HCBS), based on person-centered principles and aligned with federal and state goals. 

Our Medicaid LTSS portfolio of support includes: 

• Medicaid policy analysis and design, which could include developing section 1115 demonstration applications and 1915(c) waiver and state plan amendments, as well as assessing current LTSS systems;
• Implementation support for new initiatives, federal compliance (including the HCBS Access rule), and quality improvement activities;
• Managed LTSS (MLTSS) program design and implementation support;
• Integrated care program design and implementation to better support individuals dually eligible for Medicare and Medicaid, focused on states that do not operate MLTSS programs;
• Leveraging upstream and pre-Medicaid services to help states meet the needs of older adults and people with physical disabilities before they require an institutional level of care;
• Stakeholder engagement and facilitation, helping states build inclusive, cross-sector partnerships;
• Development and facilitation of state conferences/summits.

ADvancing States, in partnership with HSRI, administers the National Core Indicators–Aging and Disabilities™ (NCI-AD) initiative, a voluntary effort designed to measure and improve the quality of LTSS for older adults and individuals with physical disabilities. NCI-AD provides participating states with a validated, person-centered survey tool that capture the experiences and outcomes of service recipients across key domains such as community inclusion, choice and control, and health and safety, and which can be used to meet federal quality requirements. ADvancing States supports states throughout the process—from planning and implementation to data analysis and quality improvement—helping to ensure that LTSS systems are continuously evolving to meet the needs of the people they serve.

ADvancing States provides technical guidance on the development of effective policies, programs, and systems to strengthen the caregiving workforce and support unpaid family caregivers. We assist states in advancing sustainable, person- and family-centered caregiving solutions across the lifespan and care settings. 

Our caregiving support services include: 

• Policy and program development to enhance supports for unpaid family caregivers, including implementation of the RAISE Family Caregivers Act and state caregiving initiatives; 
• Direct care workforce strategies, including recruitment and retention planning, training and credentialing frameworks, and compensation improvement efforts;
• Technical assistance on respite, caregiver assessments, and support services;
• Stakeholder engagement to inform state caregiving priorities and address caregiver needs across diverse populations;
• Hosting and facilitating caregiver advisory boards to elevate the voices of paid and unpaid caregivers and ensure policies reflect lived experiences; 
• Development and facilitation of state conferences/summits.

Our tools include:

• ADvancing States, in collaboration with Altarum, supports the implementation and expansion of the Direct Care Careers platform—a statewide job-matching system that connects direct care workers with employers to strengthen recruitment, reduce turnover, streamline training opportunities, and improve access to high-quality caregiving services;
• ADvancing States, in partnership with the Human Services Research Institute (HSRI), conducts the NCI State of the Workforce™ for AD to collect critical data on the direct care workforce that supports older individuals and people with disabilities. This annual survey gathers information from service providers on wages, benefits, turnover, vacancy rates, and training practices, offering states a comprehensive view of workforce trends and challenges. The findings help inform state policy decisions, support advocacy efforts, and guide strategies to strengthen and stabilize the direct support workforce. ADvancing States provides technical assistance to help states participate in the survey, interpret results, and use the data to drive meaningful system improvements.