Medicaid officials are encouraging states to accelerate efforts to “rebalance” long-term care offerings for people with disabilities to favor home- and community-based services over institutions.

The Centers for Medicare and Medicaid Services released a toolkit this week featuring examples of how states have expanded home- and community-based services and decreased reliance on institutional care.

The 66-page toolkit includes models and best practices for increasing transitions from institutions to the community, diverting people from segregated settings, making sure that state policies align with the market of service providers and improving community living for beneficiaries receiving Medicaid home- and community-based services.

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“The COVID-19 crisis has shone a harsh light on the human costs of a long-term care system that relies too heavily on institutional services like nursing homes. Too often, they are seen as the default option, even for those who may not require round-the-clock care,” said Seema Verma, administrator of the Centers for Medicare and Medicaid Services.

The toolkit should be of use to states no matter how far along they are in the process of rebalancing their long-term care services, federal officials said. States with strong community-based services may need to make tweaks in light of COVID-19, for example, while other states may be poised to speed up their restructuring of such offerings.

Community-based services are often more cost effective than institutional care, Medicaid officials said. Nonetheless, the state-federal program has traditionally been partial to institutional care — a mandatory benefit — over community-based services, which are optional.

As of 2013, however, at least 50% of Medicaid long-term services and supports spending annually across the U.S. has gone toward home- and community-based services, according to the toolkit.

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