Real Choice Systems Change Grant Program (RCSC)

Many people of all ages, with disabilities or chronic illnesses, strongly prefer home and community-based services (HCBS) to institutional care. However, although spending for home and community-based services has increased dramatically over the past decade, institutional services still dominate Medicaid funding for long-term care in many States. Creating a more balanced service delivery system is a major goal for CMS and States.

In fiscal year (FY) 2001, Congress began funding the Real Choice Systems Change Grants for Community Living program (hereafter, Systems Change grants) to help States change their long-term care systems to rely less on institutional services and to increase access to home and community-based services. The overarching purpose of the Grants Program is to help States develop the necessary regulatory, administrative, program, and funding infrastructure to enable individuals of all ages who have a disability or long-term illness to (1) live in the most integrated community setting of their choice; (2) exercise meaningful choice and control over their living environment, services, and service providers; and (3) obtain high-quality services in a manner consistent with their preferences.

The Systems Change grant program was primarily intended to promote incremental change; thus, with the exception of the Real Choice and Comprehensive Reform grants, individual awards were relatively modest — averaging between $300,000 and $800,000 over a 3- to 4-year period. The intent of the series of grants awarded between 2001 and 2004 was chiefly to jump start new initiatives, provide funding to supplement existing initiatives to increase their scope, and provide the impetus for states that have historically lagged in developing strong HCBS systems. Grants were typically directed at one or more aspects of a state's HCBS system rather than promoting more comprehensive reform. Beginning in 2005, fewer grants were awarded, but the grant award amounts were larger, to promote more comprehensive systems change.

A number of states that have successfully completed their grants have reported a number of enduring improvements that promote a more balanced long term care system. Between FY 2001 and FY 2010, CMS awarded 352 grants in 39 categories for a total funding amount of approximately $288,586,710. Because many states received more than one grant, they were able to implement several enduring systems changes. Read on to learn more about the current categories of grants covered by the Systems Change grant program.