U.S. flag U.S. flag

An official website of the United States government

Balancing Long Term Services & Supports

The Centers for Medicare & Medicaid Services (CMS) recognizes that states are working hard to ensure that individuals eligible for long-term services and support (LTSS) receive high-quality and cost-effective person-centered care that is consistent with an individual’s needs and wishes and which promotes access to services in home and community-based settings. As the primary funder of LTSS nationally, Medicaid plays an important role in supporting states’ rebalancing efforts to achieve a more equitable balance between the share of spending and use of services and supports delivered in home and community-based settings relative to institutional settings.

Goals of a Balanced Medicaid Funded Delivery System

The goal of the Medicaid balancing initiatives is to create a person-driven, long-term support system that offers people with disabilities and chronic conditions choice, control and access to services that help them achieve independence, good health and quality of life.

A balanced system is:

  • Person-driven: The system gives people choice over where and with whom they live, control over the services they get and who they get services from, the chance to work and earn money, the option to include friends, and supports to help them participate in community life.
  • Inclusive: The system encourages people to live where they want to live, with access to a full array of community services and supports.
  • Effective and accountable: The system offers high quality services that improve quality of life. Accountability and responsibility is shared between public and private partners, and includes personal accountability and planning for long-term care needs, including greater use of private funding sources.
  • Sustainable and efficient: The system efficiently coordinates and manages a package of paid services appropriate for the beneficiary, paid for by the right entity.
  • Coordinated and transparent: The system coordinates services from various funding streams to provide a seamless package of supports, and uses health information technology to effectively provide transparent information to consumers, providers and payers.
  • Culturally competent: The system provides user-friendly, culturally-appropriate, accessible information and services.

The Long-Term Services and Supports Rebalancing Toolkit

The Long-Term Services and Supports Rebalancing Toolkit (PDF, 1.27 MB) identifies promising state models and  practices for strengthening state infrastructure to increase transitions from institutional settings to community-based settings, divert institutionalization, and improve community living for individuals eligible for Medicaid HCBS. 

The toolkit contains four modules that can each serve as an independent document. The modules provide:

  • State strategies to increase the share of LTSS provided in community-based settings;
  • Tools designed to assist states with policy and programmatic strategies;
  • Case studies of innovative programs and creative ways states are leveraging available federal authorities to transform LTSS systems; and
  • Links to relevant resources.

Legacy Projects

National Balancing Indicator Project

The Centers for Medicare & Medicaid Services (CMS) commissioned the National Balancing Indicator Project (NBIP) to develop and test the feasibility of implementing national indicators to assess states' efforts toward attaining and maintaining a balanced, person-driven LTSS system. The mission of the NBIP was to assist CMS and states in developing indicators to gauge a state's success in "balancing" its long-term support program, and inform federal and state policy making.