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Real Choice Systems Change Grant Program

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 the Centers for Medicare & Medicaid Services (CMS) and states.

In fiscal year (FY) 2001, Congress began funding the Real Choice Systems Change (RCSC) 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 HCBS. The overarching purpose of the System Change 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:

  • Live in the most integrated community setting of their choice
  • Exercise meaningful choice and control over their living environment, services, and service providers
  • 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.

Person-Centered Planning Grants

The Person-Centered Planning (PCP) grants support states and territories to enable individuals with disabilities or long-term illnesses to reside in their homes and participate fully in their communities. For additional information, visit Person-Centered Planning Grants.

Person-Centered Hospital Discharge Model (HDM)

The Person-centered HDM grant built upon the RCSC and Aging and Disability Resource Center (ADRC) grant opportunities by providing targeted assistance to states to improve hospital discharge planning through collaboration with ADRCs and Area Agencies on Aging and Centers for Independent Living. In 2008 and 2009, $12.4 million in grant money was awarded to 10 states. For additional information, visit Person-Centered Hospital Discharge Model.

State Profile Tool Grant Program

CMS awarded $1,495,162 in supplemental funding to seven of the existing State Profile Tool grants in FY 2010. For additional information, visit State Profile Tool Grant Program.