As a result of the recent changes in home based care, the Centers for Medicare & Medicaid Services (CMS) has issued an in-depth toolkit aimed at giving states and providers additional support as we work to rebalance and recalibrate long-term support services and supports (LTSS).

With the overall goal of ensuring that individuals eligible for LTSS receive the best and highest quality care, the toolkit provides strategies and tools that states can implement to expand and enhance home and community-based services (HCBS). The toolkit also offers methods to rebalance, or recalibrate, LTSS systems from institutional to community based care. Primarily geared to an audience of state Medicaid agency staff, the toolkit also contains details on opportunities for cross-system and community-wide collaboration.

Why Now?

Medicaid pays for roughly 57% of the national LTSS services delivered. The recent changes from the American Rescue Plan including the “HCBS Infrastructure Improvement Program,” call for significant changes on the part of states and providers.

The new infrastructure program offers permanent enhanced federal Medicaid matching funds for HCBS if states choose to participate and meet certain requirements.

Understanding that states must 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 care, the toolkit provides insights that can be quickly implemented.

The toolkit identifies examples of innovative state models and best practices for strengthening state infrastructure. The strategies offered aim to increase transitions from institutional settings to community-based settings, reduce institutionalization, and improve community living for individuals eligible for Medicaid HCBS.

The Toolkit:

The toolkit is structured in four modules, each of which can be used as an independent tool. The four modules focus on:

  • Tools designed to assist states with policy and programmatic strategies
  • Strategies for states to increase the share of LTSS provided in community-based settings
  • Best-practice case studies of programs including creative ways states are leveraging available federal authorities to transform LTSS systems
  • Extended resources list.

The four modules include: a module on Background; a module focused on Advancing state HCBS rebalancing strategies; a module outiling Current flexibility under Medicaid to support state rebalancing strategies; and a final module on State strategies to rebalance LTSS systems.

A full downloadable version of the toolkit can be found on

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