Flexible Accounting for Long-Term Care Services: State Budgeting Practices that Increase Access to Home- and Community-Based Services

In the context of “rebalancing” efforts, the authors describe flexible accounting as budgeting practices and contractual language that incentivize the use of less expensive noninstitutional programs and use savings to expand lower-cost services to further reduce the state’s use of institutional care. The authors offer recommendations for California and pay special attention to flexible accounting in Medicaid managed LTSS and identify examples of flexible accounting practices.