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

This report presents budgeting and contractual strategies used in Arizona, Hawaii, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Tennessee, Texas, Washington and Wisconsin. In different ways, these states have made substantial progress in transforming their LTSS systems by developing flexible accounting policies that have reduced NF utilization and captured the savings to support their HCBS programs.