What New Long-Term Services and Supports Data Show About Rebalancing – And How States Can Respond
Article Publication Date
Summary
In December 2025, CMS released several new reports detailing Medicaid long-term services and supports (LTSS) use and spending. These reports offer a comprehensive view of national and state-level trends in shifting services from institutional settings toward home and community-based services, known as LTSS rebalancing.
The Center for Health Care Strategies has recently released a blog post highlighting key themes emerging from these reports and outlining ways states can use these insights to advance their LTSS and HCBS strategies. Notable findings include:
• HCBS spending declined slightly nationally, but HCBS also made important gains.
• LTSS use among people with behavioral health disabilities is growing.
• Self-direction saw growth overall and among some populations but not others.
• Some demographic groups have high rebalancing ratios (above 90% for users and 79% for spending), but others lag behind.
• Managed care LTSS is serving more people at lower cost than fee-for-service (FFS) models, but FFS continues to dominate.
The Center for Health Care Strategies has recently released a blog post highlighting key themes emerging from these reports and outlining ways states can use these insights to advance their LTSS and HCBS strategies. Notable findings include:
• HCBS spending declined slightly nationally, but HCBS also made important gains.
• LTSS use among people with behavioral health disabilities is growing.
• Self-direction saw growth overall and among some populations but not others.
• Some demographic groups have high rebalancing ratios (above 90% for users and 79% for spending), but others lag behind.
• Managed care LTSS is serving more people at lower cost than fee-for-service (FFS) models, but FFS continues to dominate.