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The Affordable Care Act includes several provisions designed to make it easier for people to access Medicaid home & community-based services.

Money Follows the Person

This program assists individuals in nursing homes and institutions to return home. It also helps states to expand home and community-based supports. Since it began in 2005, 47 states have participated and over 88,332 individuals have transitioned back to the community. Research found that participants’ quality of lives improved significantly and on average Medicaid and Medicare costs declined 23% for participants following transition. The program expired in 2016. NCOA is working to build bipartisan support to extend the program.


Balancing Incentive Program

This grant program started in October 2011. Eligible states apply for grants to help balance their Medicaid long-term care system so that it provides more community-based services instead of institutional services. States receive additional federal funding through an enhanced federal Medicaid match of either 2% or 5%, with greater incentives going to states with greater needs to improve their systems.


Community First Choice Option

This Medicaid state plan option started in October 2011. It allows states to provide a broad range of personal attendant services and supports to eligible individuals based on functional needs. As an incentive, participating states will receive additional federal funding through an enhanced federal Medicaid match of 6%. Since it is a state plan option, states must provide these services to all eligible individuals, offering a real choice to individuals and helping those who are in institutions or on waiting lists for services.


Medicaid HCBS State Plan Option

This was first established in 2005; however, the Affordable Care Act made several improvements to provide greater flexibility to states. The option is particularly important to individuals who may need long-term services and supports but do not meet an institutional level of care, including many seniors and individuals with psychiatric disabilities.