Strategies to support HCBS

States are spending more money on home- and community- based services (HCBS) and are spending a greater proportion of their long-term care (LTC) dollars on these services rather than on institutional care. Some states have been more successful than others in supporting HCBS. This brief reviews strategies states have used to promote HCBS and summarizes existing research on the effectiveness of these strategies in increasing access, expanding revenues, and moderating institutional bed supply. Research shows that increased use of Medicaid waivers and Medicare home health services are important predictors of increased access to HCBS. Using regulation to constrain the number of institutional beds (and redirect resources to HCBS) shows mixed results. Research on the effectiveness of capitating LTC to increase access to HCBS has not been conclusive, though initial findings are promising and appear to be worth pursuing