Advocates Recommend Ways to Measure Rebalancing 

In Managed LTSS and Dual Eligible Demonstrations


Consumers, providers, regulators and policymakers generally agree that rebalancing long-term services and supports (LTSS) system towards greater use of home and community-based services versus institutional care is a shared goal as states shift to the use of managed LTSS for those older adults and persons with disabilities with Medicare and Medicaid (dual eligibles) and others with Medicaid alone.


A recent memo from 21 aging and disability organizations to the Centers for Medicare and Medicaid Services (CMS) provides recommendations for consistent metrics states can adopt to evaluate state and federal progress on rebalancing comprehensively both in managed LTSS and in the dual eligible demonstrations.  Fortunately, useful rebalancing measures exist in some state programs, and in national guidance, however, they are not consistently applied in a manner that allows for systematic, public evaluation.


Building on CMS guidance and requirements as well as measures in existing state agreements, the memo recommends four measures that can be adopted by all states to evaluate their MLTSS program's impact on rebalancing.  The measures will provide greater insight into the state's MLTSS system by looking at the following factors:

  • LTSS expenditures, distribution of individuals by LTSS setting;
  • Transitions between institutional and community setting, and
  • Authorization of personal care services.

Many states are still in the process of developing MLTSS reporting requirements. The memo details recommended measures and the method states currently use to evaluate each element. State regulators and advocates can both use the memo to determine the rebalancing measures that work best in their state.


More information and the memo available here.


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NSCLC staff are available to help advocates with answers to questions about program rules and requirements, reviewing and analyzing pleadings, commenting on proposed litigation, assisting in the formulation of strategies, drafting opinion letters and providing memoranda, articles and other written materials.