This AARP Public Policy Institute research paper examines the extent to which states have balanced the delivery of Medicaid-funded long-term care (LTC) services and supports to people in their homes (or in more home-like settings in their communities) and in institutions. What is unique about this report is its primary focus on older people and adults with physical disabilities separate from other LTC populations, such as people with developmental disabilities. The paper explores what states have been able to accomplish under current Medicaid law and addresses the impact that federal policies have on the states' ability to balance service delivery.

This report is designed to stimulate LTC reform that will improve and increase
options for older adults and people with disabilities. The ability of some states
to accomplish substantial reforms for older people and adults with physical
disabilities - as well as successes in the mental retardation/developmental
disabilities movement, which have led to increased home and community
based services options for many - demonstrates that obstacles to change can
be overcome (abstract from: http://www.aarp.org/research/longtermcare/programfunding/2008_10_ltc.html).