A report released by the Kaiser Family Foundation in September summarizes lessons from states whose Medicaid programs are at the forefront of Home and Community-Based Services (HCBS).

From the report:

Historically, most long-term services and supports financed by Medicaid have been provided in institutions, but the trend is toward offering more community-based services. States at the forefront in this respect are more likely than others to have certain characteristics in common: a philosophical commitment, sometimes accompanied by legislative direction, to provide more options for consumers; a single administrative agency; and global budgeting for the provision of all long-term services and supports rather than separate budgets for institutional and community-based services. Even without major re-focusing and restructuring, however, states have the capacity to make practical operational changes to promote community-based services and supports. This report describes current options for state Medicaid programs and draws on interviews with state officials to provide details about specific policies and procedures in states.  

Full report: Efforts in States to Promote Medicaid Community-Based Services and Supports (PDF | 232.41 KB)

The Kaiser Family Foundation. (2009). Efforts in states to promote Medicaid community-based services and supports. Summer, Laura.