In Ohio and nationally, a significant share of Medicaid is dedicated to patients who are elderly or have disabilities. Too often, this is in a high-cost nursing home setting. The ACA offers incentives to encourage more cost-effective home care services for people who need help with dressing, bathing, chores, preparing meals, or other activities of daily living. A study of state expenditures on long-term care and services between 1995 and 2005 found that states with broad access to home and community-based services realized cost savings in the long term as they shifted from institutionalized settings (nursing homes) to home care services, although there was a short-term increase in costs during the shift.

The ACA offers new opportunities to help states provide long-term services and supports to people in their homes. This brief examines two of the programs: The Balancing Incentives Payment Program, which increases federal matching funds for states like Ohio by two percentage points through 2015 for increased home and community-based services, helping with any up-front costs, and the permanent Community First Choice Option (CFCO) which provides a boost of six percentagepoints, from 63.58 to 69.58 percent, in federal funding for personal attendant services in the home or community.