States primarily finance Medicaid home and community based services through waivers and personal assistance services under the state plan. The ACA provides additional options for designing and funding these Medicaid benefits that states must now consider.

*Milestone details:

*Full name: Decide whether to adopt the new Medicaid options for financing home and community-based long-term services and supports.

*Relevance to the ACA:

The ACA gives states additional ways to finance Medicaid home and community based services and supports through a combination of enhanced matching payments, demonstrations, and state plan options. States will want to assess whether to adopt these new options and/or continue funding services through the vehicles they already use. Sections that establish new financing options are:

§2401 – Community First Choice Option gives states an enhanced match rate for covering home and community based attendant services and supports.

§ 2402 - State Plan Home and Community Based Services permits states to provide a combination of supports to eligible individuals.

§10202 – State Balancing Incentives Payment Program provides eligible states with increased FMAP for Medicaid home and community based services and supports if they make certain changes to their service delivery systems.