Long-Term Services and Support: Reform Strategies
Initiative	Funders	Focus	Evaluation
Cash and Counseling	Administration on Aging, Robert Wood Johnson Foundation, Office of Planning and Evaluation, and APSE at the Department of Health and Human Services $25 million 2004–2006 www.cashandcounseling.org	Individuals of various ages and disabilities direct their own supportive services and hire their own care managers with an individualized budget. Eleven new states funded in October 2004 that follow pilots in Florida, New Jersey, and Arkansas. New states are Alabama, Iowa, Kentucky, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia.	Independent evaluation will study costs, consumer satisfaction, access to home-based services, and quality-of-life changes.
Aging and Disability Resource Centers (ADRCs)	Administration on Aging and Centers for Medicare and Medicaid Services (CMS) $19 million 2003–2006 www.adrc.org	Create a single, coordinated system of information and access for all people seeking long-term support to enhance individual choice and informed decision making. The 23 states funded are Louisiana, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, Pennsylvania, Rhode Island, South Carolina, West Virginia, Arkansas, Alaska, California, Florida, Georgia, Illinois, Indiana, Iowa, New Mexico, North Carolina, and Wisconsin.	Will evaluate whether the Resource Centers increase informed decision making, meaningful choice, and access to long-term services and supports in the most integrated setting.
Real Choice Systems Change Grants	CMS $200 million 2001–2007 www.hcbs.org	States are funded to build infrastructure and pursue policy changes that result in “effective and enduring improvements in community long-term support systems.” There have been four rounds of funding that states have competed for that target specific theme areas, such as integrating long-term supports with accessible affordable housing, improving and expanding personal assistance services that are consumer directed, and enhancing quality management systems. Other grants focus on comprehensive system reform efforts.	Focus on sustainable system changes concerning the approach to service delivery, exercise of meaningful choices with expanded support options to live in the most integrated setting appropriate, rebalancing of funding to expand community living preferences and priorities, and nursing home diversion and transition. All states have one or more grants.
Independence Plus Waiver Demonstration	CMS www.cms.hhs.gov/ independenceplus	States are funded through the HCBS waiver authority to offer individualized budgets and consumer self-direction. Nine states have been approved: California, New Hampshire, Louisiana, South Carolina, Maryland, Florida, North Carolina, Connecticut, and Delaware	Focus on cost savings, consumer satisfaction and outcomes, and other benefits of consumer direction.