Cynthia Shirk

Document Type

Issue Brief

Publication Date



The Real Choice Systems Change grant program was created to help states transform their long-term care service systems from ones that rely on institutions to ones that are more community-based. The grants are intended to help states develop the infrastructure needed for seniors and individuals with disabilities to live in integrated community settings. This issue brief provides information about Systems Change grants and the kinds of activities state Medicaid agencies have undertaken to transform their institutionally based systems. In addition, this paper reports on some of the qualitative and quantitative responses to the changes. This brief also raises critical policy questions related to public spending for long-term care in different settings that might be considered in tandem with future grant funding decisions.


Issue brief no. 822

Open Access




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