Vermont's Choices for Care experiment in long-term services, created through a five-year Medicaid waiver in 2005, was designed to increase access to home and community-based services while reducing the use of institutional services and controlling overall costs. In exchange for agreeing to a federal funding cap, Vermont was able to expand access to community-based services and extend some services to a "moderate need" group for the first time to test the theory that early interventions can be cost-effective and help keep people in community settings. In the three years since, the state has seen a shift of people and money toward community settings, but also the return of waiting lists for some populations. Because of circumstances unique to Vermont, it is unclear how appropriate this waiver approach would be for other states.

 Report (.pdf)