ABSTRACT
This chapter analyses the status of home and community-based services in the United States at the state level, where most long-term care policy is formulated and implemented. It provides a brief overview of the American system of long-term care financing and then focuses on how home and community-based services are financed at the state level. Financing for long-term care services, such as nursing home care and home and community-based services, is through a combination of Medicaid, Medicare, state-funded programmes, out-of-pocket payments and private insurance. The administrative fragmentation at the state level is often compounded by fragmentation at the local level, and few states have a single point of entry to the long-term care system. Most states separate assessment and case management from service provision in order to avoid conflict of interest. The states' home health benefit consists of traditional nursing, therapy, and home health aide services provided by certified agencies.
