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Efforts to reform entitlement spending should recognize the following factors: 

States should fund the services needed to meet individuals’ LTSS needs and allow them to remain in the community.

States should coordinate LTSS programs, policies, and budgets. This can be done in one state agency or across multiple agencies.

Medicaid is the single largest public funding source for long-term services and supports (LTSS). It is a combined federal-state program. Some Medicaid services are federally mandated.

All federal and state agencies with a key role in financing or delivering LTSS should coordinate their efforts.

States should consolidate or coordinate agencies responsible for LTSS, including Medicaid, state-funded programs, Older Americans Act programs, and the state agency on aging.

The operations and functions of each organization in an Aging and Disability Resource Center (ADRC) model vary greatly. States should streamline eligibility determinations for LTSS programs.