Analysis shows concentration of home- and community-based services in urban areas, highlighting rural access issues.
The rebalancing of Medicaid LTSS toward home- and community-based services appears to be concentrated in larger cities, with other areas, particularly rural, lagging behind. Given challenges with nursing home closures and workforce shortages, more attention on rural access to HCBS is needed amid efforts to rebalance toward noninstitutional LTSS.
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Keesee et al. (2026) studied this question.
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