Policy-makers are consistently challenged to make the most of available resources. . HSRI has extensive experience assisting policy-makers to review and revise, as needed, their financing strategies and operations. This could include shifting dollars among services to secure meaningful savings that can be redirected. It may also involve use of state tax dollars to leverage federal Medicaid reimbursement through development of Home and Community Based Services “waivers” or federal alternatives. HSRI also assists states to weave together various means to establish the most efficient and effective financing strategies. In work with the Centers for Medicare and Medicaid Services, HSRI prepared an overview of the use of “supports waivers” to stretch available resources to meet the needs of people on waiting lists. HSRI has also provided technical assistance to states regarding the use alternative waiver strategies including 1915(i). We have also assisted managers in a managed care setting regarding financing options.