States have significant roles in implementing practically all aspects of the Affordable Care Act. The Act gives states additional options for financing Medicaid home and community based services and supports (HCBS) through a combination of enhanced Medicaid matching payments, demonstrations, and new Medicaid state plan options. They include the State Balancing Incentive Payments Program, the Money Follows the Person Rebalancing Demonstration, State Plan HCBS, and Community First Choice Option. This issue brief analyzes the scenarios under which states might adopt them. In making those determinations, states will assess whether the new options improve upon the Medicaid authorities they currently use to finance HCBS, namely Medicaid 1915(c) HCBS waivers and state plan personal assistance.