Although transitioning people out of institutions can save money over the long term, the process can incur major costs, and not all may be reimbursable by Medicaid. Given this, it makes sense for states to consider strategies that will divert people from entering institutions in the first place and ensure a quick return to the community if placement is unavoidable.
The ICFs/ID experience illustrates that the best transition program is one that makes sure that very few people will need to be transitioned. In the ID/DD field, this is known as the front door/back door connection. Little progress with transitioning can be made as long as the front door to the institution remains open; intervention before inappropriate placement (i.e., diversion) is easier than intervention after placement.