Nearly 1 in 11 Californians ages 65+ lives in a rural community. Rural California has higher proportions of older adults, adults with disabilities, and chronic illness, yet faces severe shortage of services and providers. Long-Term Services and Supports (LTSS), including home- and community-based services (HCBS) and institutional care, are essential for dignity, independence, and cost-effective care. While institutional care remains necessary for some, HCBS allows more people to remain safely at home and reduces state spending on costly nursing home and hospital care. 

Federal budget cuts through H.R.1 (2025-2026) and a tight fiscal environment create real constraints on new investments. Yet failing to act on rural LTSS will lead to higher long- term costs through preventable hospitalizations, premature institutionalization, workforce gaps and turnover. Authors' policy recommendations prioritize scalable, cost- effective strategies that strengthen care now while reducing expenditures over time.