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The demand for long-term care in the United States is rapidly rising due to the high growth rate of the elderly population. Along with other states, New Hampshire and Vermont must develop financially viable strategies to ensure adequate and efficient programs for long-term care. Medicaid is the largest public source of funding long-term care but it is administered differently from state to state. This paper focuses on the contrast between New Hampshire and Vermont Medicaid programs for long-term care. It explains how New Hampshire may reduce its disproportionately high average Medicaid long-term care costs by adopting elements of the Vermont model and reducing its reliance on institutional care. It also explores other potential initiatives such as social insurance and the promotion of preventative care programs.