The Affordable Care Act includes many new provisions for long-term services and supports (LTSS). Among these are several new options, improvements, and incentives within Medicaid to balance service systems and expand access to home and community-based services. This article discusses some of the major provisions, implementations, and implications of the new LTSS policies. It also examines how the major principles of rehabilitation counseling are central to advancing LTSS policy and how rehabilitation counselors can play a key role in ensuring quality LTSS services for persons with disabilities.