The Affordable Care Act of 2010 builds on earlier efforts to expand home and community-based alternatives to institutional long-term care. Identifying people living in the community who have unmet long-term care needs and who may be at risk for entering nursing homes may be crucial to these efforts. The Arkansas Community Connector Program used specially trained community health workers to identify such people in three disadvantaged counties and connect them to Medicaid home and community-based services. The result was a 23.8 percent average reduction in annual Medicaid spending per participant during the period 2005–08. Net three-year savings to the Arkansas Medicaid program equaled $2.619 million. Similar interventions may help other localities achieve cost-saving and equitable access to publicly funded long-term care options other than institutional care.