Vermont Department of Banking, Insurance, Securities, and Health Care Administration wrote in The 2009 Health Resource Allocation Plan that home health agencies in Vermont were struggling in the current financial climate. "Kaye, et al. show that states that expand home and community based services may spend more money on Medicaid long-term care services initially, but ultimately see a reduction in spending and long term savings.(Kaye, H.S., LaPlante, M.P., & Harrington, C. 2009) If Vermont intends to continue to support its strong commitment to home health care services as an alternative to institutional care, we must be cautious about putting additional financial strain on this system."