The federal government is aggressively attempting to keep people out of skilled nursing facilities by enrolling them in home- and community-based programs instead, the Associated Press reports.

The push comes as care demands continue to escalate among the aged. 

As Medicaid is one of the largest expenses facing most states, officials are looking to cut costs by trimming growth among the skilled care population. 

In 2013, $89 billion of the $146 billion that states spent on Medicaid in 2013 went toward care for the elderly, the AP reported.

In addition, some states are switching from fee-for-service to managed care payment systems. To address concerns, proposed federal regulations due this spring aim to strengthen consumer protections.