Ten years ago, 60 percent of Arizonians covered by Medicare and Medicaid, too sick, frail or disabled to live in a nursing home, lived in a skilled nursing facility. Today, only 27 percent do and of the rest, nearly three out of four live in assisted living facilities or at home with the help of professionals provided for by government health plans. But how did Arizona, a conservative state that has resisted PPACA tooth and nail, manage such a thing? By crafting a novel public-private approach that pays health plans a set monthly fee which is expected to cover all of a patient’s needs. Might this be the model every other state should follow?