Following the publication of a first report by our group on the evaluation of future needs and costs related to the support of the autonomy of elderly people in Quebec (Clavet et al., 2021), this report aims to consider possible reform scenarios and to evaluate their impacts. They all have in common that they involve a major shift towards home care and services for people with moderate to major needs, and they all involve an adjustment of the resident's contribution to housing. According to our calculations, substantial savings are generated by the proposed reforms, compared to the status quo scenario. This makes it possible to improve home support through the creation of an autonomy account. With this account, the number of hours of publicly funded services is modulated according to the individual's support needs, thus ensuring horizontal equity in the system. Finally, we discuss the possibility of modulating public funding according to the person's financial resources, both in housing and home support, in order to improve vertical equity.