As states continue to implement various aspects of the Affordable Care Act (ACA), developing and expanding home and community-based alternatives to institutional care remains a priority for many state Medicaid programs. While the majority of Medicaid long-term services and supports (LTSS) dollars still go toward institutional care, the national percentage of Medicaid spending on home and community-based services (HCBS) has more than doubled from 20 percent in 1995 to 45 percent in 2012. State Medicaid programs are operating in an environment of slow economic recovery and as of 2014, are facing the competing priorities of implementing the ACA’s new streamlined eligibility and enrollment processes and determining whether to adopt the ACA’s Medicaid expansion. States also are choosing among the ACA’s new and expanded LTSS options, some of which offer enhanced federal matching funds, to expand beneficiary access to Medicaid HCBS.
This report summarizes the key national trends to emerge from the latest (2011) participant and expenditure data for the three main Medicaid HCBS programs: (1) the mandatory home health services state plan benefit, (2) the optional personal care services state plan benefit, and (3) optional § 1915(c) HCBS waivers. It also briefly discusses the provision of Medicaid HCBS through § 1115 demonstration waivers and highlights findings from a 2013 survey of Medicaid HCBS participant eligibility, enrollment, and provider reimbursement policies. It does not include enrollment and spending for the Money Follows the Person, § 1915(i) HCBS state plan option, Balancing Incentive Program, or Community First Choice state plan option.
– The Kaiser Family Foundation