Medicaid LTSS Balance: Spending

This Scorecard for the first time finds that more than half of Medicaid LTSS spending nationally for older people and adults with physical disabilities went to HCBS, at a rate of 53 percent in FY 2020(the year this Scorecard uses to score and rank states) Eleven states exceed this national average. In addition, more than a quarter (14) of states spend the majority of Medicaid LTSS funding for older people and adults with physical disabilities on HCBS (up from seven states in 2009). In 18 states, however, significant opportunity to improve exists as these states spend less than $1 in $3 Medicaid LTSS dollars on HCBS for older adults and people with physical disabilities.

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* data not available (including concerns about data quality) or not calculated due to missing data needed for calculation.
** indicator not calculated.  An imputed value was used for scoring, but not displayed or ranked.


The percentage of Medicaid LTSS spending for programs used primarily by older people and adults with physical disabilities going to HCBS programs as opposed to facility-based services.  

Both current and reference year data are taken from the 2020 LTSS Expenditure Report.  The services included (except as noted below) are nursing homes, other institutional LTSS, home health, personal care, 1915(c) waivers for aged and physically disabled, Community First Choice, Money Follows the Person, PACE, private duty nursing, 195(i), other HCBS LTSS, 1115/1915(b), and 1915(j).

The most current data year is 2020 and the reference data year is 2018, where possible.  AARP Public Policy Institute made the following adjustments to several states to address issues of data quality, completeness, and comparability.

Other MLTSS spending was fully allocated to older people and adults with physical disabilities in Delaware, Hawaii, and Tennessee.  13% of other MLTSS spending was allocated in Iowa.  Other MLTSS spending was excluded in all other states. Community First Choice spending in Oregon was allocated 41% to older people and adults with physical disabilities.

Mathematic Policy Research: Email correspondence (January 2023), Medicaid LTSS Expenditure Report: Email correspondence (January 2023)


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