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Medicaid Home and Community-Based Services Programs: 2010 Data Update

Over the past three decades, state policymakers have responded to beneficiary preferences for alternatives to institutional care, and a growing number of options have become available to states to expand access to Medicaid HCBS. In 2010, the number of Medicaid enrollees receiving HCBS in the three major programs grew to almost 3.2 million, which represents a slight one percent increase over the previous year and the lowest rate of growth since 2006. The three percent increase in the number of Medicaid enrollees in § 1915(c) HCBS waivers from 2009 to 2010, waiver waiting list enrollment of almost 524,000 persons nationally, and waiting times of more than two years highlight the need for community-based LTSS, especially for individuals with I/DD and aged or disabled populations. The average annual growth rates in Medicaid HCBS participants and expenditures continue to vary widely among states.

Even as a slow economic recovery continues, pressure on state budgets will mean states may face uncertainties for the provision of Medicaid services in the coming years. States are continuing to utilize cost control measures within their Medicaid programs even as state finances slowly improve from the worst of the recent financial crisis. In response to fiscal pressures and a desire to better coordinate beneficiaries’ LTSS, some states are looking to incorporate HCBS into Medicaid managed care arrangements, and the inclusion of LTSS in  § 1115 waivers highlights the importance of evaluating the impact of those initiatives on HCBS access. Additionally, the integration of LTSS with acute care services in the financial alignment demonstrations for dual eligible beneficiaries established by the ACA will be evaluated to determine the potential impact on increasing access to HCBS for some of the most vulnerable populations. States also are exploring the new and expanded options, some with financial incentives, to increase access to HCBS offered by the ACA as well as implementing the ACA’s new streamlined eligibility and enrollment processes and the Medicaid expansion. In this context, it is important to monitor the differences in services and spending across states as well as the impact of HCBS cost controls on access, quality, and overall Medicaid costs.

This report was prepared by Terence Ng and Charlene Harrington of the University of California, San Francisco, and MaryBeth Musumeci and Erica L. Reaves of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. All findings are drawn from the researchers’ analysis of CMS Form 372 data, their annual surveys of the Medicaid home health state plan services, personal care state plan services, and § 1915(c) HCBS waiver programs, and state reports.

Medicaid Home Health and Personal Care Services State Plan Benefits