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Medicaid Long-Term Services and Supports Shifts to Community Settings

Medicaid is the primary source of funding for long-term services and supports, providing care to millions of low-income Americans of all ages. When the program was first enacted, Medicaid provided long-term services primarily in institutional settings, like nursing homes. Over time, there has been a dramatic shift towards helping individuals with disabilities and seniors to live independently and avoid unwanted, unnecessary institutional care. All states now have waivers to offer home and community-based services to target populations. These waivers, along with state plan options such as personal care, Community First Choice, and the 1915(i) Home and Community Based Services (HCBS) authority, provide multiple mechanisms for states to continue to shift the focus of long-term services and supports to the community. Nationally, roughly 80% of non-elderly Medicaid beneficiaries with disabilities who use long-term services and supports now receive services in the community rather than in institutions. In addition, half of all elderly Medicaid beneficiaries who use long-term care are now receiving services and supports at home or in the community.

Under a Medicaid waiver, or the state plan options mentioned earlier, states can provide HCBS to a variety of populations, such as people with mental illnesses, intellectual or developmental disabilities, and/or physical disabilities. These authorities allow states to provide HCBS such as case management, homemaker services, personal care, home modifications, transportation, respite care and services for transition or diversion of people from institutions to their homes and communities.

In 2003, only 33% of long-term support and services expenditures were dedicated to HCBS. By 2013, the expenditures on long-term supports and services increased to 51%.

CMS is offering links/charts for informational purposes only, facts should not be construed as an endorsement of the organization's programs or activities

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