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Long-Term Services and Supports Expenditures on Home & Community-Based Services


VISIT THE PILLAR: National Context

These data show expenditures on Home & Community-Based Services (HCBS) as a percent of total long-term services and supports (LTSS) spending by state for federal fiscal year (FFY) 2018. These data show the overall expenditures for HCBS as a percent of total LTSS and for the following population groups:

  • Older adults and people with physical disabilities
  • People with intellectual and/or developmental disabilities
  • People receiving behavioral health services
  • Other or multiple populations
Medicaid covers LTSS through a range of programs and settings. Through HCBS, people receive care in their own homes and communities instead of institutional settings. These programs serve many populations, including older adults and people with intellectual, developmental, or physical disabilities, or mental illness.

Expenditures on HCBS as a Percent of Total LTSS Expenditures

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Detailed description of visualization provided below

US Map with the categories and values:

State Category
Alabama 30.0-43.5%
Alaska 60.9-83.4%
Arizona 60.9-83.4%
Arkansas 43.6-52.4%
California Not available
Colorado 52.5-60.8%
Connecticut 52.5-60.8%
Delaware 43.6-52.4%
Distict of Columbia 60.9-83.4%
Florida 30.0-43.5%
Georgia 43.6-52.4%
Hawaii 43.6-52.4%
Idaho 52.5-60.8%
Illinois Not available
Indiana 30.0-43.5%
Iowa 30.0-43.5%
Kansas 60.9-83.4%
Kentucky 30.0-43.5%
Louisiana 30.0-43.5%
Maine 52.5-60.8%
Maryland 60.9-83.4%
Massachusetts 60.9-83.4%
Michigan 30.0-43.5%
Minnesota 60.9-83.4%
Mississippi 30.0-43.5%
Missouri 52.5-60.8%
Montana 52.5-60.8%
Nebraska 52.5-60.8%
Nevada 60.9-83.4%
New Hampshire 43.6-52.4%
New Jersey 30.0-43.5%
New Mexico 60.9-83.4%
New York Not available
North Carolina Not available
North Dakota 30.0-43.5%
Ohio 52.5-60.8%
Oklahoma 43.6-52.4%
Oregon 60.9-83.4%
Pennsylvania 52.5-60.8%
Rhode Island 30.0-43.5%
South Carolina 43.6-52.4%
South Dakota 43.6-52.4%
Tennessee 43.6-52.4%
Texas 52.5-60.8%
Utah 43.6-52.4%
Vermont 52.5-60.8%
Virginia Not available
Washington 60.9-83.4%
West Virginia 30.0-43.5%
Wisconsin 60.9-83.4%
Wyoming 43.6-52.4%

National Percent of Total LTSS Expenditures by Population Category

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Detailed description of visualization provided below.

Bar Graph with the categories and values:

Category Percent
Older Adults & People with Physical Disabilities 55.2%
People with Intellectual and/or Developmental Disabilities 25.2%
Behavioral Health Services 6.8%
Other/Multiple Populations 12.8%

Expenditures on HCBS as a Percent of Total LTSS Expenditures for Older Adults & People with Physical Disabilities

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Detailed description of visualization provided below.

US Map with the categories and values:

State Category
Alabama 3.0-20.7%
Alaska 37.5-71.9%
Arizona 37.5-71.9%
Arkansas 26.8-37.4%
California Not available
Colorado 37.5-71.9%
Connecticut 26.8-37.4%
Delaware 20.8-26.7%
Distict of Columbia 37.5-71.9%
Florida 20.8-26.7%
Georgia 26.8-37.4%
Hawaii 3.0-20.7%
Idaho 37.5-71.9%
Illinois Not available
Indiana 3.0-20.7%
Iowa 3.0-20.7%
Kansas Not available
Kentucky 3.0-20.7%
Louisiana 20.8-26.7%
Maine 26.8-37.4%
Maryland 3.0-20.7%
Massachusetts Not available
Michigan 26.8-37.4%
Minnesota 37.5-71.9%
Mississippi 26.8-37.4%
Missouri 37.5-71.9%
Montana 20.8-26.7%
Nebraska 26.8-37.4%
Nevada 26.8-37.4%
New Hampshire Not available
New Jersey 20.8-26.7%
New Mexico 37.5-71.9%
New York Not available
North Carolina Not available
North Dakota 3.0-20.7%
Ohio 37.5-71.9%
Oklahoma 26.8-37.4%
Oregon 20.8-26.7%
Pennsylvania Not available
Rhode Island 3.0-20.7%
South Carolina 26.8-37.4%
South Dakota 20.8-26.7%
Tennessee 3.0-20.7%
Texas Not available
Utah 20.8-26.7%
Vermont Not available
Virginia Not available
Washington 3.0-20.7%
West Virginia 20.8-26.7%
Wisconsin 37.5-71.9%
Wyoming 20.8-26.7%

Expenditures on HCBS as a Percent of Total LTSS Expenditures for People with Intellectual and/or Developmental Disabilities

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Detailed description of visualization provided below.

US Map with the categories and values:

State Category
Alabama 91.3-100.0%
Alaska 91.3-100.0%
Arizona Not available
Arkansas 11.7-75.1%
California Not available
Colorado 91.3-100.0%
Connecticut 75.2-81.1%
Delaware 75.2-81.1%
Distict of Columbia 11.7-75.1%
Florida 75.2-81.1%
Georgia 91.3-100.0%
Hawaii 91.3-100.0%
Idaho 81.2-91.2%
Illinois Not available
Indiana 75.2-81.1%
Iowa 11.7-75.1%
Kansas Not available
Kentucky 75.2-81.1%
Louisiana 11.7-75.1%
Maine 81.2-91.2%
Maryland 91.3-100.0%
Massachusetts Not available
Michigan 91.3-100.0%
Minnesota 81.2-91.2%
Mississippi 11.7-75.1%
Missouri 81.2-91.2%
Montana 91.3-100.0%
Nebraska 75.2-81.1%
Nevada 81.2-91.2%
New Hampshire Not available
New Jersey 11.7-75.1%
New Mexico 91.3-100.0%
New York Not available
North Carolina Not available
North Dakota 11.7-75.1%
Ohio 11.7-75.1%
Oklahoma 75.2-81.1%
Oregon 91.3-100.0%
Pennsylvania Not available
Rhode Island Not available
South Carolina 11.7-75.1%
South Dakota 75.2-81.1%
Tennessee 75.2-81.1%
Texas Not available
Utah 75.2-81.1%
Vermont Not available
Virginia Not available
Washington 11.7-75.1%
West Virginia 81.2-91.2%
Wisconsin 81.2-91.2%
Wyoming 81.2-91.2%

Expenditures on HCBS as a Percent of Total LTSS Expenditures for Behavioral Health Services

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Detailed description of visualization provided below.

US Map with the categories and values:

State Category
Alabama 39.2-70.0%
Alaska 0.0-7.9%
Arizona 39.2-70.0%
Arkansas 70.1-100.0%
California Not available
Colorado 70.1-100.0%
Connecticut 8.0-39.1%
Delaware 39.2-70.0%
Distict of Columbia 8.0-39.1%
Florida 0.0-7.9%
Georgia 70.1-100.0%
Hawaii 70.1-100.0%
Idaho 0.0-7.9%
Illinois Not available
Indiana 8.0-39.1%
Iowa 8.0-39.1%
Kansas Not available
Kentucky 0.0-7.9%
Louisiana 0.0-7.9%
Maine 8.0-39.1%
Maryland 70.1-100.0%
Massachusetts Not available
Michigan 0.0-7.9%
Minnesota 8.0-39.1%
Mississippi 39.2-70.0%
Missouri 8.0-39.1%
Montana 39.2-70.0%
Nebraska 0.0-7.9%
Nevada 70.1-100.0%
New Hampshire Not available
New Jersey 0.0-7.9%
New Mexico 8.0-39.1%
New York Not available
North Carolina Not available
North Dakota 8.0-39.1%
Ohio 70.1-100.0%
Oklahoma 39.2-70.0%
Oregon 70.1-100.0%
Pennsylvania Not available
Rhode Island 70.1-100.0%
South Carolina 8.0-39.1%
South Dakota 39.2-70.0%
Tennessee 70.1-100.0%
Texas Not available
Utah 39.2-70.0%
Vermont Not available
Virginia Not available
Washington 0.0-7.9%
West Virginia 39.2-70.0%
Wisconsin 39.2-70.0%
Wyoming 0.0-7.9%

Expenditures on HCBS as a Percent of Total LTSS Expenditures for Other/Multiple Populations

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Detailed description of visualization provided below.

US Map with the categories and values:

State Category
Alabama 100%
Alaska 100%
Arizona 90.0-99.9%
Arkansas 100%
California Not available
Colorado Not available
Connecticut 100%
Delaware 100%
Distict of Columbia 100%
Florida 61.2-89.9%
Georgia 100%
Hawaii 61.2-89.9%
Idaho 100%
Illinois Not available
Indiana 100%
Iowa 100%
Kansas Not available
Kentucky 100%
Louisiana 100%
Maine 100%
Maryland 100%
Massachusetts Not available
Michigan 100%
Minnesota 90.0-99.9%
Mississippi 100%
Missouri 100%
Montana 100%
Nebraska 100%
Nevada 100%
New Hampshire Not available
New Jersey 100%
New Mexico 100%
New York Not available
North Carolina Not available
North Dakota 100%
Ohio 100%
Oklahoma 100%
Oregon 100%
Pennsylvania Not available
Rhode Island 100%
South Carolina 100%
South Dakota 100%
Tennessee 100%
Texas Not available
Utah 100%
Vermont Not available
Virginia Not available
Washington 100%
West Virginia 100%
Wisconsin 100%
Wyoming 100%

These data show expenditures on home & community-based services as a percent of total long-term services and supports spending by state.

Source: Medicaid Long Term Services and Supports Annual Expenditures Report: Federal Fiscal Years 2017 and 2018

Notes: These data should be interpreted with caution, as there are a number of data limitations. For example, data from states using managed care arrangements to provide LTSS (called MLTSS) include estimates that were collected from states by the study’s researchers. Researchers requested state estimates of expenditures for the most common LTSS program authorities, but not less common authorities.

There are several changes to the population categories for the FFY 2018 calculations compared to previous years. Expenditures from Community First Choice (CFC) programs have been combined with the “Older Adults & People with Physical Disabilities” population category. The “Other/Multiple Populations” category is new in the FFY 2018 rebalancing calculations.

Data for California, Illinois, New York, and Virginia were not included because much of their FFY 2018 LTSS was delivered through managed care. Detailed information about HCBS and institutional spending within managed care was not available.

North Carolina submitted total MLTSS expenditures. However, because the state did not break out spending by HCBS or institutional services, it is excluded from the rebalancing calculations. North Carolina is included in the Total LTSS expenditure calculations only.

South Carolina did not submit their MLTSS expenditures. However, because the MLTSS expenditures do not account for a large proportion of overall LTSS expenditures, they are included in the rebalancing calculations.

Kansas, Massachusetts, Pennsylvania, Texas, and Vermont did not provide category of service breakouts for either their total HCBS and/or total institutional MLTSS expenditures for 2018, and are excluded from the rebalancing calculations.