Long-term Services and Supports Expenditure Reports Project
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services
Medicaid Long-Term Services and Supports Annual Expenditures Report: Federal Fiscal Years 2017 and 2018
Associated Project
Key Findings
- The share of long-term services and supports (LTSS) out of total Medicaid expenditures declined from 47 percent in FY 1988 to 32 percent in FY 2018.
- The percentage of home and community-based services (HCBS) expenditures of total Medicaid LTSS expenditures has steadily increased over the last three decades, but it has slowed in recent years. The U.S. total toward HCBS surpassed the long-standing benchmark of 50 percent of LTSS expenditures in FY 2013 and has remained higher than 50 percent since then, reaching 55.4 percent in FY 2017 and 56.1 percent in FY 2018.
- The absolute amount spent on managed long-term services and supports programs increased more than three-fold in the past 20 years, climbing from $6.7 billion in FY 2008 to $30.1 billion in FY 2018.
- LTSS expenditures vary considerably across states and are influenced by factors such as demographics, the Medicaid landscape, and existing program structures within a given state.
Long-term services and supports (LTSS) cover a wide range of medical and nonmedical services and supports for people with physical, cognitive, mental, or other disabilities or conditions. These can include institutional care such as those provided in nursing facilities and mental health facilities, and home and community-based services (HCBS) such as personal care and home health, among other services approved by CMS. Medicaid is the primary payer of LTSS, covering just over half of all spending for such services and supports (O’Malley Watts et al. 2020). Over the past several decades, the U.S. Supreme Court 1999 Olmstead decision, federal and state initiatives, and consumer preferences have led to shifts in LTSS expenditure patterns across settings and service types, including shifts towards rebalancing away from institutional services toward more HCBS.
This report is the latest in a series of reports on Medicaid LTSS expenditures sponsored by the Centers for Medicare & Medicaid Services (CMS). It contains detailed information about Medicaid LTSS expenditures at the national and state levels by service category, LTSS setting, payment model, and targeted population subgroups for federal fiscal year (FY) 2017 (October 2016 to September 2017) and FY 2018 (October 2017 to September 2018). The accompanying Excel attachment contains state data tables, managed LTSS expenditures, and additional non-LTSS expenditures for several relevant categories. The report is based on data from several sources, including Medicaid CMS-64 expenditure reports, state-reported managed LTSS (MLTSS) expenditures, Money Follows the Person (MFP) worksheets for proposed budgets, CMS 372 report data for section 1915(c) waiver programs, and U.S. Census data.
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