In response to consumer demand, policies such as the New Freedom Initiative and the Supreme Court decision in the Olmstead case, states have unevenly expanded combinations of three Medicaid home and community based services (HCBS) for the elderly : home health, state plan personal care services (PCS), and 1915(c) waivers.

With 43 states reporting budget deficits in 2003, the key elements of the Deficit Reduction Act (2005) reflect growing concern about Medicaid HCBS and the need for information on program and policy trends.

This paper draws from a unique national dataset to present the latest trends in participants, expenditures and policies for the three Medicaid HCBS programs serving the elderly. Trend data (1999-2004) show a steady increase in participants and expenditures in each program although growth rates have slowed since 2001. Findings from an annual survey of policies used on the programs in 2006 show that states are increasing the number of waiting lists for waiver services even as the number of available "slots" increases. Cost caps such as service and cost limits are also used in almost half the state plan personal care programs and almost a third of home health programs.

Benefits and Learning Objectives
Highlight the program and policy trend of Medicaid Home and Community Based Services.