Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007.

Recent and deep fiscal problems at both the state and federal levels caused by the recession will bring new uncertainties for the provision of HCBS in the coming years. This is expected to impact the ability of many states to provide both acute and long-term care Medicaid services to the growing number of individuals eligible for Medicaid. The ongoing health reform debate also could affect Medicaid eligibility and services provided in home and community-based settings.



This report presents a summary of the main trends to emerge from the latest (2006) expenditures and participant data for the three main Medicaid Home and Community-Based Service programs: optional 1915 (the letter "c") HCBS waivers; the mandatory home health benefit; and the optional state plan personal care services benefit. 



It also presents findings from the survey of policies used on the three main Medicaid HCBS programs such as eligibility criteria, provider, service and waiting list data, and provider reimbursement rates for the home health benefit and the personal care services benefit in 2008 (abstract from: http://www.kff.org/medicaid/7720.cfm).