A recent AARP Public Policy Institute research paper examines the extent to which states have balanced the delivery of Medicaid-funded long term care (LTC) services and support to people in their homes (or in more home-like settings in their communities) and in institutions. The paper explores what states have been able to accomplish under current Medicaid law and addresses the impact that federal policies have on the states' ability to balance service delivery.
This report is designed to stimulate LTC reform that will improve and increase options for older adults and people with disabilities.
Findings include:
- In 2006, only seven states spent 40 percent or more of their Medi-caid LTC dollars for older people and adults with physical disabilities on home and community-based services (HCBS): Alaska, California, Minnesota, New Mexico, Oregon, Texas, and Washington.
- Medicaid long-term services and support (LTSS) funds for older people and adults with disabilities going toward HCBS vary greatly among states, from less than 5 percent to more than 50 percent.
- As a whole, the nation made progress in balancing its growth of Medicaid LTC expenditures for elderly consumers and adults with disabilities from 2001 to 2006 by increasing HCBS spending by $6.1 billion, compared with a $6.6 billion increase for nursing home services.
- However, progress in balancing Medicaid spending varied greatly among states. In 22 states, the dollar increase in Medicaid spending on HCBS from fiscal years 2001 to 2006 was greater than the dollar increase in spending on nursing home care. Another 27 states added more Medicaid funds to nursing home services than to HCBS during these five years.
- The nation made considerable progress by placing more elderly consumers and adults with physical disabilities on home and community-based services, compared with the number that were served in nursing homes from 1999 to 2004.
- The number of HCBS participants increased from 1999 to 2004 in 43 states and declined in seven. In 27 states, the number of nursing home participants increased over the same period, while the number declined in 24 states.
The report offered several recommendations for reforms, including the adoption of federal and state policies that allow consumers to receive LTC services in the setting of their choice, adoption of nursing home diversion programs that prevent people from ever entering a nursing home, elimination of waiting lists for HCBS, and increased support for family caregivers.
