Medicaid LTSS Spending Shift to HCBS for Older Adults

Medicaid LTSS spending continues shift toward HCBS for older adults

Two new federal government reports indicate that Medicaid long-term care and support spending is still moving towards home- and community-based services, including assisted living community services.

The Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report 2018-2019 and the Medicaid Long Term Services and Supports Annual Expenditures Report FY 2020 from the Centres for Medicare & Medicaid Services offer insights into how states are utilizing waiver programs to offer alternatives to institutional care given in places like nursing homes.

1.9M served via section 1915(c) waivers

According to the waiver spending report, programs operating under the 1915(c) waiver, the programme most frequently linked to assisted living providers (as well as other providers), served 1.9 million participants in 2019, an increase of 5.2% from 2018.

In 2019, the average annual spending for older persons and people with physical disabilities was under $15,000, but the per-enrollee cost grew slightly over $30,000 yearly.

According to CMS, Section 1915(c), waiver programs are now a critical component of the Medicaid program. They are part of a larger “framework of progress” towards integrating people with disabilities and older adults into the community.

The agency further noted that many beneficiaries would prefer to receive care in the larger community.

There were 262 active waivers in 47 states in 2019—five fewer than the previous year.

Programs for the elderly and disabled accounted for 44.5% of participants in waiver programs. When combined with initiatives for those with developmental, intellectual, or autistic disorders, those categories accounted for 84.5% of waiver programme participants overall.

The average yearly spending per participant in the waiver programme 2019 was $30,063, accounting for 71.3% of the total annual Medicaid spending. Target groups’ average spending on waiver programs differed.

The two main categories of waiver programs—those catering to the elderly and disabled and those with autism or intellectual or developmental disabilities—showed comparable participation rates, although the average amount spent varied significantly.

While the average waiver programme spending per participant for individuals with disabilities and older adults was $14,395 in 2019, the average spending for the autism and intellectually or physically challenged category was $49,192, more than three times higher.

According to CMS, these results indicate a potential area for further research.

Waiver spending arrives at $53.8B

According to information provided by CMS in the Medicaid LTSS report, Arizona, New Jersey, Rhode Island, and Vermont are the four states that operated at least one section 1915(c) waiver program to provide HCBS in fiscal year 2020.

Over the past decade, the waiver program’s spending growth has fluctuated; however, in FY20, spending reached $53.8 billion.

Waiver program spending for individuals with autism or intellectual or developmental disabilities, as well as older persons and people with disabilities, accounted for 94.2% of all 1915(c) waive program spending in FY20.

The report states that the waiver program’s overall spending went to supporting older adults and people with disabilities by 17.5%.

In comparison, over three-fourths (76.7%) went to supporting people with autism or intellectual or developmental disabilities, and 5.8% went to supporting all other population groups, such as those with brain injuries, those who are medically fragile or dependent on technology, those with serious emotional disturbances, and those living with HIV/AIDS.

The number of eligible older persons and people with disabilities fell from 29% in FY18 to 18.3% in FY18 due to state LTSS system rebalancing initiatives to support cost-effective HCBS.

76 programs across 40 states provided services to individuals with disabilities and older adults in 2019, making up 29% of the recipients who were served under HCBS waiver programs.

About the author

Nancy Beverly

Nancy Beverly is a prominent political journalist and editor at World-Wire, known for her sharp analysis and deep understanding of global politics. With a Master's degree in Political Science, she excels in breaking down complex political issues, making them relatable to the public. At World-Wire, Nancy crafts compelling political narratives covering everything from local governance to international relations. Recognized for her expertise, she received the 'Excellence in Political Journalism' award in 2021. Nancy's work not only informs but also enriches her readers' understanding of political dynamics.

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