Medicaid 1915(c) home and community-based service programs: data update

Developing home and community-based options as an alternative to institutional care has been a priority for many state Medicaid programs over the last two decades. While the majority of Medicaid long-term care dollars go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 15 percent in 1992 to 31 percent in 2002. Despite an improving fiscal situation, states continue to focus on measures to slow the growth in Medicaid spending. These cost containment strategies are having an impact on states’ capacity to expand Medicaid HCBS to meet the demands of consumers, federal policies such as the New Freedom Initiative, and the Supreme Court ruling in the Olmstead case.