Medicaid Long-Term Services and Supports Use and Expenditures by Service Category, 2019–2021
Download
Associated Project
Long-term Services and Supports Expenditure Reports Project
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services
Key Findings
- 7.5 million home and community-based services (HCBS) users had $115.0 billion in HCBS spending in 2021. HCBS users and expenditures increased by 0.3 percent and 18.4 percent, respectively, from 2019 to 2021.
- 1.5 million institutional service users had $67.0 billion in institutional spending in 2021. Institutional users and expenditures decreased by 18.0 percent and 7.2 percent, respectively, from 2019 to 2021.
- Fee-for-service (FFS) accounted for 46.2 percent of long-term services and supports (LTSS) users and 62.0 percent of LTSS expenditures in 2021, while managed care accounted for 60.3 percent of LTSS users and 38.0 percent of LTSS expenditures.
Federal Medicaid rules allow states to cover a wide range of institutional and home and community-based LTSS. States use a combination of different programs, types of services, and delivery models to serve people who need LTSS. We analyzed the national distribution of Medicaid users and expenditures across different HCBS and institutional categories for 2021 using data from the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF). We also analyzed trends in HCBS and institutional users and expenditures between 2019 and 2021. We found far more people received HCBS than institutional services in 2021, and HCBS expenditures accounted for a higher proportion of LTSS spending than institutional services. States used a combination of different programs and state plan options to deliver these services, with state plan home health services as the most common among HCBS users, section 1915(c) waiver program services as the largest HCBS expenditure category, and nursing facility users and expenditures comprising the majority of institutional users and expenditures.
More like this from Mathematica
Featured Project
Long-term Services and Supports Expenditure Reports Project
How do you apply evidence?
Take our quick four-question survey to help us curate evidence and insights that serve you.
Take our survey