Medicaid Long-Term Services and Supports Users and Expenditures by Service Category, 2022
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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
- In 2022, 7.8 million home and community-based services (HCBS) users accounted for $129.4 billion in HCBS spending. HCBS users and expenditures increased by 5.1 percent and 12.5 percent, respectively, from 2021 to 2022.
- In 2022, 1.5 million institutional service users accounted for $71.0 billion in institutional spending. Institutional users and expenditures increased by 0.8 percent and 6.1 percent, respectively, from 2021 to 2022.
- Fee-for-service (FFS) accounted for 45.8 percent of long-term services and supports (LTSS) users and 62.6 percent of LTSS expenditures in 2022, whereas managed care accounted for 60.2 percent of LTSS users and 37.4 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 2022 using data from the Transformed Medicaid Statistical Information System Analytic Files (TAF). We also analyzed trends in HCBS and institutional users and expenditures between 2021 and 2022. We found far more people received HCBS than institutional services in 2022, 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 rehabilitative 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.
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