Trends in Users and Expenditures for Home and Community-Based Services as a Share of Total Medicaid LTSS Users and Expenditures, 2022

Federal Medicaid rules allow states to cover a wide range of institutional and home and community-based LTSS. Over the last several decades, states have sought to rebalance their Medicaid LTSS systems by increasing access to HCBS and reducing reliance on institutional care. Measurement of national and state progress toward this goal includes both the share of total Medicaid LTSS users receiving HCBS and the share of total Medicaid LTSS spending for HCBS. These measures are commonly referred to as LTSS user and expenditure rebalancing ratios. We analyzed national and state trends in Medicaid LTSS user and expenditure rebalancing ratios for 2022, based on data from the Transformed Medicaid Statistical Information System Analytic Files (TAF). We also examined national rebalancing ratios by select characteristics, including age, sex, dual-eligibility status, urban or rural residence, primary spoken language, and race and ethnicity, and by key LTSS subpopulations, for 2022. We found that in 2022, 86.6 percent of Medicaid LTSS users received HCBS and HCBS accounted for 64.6 percent of Medicaid LTSS expenditures. Both user and expenditure rebalancing ratios varied the most by age group: those ages 0 to 20 had the highest rebalancing ratios and those ages 65 and over had the lowest.