States Turn Focus to Home-Based Long Term Care, Despite Limited Budgets

While states are suffering from budgetary restrictions following the recession, the little funding they do have for long term care initiatives is projected to go to home and community based care. 

The vast majority of states plan to increase their spending this year on community and home based services, with additional attention to changing their approach to long term services and supports for the aging population, according to a report released this week by the AARP Public Policy Institute. 

Many states are finding they are at a “crossroads” for long-term services and supports following the recession, including reorganization among state agencies for long term care as well as reallocation of funding in light of budgetary restrictions and post-recession pressures.


“Nevertheless, most states continue to expand Medicaid home and community-based services (HCBS) waiver recipients and expenditures,” the report states.

Over 2012 and 2013, of the 49 states and District of Columbia surveyed by AARP, the National Association of States United for Aging and Disabilities (NASUAD), and Health Management Associates, 80% reported their HCBS waiver census has or will increase.

Just 25% of the states reported “slight” increases in Medicaid nursing home populations, with three states—Indiana, South Carolina and Oklahoma—adding assisted living services to their HCBS waivers.


Medicaid marked the greatest long-term services expenditure nationally, with a combined $131 billion among states and federal spending. Medicaid long term services and supports account for 7% of Medicaid recipients, but for 30% of Medicaid expenditures, according to the findings.

Additionally, states are looking closely at their approach to long term supports and services with many expecting change on the horizon.

“Cost containment and delivery reform strategies for people with LTSS needs are at the forefront of health policy actions,” the report concludes. “With the increased demand for publicly funded LTSS, state policy makers are transforming the ways in which LTSS are financed, delivered, and administered.

Home-based services will be top of mind under the new policies.

“States are continuing to prioritize access to HCBS and to further target limited resources.”

Written by Elizabeth Ecker

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