Home- And Community-Based Services Make Up $69.5 Billion Of Fee-For-Service Medicaid Expenditures

Total Medicaid managed care spending across all 50 states saw an increase last year. In fact, spending checked in at $420.5 billion in 2021, compared to $359.6 billion in 2020, according to data collected in the annual CMS-64 Medicaid expenditure report.

Additionally, home and community-based services make up a big chunk of this spending. At $69.5 billion, these services are responsible for 24% of fee-for-service spending. Personal care was responsible for $12.6 billion, or 4.4%.

One major factor that contributed to spending growth for total Medicaid managed care was higher Medicaid enrollment due to the COVID-19 pandemic.


Overall, total Medicaid managed care spending spiked 16.9% in 2021. This is a reverse from a previous trend. Before 2020, the rate of growth had been decreasing since 2016. Since the COVID-19 pandemic, the rate of growth has been increasing.

When looking at the data on the state level, the report found that average managed care organization spending increased 17.6% in 2021 for the 44 states that contract with risked-based organizations.

At 63.3%, North Carolina saw the highest — on a percentage basis — year-over-year growth in Medicaid managed care spending. This bump was due to the implementation of its risk-based Medicaid managed care program.


Of the states that had more established programs, Colorado saw the fastest growth in 2021 at 59%. Nebraska was right behind Colorada at 55.6%.

In dollar terms, Illinois saw the biggest increase in Medicaid managed care year-over-year spending growth at $5.5 billion.

Some of the other states that saw major year-over-year spending increases, in dollar terms, are Texas at $5.2 billion, California at $5.2 billion and New York at $5.1 billion.

There were 13 states that didn’t utilize risk-based comprehensive Medicaid managed care in 2021. These were usually smaller states.

In total, Medicaid spending across these 13 states was $29.8 billion. These states include Alabama, Alaska, American Samoa, Connecticut, Guam, Maine, Montana, Northern Mariana Islands, Oklahoma, South Dakota, Vermont, Virgin Islands and Wyoming.

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