As states continue to implement various aspects of the Affordable Care Act (ACA), developing and expanding home and community-based alternatives to institutional care remains a priority for many state Medicaid programs. While the majority of Medicaid long-term services and supports dollars still go toward institutional care, the national percentage of Medicaid spending on home and community-based services (HCBS) has more than doubled from 20 percent in 1995 to 45 percent in 2010. This issue paper summarizes the main trends to emerge from the latest (2009)participant and expenditure data for the three main Medicaid HCBS programs: (1) the mandatory home health services state plan benefit; (2) the optional personal care services state plan benefit; and (3) optional section 1915(c) HCBS waivers. It also briefly discusses the provision of HCBS through section 1115 waivers and highlights findings from a 2011 survey of Medicaid HCBS participant eligibility and enrollment and provider reimbursement policies.
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