A CR OSS T H E S TAT E S PROFILES OF LONG-TERM CARE AND INDEPENDENT LIVING by Ari Houser Wendy Fox-Grage Mary Jo Gibson EXECUTIVE SUMMARY, STATE DATA, AND RANKINGS ©1994-2009 AARP 2009 EIGHTH EDITION Introduction Across the States 2009: Profiles of Long-Term Care and Independent Living is the eighth edition of the AARP Public Policy Institute’s state long-term care reference report. Published approximately every two years, the Across the States series was developed to help inform policy discussions among public and private sector leaders in long-term care throughout the United States. Across the States 2009 presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single convenient reference. This publication presents the most up-to-date data available at the time of production, and is displayed in easy-to-use maps, graphics, tables, and state profiles. Across the States 2009 comes in two volumes: •  full report with an overview of key findings and trends, maps and graphs, and individual A profiles for each state, the District of Columbia, Puerto Rico, the Virgin Islands, and the nation as a whole. The full report provides a complete picture of long-term services and supports in each state. •  n executive summary with an overview of key findings and trends, and ranking tables for each A indicator, such as percentage of Medicaid long-term care spending for older people and adults with physical disabilities going to home and community-based services, which permit readers to easily see variation among states. Some of the indicators in Across the States 2009 may be found in prior editions. Please exercise caution when making comparisons with information in earlier editions because of possible changes in the source or definition. Complete descriptions of all indicators, and how they may differ from previous editions, can be found in the Data Documentation section in the back of the full report. Data sources and descriptions of indicators are only found in the full report, not in the executive summary. Copies of Across the States 2009 are available free of charge. To order, please call the AARP Public Policy Institute at (202) 434-3890 or email jgasaway@aarp.org. The full report and executive summary are also available on the web. The most recent edition of Across the States can always be found at http://www.aarp.org/acrossthestates. 2 AARP Public Policy Institute OVERVIEW Across the States 2009: Profiles of Long-Term Care and Independent Living contains thousands of numbers. Taken alone, each number is simply that—a number. However, when these numbers are woven together, they tell a compelling story about the changing demand for long-term services and supports, more commonly known as long-term care, in the United States and the strategies for delivering such services and paying for them across all of the states. The report focuses on comparative state data, because much of the policymaking and innovation in long-term care is governed by the states. Given the growing older population, the rising demand for long-term care and the increasing cost of services, consistent data across all the states are critical in order to understand how to improve the lives of those with long-term care needs, their family caregivers, and others around them. In this overview we present 10 key findings from the state and national data, a small sampling of the data presented in this volume.   1:  The population age 85 or older—the age group that is most likely to need long-term care services—is growing at a dramatic rate.   2:  The older population is more racially and ethnically diverse than ever before.   3:  The older population is financially and socially diverse.   4:   Family caregivers are the main providers of long-term care services in all states.   5:  Older people with disabilities have a growing array of service options, but the services are costly and can deplete the life savings of older households.   6:  Nursing facility residents, beds, and occupancy rates have remained nearly constant over the last five years, despite an increase in the older population.   7:  The bulk of Medicaid long-term care dollars go to nursing homes rather than home and community-based services.   8:  The number of older people and adults with physical disabilities receiving Medicaid- funded home and community-based services has increased over the past five years.   9:  Long-term care spending is not the primary cause of Medicaid spending growth.   On average, Medicaid dollars can support nearly three older people and adults with 10: physical disabilities in home and community-based settings for every person in a nursing facility. Blue line = 50-64 Purple line = 65-74 The population age 85 or older—the age group that is most likely to 1: need long-term care Yellow line = 75-84 services—is growing at a dramatic rate. Red line = 85+ Projected Growth in the Older Population in United States as a Percentage of 2000 Census, by Age Group, 2000-2030 240% 220% 85+ Population (% of 2000 Census) 200% 75-84 180% 160% 50-64 140% 65-74 120% 100% 80% 2000 2005 2010 2015 2020 2025 2030 From 2007 to 2030, the population age 65+ is projected to grow by 89%, more than four times as fast as the population as a whole (+21%). Most of this growth, especially over the next 10 to 15 years, will be among the young old (age 65-74) because of the aging of the baby boomers. A better barometer for the potential demand for long-term care services is the growth in the population age 85 or older, which is expected to increase by 74% between 2007 and 2030. The oldest old not only have much higher rates of disability, but they also are much more likely to be widowed and without someone to provide assistance with daily activities. The 85+ population will grow even faster after 2030. The increase in the 85+ population between now and 2030 is largely driven by the aging of the parents of the baby boom generation; the baby boomers will begin to turn age 85 in 2031. Between 2030 and 2050, the age 85+ population is projected to increase by another 118 percent. The states with the greatest projected age 85+ population growth from 2007 to 2030 are: Alaska (+297%), Nevada (+176%), Arizona (+135%), Wyoming (+126%), and New Mexico (+123%). The age 85+ population is also projected to more than double during this time period in Virginia, Vermont, Colorado, and Texas. The older population is more racially and ethnically diverse than 2: ever before. Black: 8.7% Hispanic: 6.6% acif ic Islander: 3 ia n/P .6 % As Other: 1% Older People of Color: 19.3% Categories do not sum to total because individuals may belong to more than one racial/ethnic group. Nearly one out of every five people (19.3%) age 65+ is non-White or Hispanic, a percentage that is projected to increase in the coming decades. The growing racial and ethnic diversity of the older population has enormous implications for meeting diverse long-term care preferences, addressing the role of paid and unpaid caregivers, providing services with cultural sensitivity, and training the paid long-term care workforce in cultural competence in meeting diverse needs. Aging populations of color in Hawaii (Asian), Puerto Rico (Hispanic), and the District of Columbia and the Virgin Islands (Black) outnumber Whites. More than 30% of people age 65+ in New Mexico, California, and Texas—the states with the highest proportion of Hispanic elders— are people of color. The older population will continue to become more racially and ethnically diverse in the coming years. By 2030, when the last of the baby boomers have turned age 65, the Census Bureau projects that 29% of Americans age 65 or older will be people of color. By 2050, the proportion who are people of color will reach 42%. 3: The older population is financially and socially diverse. Education Disability Housing Need for Long-Term Care Poverty $ Economic Value of Family Caregiving in 2007: $375 billion $ Geography Medicaid LTC Spending Age is not the only factor affecting the need for and access to long-term of services. The demand in 2007 (Largest payer care for long-term care services is also driven by social and economic characteristics like income, formal LTC): $97 billion assets, education, marital status, and the availability of a family member or friend to provide care. Economic and even geographic factors can greatly affect a person’s ability to gain access to needed services. Poverty: Roughly one-half (51%) of people age 65+ have incomes at or below 300% of poverty (about $30,000 for a single person over age 65+ or $38,000 for a family of two), an income level that makes them financially vulnerable and unlikely to be able to afford to pay for long-term care services out-of-pocket. Geography: One out of every five people age 65+ lives in rural, non-metropolitan areas where home and community-based services are typically harder to find. Education: Level of education is one of the strongest predictors of the likelihood of having a long- term care need as well as having the economic capacity to pay for services. Less than one out of five (19%) people age 65+ has a bachelor’s degree or higher. Living Alone: One-third of people age 75+ live alone, which means that there is no one in the household to provide assistance if they need help with daily activities. People living alone are more likely to have to move to a care facility if they need long-term care. Disability: More than four out of 10 (41%) people age 65+ have one or more of the following disabilities that affects their ability to accomplish common tasks of everyday living: sensory, physical, mobility, self-care, and cognitive/mental. By 2010, 13% of people age 65+ are projected to have Alzheimer’s disease. Family caregivers are the main providers of long-term care services 4: in all states. $ $ Economic Value of Family Caregiving in 2007: Value billion Economic $375 of Family Caregiving in 2007: $375 billion $$ Medicaid LTC Spending in 2007 (LargestLTC Spending Medicaid payer of formalin 2007 $97 billion LTC): (Largest payer of formal LTC): $97 billion In the U.S., 34 million caregivers age 18 or older were providing unpaid care to friends and family at any given time during 2007. They provided an average of 21 hours of care per week, at an average value of $10.10 per hour. Since periods of caregiving may begin or end during the year, the number of adults providing care during the year is significantly higher, estimated at 52 million in 2007. Although Medicaid is the largest payer of long-term care services ($97 billion), the foundation of long-term care in all states is family caregivers. The estimated economic value of the 34 million caregivers’ unpaid contributions was $375 billion in 2007, and the economic value of family caregiving exceeded Medicaid long-term care spending in all states.1 A critical dimension of home and community-based services is support for family caregivers. By providing personal care and help with everyday tasks as well as health-related interventions, such as administering complex medications, family caregivers help to contain health and long-term care costs by delaying or preventing the use of nursing home and hospital care. Any strategy to promote home and community-based services will depend heavily on the continued support of family caregivers. They are essential to the financing and delivery of long-term care, yet they often are at risk of becoming “patients” themselves because of the physical and mental health effects of caregiving.2 1 Houser A., and Gibson, M.J. “Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update.” Washington DC: AARP Public Policy Institute. November 2008. 2 Reinhard, S., Brooks-Danso, A., Kelly, K. and Mason, D. “How Are You Doing? State the Science: Professional Partners Supporting Family Caregivers.” American Journal of Nursing 108(9) Supplement. September 2008. Older people with disabilities have a growing array of service 5: options, but the services are costly and can deplete the life savings of older households. In the United States, the primary responsibility for paying for long-term care services remains with the individuals who need those services. Medicare will pay for limited nursing home and home health services but only for a limited time after a major acute care episode, typically after a hospital stay. Medicaid pays for services only after beneficiaries have depleted their income and assets. Medicaid has lower payment rates for long-term care services than private pay, while Medicare has higher payment rates (Medicare spending for nursing home services is generally for medically intensive post-acute care, rehabilitation, or end-of-life care). For nursing facility care, the average private pay rate was $209 per day for a private room. Medicaid nursing facility reimbursement averaged $158 per day in 2007, and Medicare reimbursement averaged $305 per day in 2006. Assisted living has emerged as a major option for many older people with less intensive care needs than are typical in most nursing homes. The average private-pay base rate for assisted living services is about $3,000 per month, roughly half the private pay rate in a nursing home, though this does not typically include skilled nursing or other intensive health-related services that are included in nursing facility rates. While nearly two-thirds of nursing facility residents have Medicaid as the primary payer, the share of assisted living residents receiving such assistance ranges is far lower.1 The costs of home and community-based services vary significantly, depending primarily on the hours of care needed. Personal care services or adult day services a few times a week costs far less than 24-hour home care. The private pay daily rate for adult day services, often for older people with relatively mild cognitive disorders, averaged $59 per day in 2008. The private pay hourly rate for home health services was $19 in 2008, and $38 for Medicare- certified home health aides, who are often associated with a skilled nursing visit that could include specialized care such as bathing. The average Medicare reimbursement for a home health visit was $134 in 2006. 1 In 2007, there were about 1 million units in assisted living and residential care facilities; roughly 117,000 residents in these facilities were supported by Medicaid or state financing. The number of assisted living residents supported by Medicaid is down slightly and the number of units up slightly from 2004. See Mollica, R., Sims-Kastelein, K., and O’Keeffe, J. “Residential Care and Assisted Living Compendium: 2007.” National Academy for State Health Policy and RTI International. November 30, 2007. Nursing facility residents, beds, and occupancy rates have remained 6: nearly constant over the last five years, despite an increase in the older population. Percent Change in Number of Nursing Facility Residents and Beds, Occupancy Rate, and Population Age 85 or older, 2002-2007 +8% +6.5% +6% Percent Change, 2002-2007 +4% +1.7% +2% +0.9% 0% -0.7% -2% Nursing Facility Nursing Facility Occupancy Rate Age 85+ Residents Beds Population About 1.44 million Americans live in nursing facilities, occupying 85% of a total of 1.7 million nursing home beds. Although people tend to associate long-term care with nursing homes, the great majority of people with disabilities live in community settings. Only 3.3% of people age 65+ live in nursing facilities, though this rises to 14% of people age 85+. From 2002 to 2007, the number of nursing facility residents increased about 0.9% and the number of nursing facility beds increased about 1.7%, while the age 85+ population increased 6.5%. The average nursing facility occupancy rate declined 0.7 percentage points over this time period. South Carolina and Alabama had the largest increases in nursing facility beds and residents between 2002 and 2007, with South Carolina increasing the number of beds by 16% and residents by 18% and Alabama increasing beds by 14% and residents by 11%. In contrast, Louisiana had the largest nursing home bed and resident reduction of any state, in part because of the devastation of Hurricane Katrina: nursing facility beds declined by 15% and residents by 20%. South Dakota (-11%) and Wisconsin (-12%) also had large bed reductions. Minnesota and Iowa saw 10% declines in the number of nursing facility residents. In 2007, nearly one-half (46%) of residents had dementia, and most (64%) had Medicaid as the primary payer of nursing facility costs. These residents have low incomes and little savings or spent their life savings paying for long-term care services before becoming eligible for Medicaid coverage. The percentage of nursing facility residents with Medicaid as the primary payer has declined somewhat from 67% in 2002, while Medicare’s share increased from 11% in 2002 to 14% in 2007, illustrating a decline in the use of nursing homes for long-term care as providers increasingly move to providing post-acute care services, much of it funded by Medicare. The bulk of Medicaid long-term care dollars go to nursing homes 7: rather than home and community-based services. Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in the United States, 2007 10% 17% 73% Aged/Disabled Waivers PCS and other HCBS Nursing Homes Medicaid—jointly financed by the federal and state governments—pays for most formal long- term care in the United States. In 2007, nearly three out of every four (73%) Medicaid long-term care dollars for older people and adults with physical disabilities went toward nursing facility care even though most people prefer to live at home or in their communities.1 Medicaid home and community-based spending was $17 billion for older people and adults with physical disabilities compared to $47 billion for Medicaid nursing home spending. Many states maintain waiting lists or interest lists for Medicaid aged/disabled home and community-based waiver programs because of the great demand. In 2007, nearly 90,000 were reported to be on such lists. Despite its institutional bias, Medicaid plays an important and growing role in the funding of home and community-based services. Every state Medicaid program has federal waivers to provide a wide range of such services. Also, 30 states and the District of Columbia (see map) cover personal care services for adults in the home under their Medicaid state plans. However, the percentage of Medicaid long-term care funds going toward home and community- based services for older people and adults with physical disabilities varies enormously among the states, ranging from 1% to 61% of such spending. 1 These data update the analysis from Kassner, E. et al. “A Balancing Act: State Long-Term Care Reform.” Washington, DC: AARP Public Policy Institute. July 2008. Percentage of Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities going to HCBS, by State, 2007 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI NV IL IN OH NJ CT UT CO KS WV DE MO MD KY VA CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI > 40% 20 - 40% ≤ 20% "Medicaid HCBS spending for older people and adults with In 2007, five states— New Mexico,disabilities, Washington,spending, 2007"California—spent more physical Oregon, as a % of LTC Alaska, and > 40% than 50% of their Medicaid 20 - 40% ≤ 20% long-term care funds on home and community-based services. On the other end of the range, Tennessee, Indiana, North Dakota, Utah, South Dakota, Kentucky, Alabama, Connecticut, and Delaware had the lowest percentages: 10% or less. Medicaid is not the only source of public funding for home and community-based services. State- funded home and community-based services totaled $1.2 billion in 2007. While the total amount of state-funding spending is only about 7% of Medicaid home and community-based services expenditures for older people and adults with physical disabilities, in some states these programs provide important services to people who might not qualify for Medicaid. ne = 65-74 ne = 75-84 = 85+ The number of older people and adults with physical disabilities 8: receiving Medicaid-funded home and community-based services (HCBS) has increased over the past five years. Older People and Adults with Physical Disabilities Receiving Medicaid HCBS, 2000-2005 1.5 Persons Served (Millions) 1.4 +34% line = 50-64 1.3 le line = 65-74 1.2 w line = 75-84 ine = 85+ 1.1 1.0 0.9 2000 2001 2002 2003 2004 2005 Year Medicaid HCBS Spending for Older People and Adults with Physical Disabilities, 2002-2007 $21 Spending (Billions of Dollars) $18 +68% $15 $12 $9 $6 2002 2003 2004 2005 2006 2007 Year The number of older people and adults with physical disabilities receiving Medicaid-funded home and community-based services increased by about one-third from 2000 to 2005, to a total of nearly 1.4 million beneficiaries in 2005. From 2002 to 2007, Medicaid home and community-based spending for older people and adults with physical disabilities increased by 68% to $17 billion in 2007.1 1 These measures of Medicaid home and community-based services exclude home health services, since home health programs in many states provide mostly or entirely post-acute care services, not long-term care, and it is not possible to differentiate the spending and participants between post-acute and long-term care. This choice is further discussed in Kassner, E. et al. “A Balancing Act: State Long-Term Care Reform.” Washington, DC: AARP Public Policy Institute. July 2008. The number of older people and adults with physical disabilities receiving Medicaid home and community-based services increased from 2000 to 2005 in 46 states and declined in only five states: Kentucky, West Virginia, Arkansas, South Carolina, and New York. The states with the biggest percentage gains in home and community-based participants were New Mexico, North Dakota, and Louisiana. From 2002 to 2007, all states—except Kentucky—increased Medicaid home and community-based expenditures. The largest percentage increases in Medicaid home and community expenditures were in the District of Columbia, Louisiana, Nevada, and Pennsylvania. The District of Columbia, Louisiana, and Minnesota had the greatest percentage point increases in the proportion of Medicaid long-term care spending going to home community-based services from 2002 to 2007. Increase in Medicaid Long-Term Care Spending in the United States, 2002-2007, by Service $9,000 $7,712 $8,000 $7,000 Millions of Dollars $6,000 $4,551 $5,000 $4,000 $2,651 $2,433 $3,000 $2,000 $629 $1,000 $0 ICF-MR MR/DD Nursing Aged/ PCS and Waivers Facilities Disabled other Waivers HCBS Although Medicaid spending on home and community-based services increased for older people and adults with physical disabilities, people with mental retardation or developmental disabilities (MR/DD) made even more progress toward access to Medicaid-funded home and community- based services and can serve as a model for reform. More Medicaid funding goes toward MR/ DD waiver programs, serving people in their homes and communities, than goes to institutional Intermediate Care Facilities for Mental Retardation (ICF-MRs). The spending increase for MR/ DD waiver programs from 2002 to 2007 ($7.712 billion) was more than 10 times as great as the spending increase for ICF-MRs ($629 million). In comparison, the spending increase for home and community-based services for older people and adults with physical disabilities ($6.984 billion) was about three times the spending increase for nursing homes ($2.651 billion). Long-term care spending is not the primary cause of Medicaid 9: spending growth. Percent Increase in Total Medicaid Spending and Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities, 2002-2007 +35% 0.3 +30% +28% 0.3 0.2 Relative to 2002 Spending +25% Percent Change +20% +18% 0.2 +15% 0.1 +10% 0.1 +5% 0.0 0% 0.0 2002 2003 2004 2005 2006 2007 Year Total Medicaid Spending Medicaid LTC for Older People and Adults with Physical Disabilities Despite the growth in the older population who are primary users of long-term care services, total Medicaid spending has increased at a faster rate than Medicaid long-term care spending for older people and adults with physical disabilities over the past five years. Total Medicaid spending increased from $243 billion in 2002 to $312 billion in 2007, an increase of 28%. During the same time period, Medicaid long-term care spending for older people and adults with physical disabilities increased by 18%, from $54 billion to $64 billion. On average, Medicaid dollars can support nearly three older people 10: and adults with physical disabilities in home and community-based settings for every person in a nursing facility. Medicaid Long-Term Care Spending per Person Served, by Service, 2005 } Aged/Disabled $9,176 Waiver Services Home and Community-Based Services Personal Care $9,666 Services Nursing Facility $26,096 Services $0 $10,000 $20,000 $30,000 Spending per Person Served Per person served, nursing facility services are generally more costly than home and community- based services. On average, Medicaid spending for home and community-based services for each older person and adult with physical disabilities receiving services was $9,459 in 2005, compared to $26,096 for each person receiving services in a nursing facility. It is important to note, however, that a dollar spent on home and community-based services is not equivalent to a dollar spent on nursing home services. Medicaid pays for services and room and board costs in nursing homes. In contrast, Medicaid is required by law to exclude coverage of room and board costs for home and community-based beneficiaries, even if they live in residential care settings such as assisted living. It is also the case that people receiving home and community-based services may have less intense needs, especially for medically oriented services. Conclusion This report provides the latest available data on long-term care in the United States at a time of rapid change in the delivery and financing of such services. Each state is unique, and the states exhibit great diversity in demographics, service delivery, and financing. Across the States offers a picture of past and present trends at both the national and state levels as well as factors that could potentially drive future trends. It provides comparable data across all the states, so policymakers in each state can use it to benchmark progress in improving the quality of life for those who need, use, and provide long-term care services. This page intentionally left blank AARP Public Policy Institute National Long-Term Care and Independent Living Profile AARP Public Policy Institute United States % of Total Population (thousands) Year Value Population All ages 2007 301,621 2030 363,584 % change +21% Age 50-64 2007 53,725 17.8% 2030 59,928 16.5% % change +12% Age 65+ 2007 37,888 12.6% 2030 71,453 19.7% % change +89% Age 65-74 2007 19,352 6.4% 2030 Blue line = 50-64 37,948 10.4% Purple line = 65-74 % change +96% Age 75-84 Yellow line = 75-84 2007 13,024 4.3% Red line = 85+2030 23,903 6.6% % change +84% Age 85+ 2007 5,512 1.8% 2030 9,603 2.6% % change +74% Race & Ethnicity, Age 65+ Projected Growth in the Older Population in the United States as a Percentage of 2000 Census, by Age Group, 2000-2030 Older People of Color (%), 2007 240% 19.3% Population (% of 2000 Census) 220% 85+ Asian/Pacific Islander 200% 180%   3.6% 75-84 160% 50-64 Black 140%   8.7% 65-74 120% 100% Hispanic 80%   6.6% 2000 2005 2010 2015 2020 2025 2030 18 Population & Characteristics United Stat es Population Characteristics Value Men per 100 women age 85+, 2007 48 Persons age 75+ living alone, 2007 33% Non-metropolitan population age 65+, 2007/2008 20% Bachelor level education or higher age 65+, 2007 19% Persons age 60+ raising grandchildren, 2007 1.6% Income & Poverty Value Median household income age 65+, 2007 $32,158 At/below poverty level age 65+, 2007 9.5% At/below 200% of poverty level age 65+, 2007 32% At/below 300% of poverty level age 65+, 2007 51% Women age 75+ at/below poverty level, 2007 13% Number Disability Rates (1,000s) Percent Persons age 65+ with disabilities, 2007 Sensory disability 5,893 16% Physical disability 11,285 31% Mobility disability 6,354 18% Self-care disability 3,772 10% Cognitive/mental disability 4,467 12% Any disability (one or more of the five 14,735 41%   listed above) Cognitive/mental disability + any other disability 4,010 11% Persons age 18-64 with disabilities, 2007 Any disability 21,460 11% Cognitive/mental disability + any other disability 6,002 3.2% Persons age 65+ with Alzheimer’s disease, 2010 5,300 13% (projected) Family Caregivers Value Family caregivers (thousands), 2007 34,000 Economic value of family caregiving (millions), 2007 $375,000 Economic value per hour, 2007 $10.10 Ratio of the economic value of family caregiving to Medicaid 3.7 long-term care spending, 2007 19 Long-Term Care Financing United States Medicaid Expenditures Value Total Medicaid expenditures (millions), 2007 $311,848 Medicaid home and community-based services (HCBS) spending 27% for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 * Medicaid Long-Term Care Spending for Older People and Adults with Physical Disabilities in the United States, 2007 United States 10% 17% 73% Aged/Disabled Waivers PCS and other HCBS Nursing Homes Total Per Person Long-Term Care Expenditures by Service (millions) in the State Medicaid LTC expenditures for older people and $64,168 $213 adults with physical disabilities, 2007 Nursing facilities $46,980 $156 HCBS $17,188 $57 Personal care services (PCS) ** $10,396 $34 Aged/disabled waiver services $6,340 $21 Medicaid LTC expenditures for all populations, 2007 $97,295 $323 Institutional services $58,993 $196 HCBS $38,303 $127 Waiver services (all populations) $27,455 $91 Medicaid home health expenditures * $3,966 $13 Expenditures Per Person Served Value Medicaid nursing facility expenditures per person served, 2005 $26,096 Medicaid HCBS expenditures for older people and adults with $9,459 physical disabilities per person served, 2005 Personal care services ** $9,666 Aged/disabled waiver services $9,176 HCBS waiver services (all populations) $21,681 * Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States. 20 Federal/State/Personal Contributions Value United States Federal Medical Assistance Percentage (FMAP), 2007 NA Medicaid personal needs allowance (per month), 2007 *** $50 State-funded HCBS for older people (millions), 2007 $1,192.4 Long-Term Care Utilization Medicare HCBS Utilization Value Medicare beneficiaries receiving home health services, 2006 8.4% Medicare home health visits per user, 2006 35 Per 1,000 Medicaid HCBS Utilization Value Population Medicaid HCBS participants, 2005 1,854,998 6.3 Personal care services ** 794,642 2.7 HCBS waiver services 1,060,356 3.6 Aged/disabled waiver services 582,342 2.0 Medicaid aged/disabled waiver participants per 34 100 beneficiaries using nursing facilities, 2005 Persons in assisted living/residential care covered by 117,265 0.39 Medicaid or state funding, 2007 Medicaid home health participants, 2005 * 924,259 3.1 Nursing Facility Utilization Value Total nursing facility residents, 2007 1,440,358 Nursing facility residents per 100 age 65+, 2007 3.8 Nursing facility residents per 100 age 75+, 2007 7.8 Total nursing facility stays, 2006 3,176,119 Residents with Medicaid as primary payer, 2007 64% Residents with Medicare as primary payer, 2007 14% Residents with “other” as primary payer, 2007 22% Residents with dementia, 2007 46% Long-Term Care Costs Public & Private Payment Rates Value Medicaid payment per day for nursing facility care, 2007 $158 Medicare payment per day for nursing facility care, 2006 $305 Average private pay rate per day in nursing facility, 2008 $209 Average private pay rate per month in assisted living, 2008 $3,008 Medicare reimbursement per home health visit, 2006 $134 Average private pay hourly rate for home health aide, 2008 $19 Medicare-certified home health aide, 2008 $38 Average private pay daily rate for adult day care, 2008 $59 21 Long-Term Care Resources United States Per 1,000 HCBS Resources Value Age 65+ Medicare-certified home health agencies, 2006 8,448 0.22 Adult day facilities, 2001-02 3,407 0.09 Assisted living and residential care facilities, 2007 39,005 1.0 Assisted living and residential care units, 2007 1,000,476 26 Personal and home care aides, 2007 595,350 16 Median hourly wage, 2007 $8.89 Home health aides, 2007 834,580 22 Median hourly wage, 2007 $9.62 Medicaid aged/disabled waiver waiting list, 2007 89,938 Per 1,000 Nursing Facility Resources Value Age 65+ Total nursing facilities, 2007 16,145 0.43 Nursing facility beds, 2007 1,699,494 45 Nursing facility occupancy rate, 2007 85% Quality & Oversight of Nursing Facilities Value Direct care nursing hours per patient day, 2007 3.7 Nursing facilities with deficiency for actual harm or jeopardy of 18% residents, 2007 Residents with physical restraints (%), 2007 6% Long-term care facility beds per FTE ombudsman, 2006 2,192 Nursing facilities visited by ombudsman at least quarterly, 2006 79% Change in Medicaid LTC Percent Change in Medicaid LTC Spending, 2002–2007, by Service Spending, 2002–2007, by Service $9,000 80% 72% $8,000 $7,712 60% 62% $7,000 Millions of Dollars 60% $6,000 $5,000 $4,551 40% $4,000 $3,000 $2,651 $2,433 20% $2,000 $1,000 $629 6% 6% $0 0% ICF-MR MR/DD Nursing Aged/ PCS and ICF-MR MR/DD Nursing Aged/ PCS and Waivers Facilities Disabled other Waivers Facilities Disabled other Waivers HCBS Waivers HCBS 22 Trends United Stat es Home & Community-Based Services Year Value Medicaid HCBS participants, older people and 2000 1,026,374 adults with physical disabilities 2005 1,376,984 % change +34% Medicaid aged/disabled waiver participants 2000 448,167 2005 582,342 % change +30% Medicare home health visits per user 2001 31 2006 35 % change +13% Nursing Facilities Year Value Nursing facility residents 2002 1,428,117 2007 1,440,358 % change +1% Nursing facility beds 2002 1,671,744 2007 1,699,494 % change +2% Nursing facility occupancy rate 2002 85% 2007 85% change -1% Long-Term Care Financing Year Value Total Medicaid spending (millions) 2002 $243,497 2007 $311,848 % change +28% Medicaid LTC spending for older people and adults 2002 $54,261 with physical disabilities (millions) 2007 $64,168 % change +18% Medicaid HCBS spending for older people and adults 2002 $10,204 with physical disabilities (millions) 2007 $17,188 % change +68% Medicaid nursing facility spending (millions) 2002 $44,057 2007 $46,980 % change +7% Medicaid HCBS spending for older people and adults 2002 19% with physical disabilities, as a percentage of total 2007 27% LTC spending change +8% 23 In addition to the national long-term care and independent living profile, you can find profiles for every state, the District of Columbia, Puerto Rico, and the Virgin Islands in the full report volume of Across the States 2009. Copies are available free of charge. To order, please call the AARP Public Policy Institute at (202) 434-3890 or email jgasaway@aarp.org. The full report and executive summary are also available on the web. The most recent edition of Across the States can always be found at http://www.aarp.org/acrossthestates. 24 AARP Public Policy Institute State Data and Rankings Population & Projections Population, All Ages, Population, All Ages, Percent Change in 2007 2030 Population, All Ages, 2007-2030 Value (Millions) Rank Value (Millions) Rank Value Rank Alabama 4,628 23 4,874 24 +5% 39 Alaska 683 47 868 46 +27% 12 Arizona 6,339 16 10,712 10 +69% 1 Arkansas 2,835 32 3,240 32 +14% 22 California 36,553 1 46,445 1 +27% 11 Colorado 4,862 22 5,792 22 +19% 18 Connecticut 3,502 29 3,689 30 +5% 39 Delaware 865 45 1,013 45 +17% 19 District of Columbia 588 50 433 51 -26% 51 Florida 18,251 4 28,686 3 +57% 3 Georgia 9,545 9 12,018 8 +26% 13 Hawaii 1,283 42 1,466 41 +14% 23 Idaho 1,499 39 1,970 37 +31% 8 Illinois 12,853 5 13,433 5 +5% 41 Indiana 6,345 15 6,810 18 +7% 33 Iowa 2,988 30 2,955 34 -1% 48 Kansas 2,776 33 2,940 35 +6% 37 Kentucky 4,241 26 4,555 27 +7% 32 Louisiana 4,293 25 4,803 26 +12% 25 Maine 1,317 40 1,411 42 +7% 34 Maryland 5,618 19 7,022 16 +25% 15 Massachusetts 6,450 14 7,012 17 +9% 30 Michigan 10,072 8 10,694 11 +6% 36 Minnesota 5,198 21 6,306 20 +21% 16 Mississippi 2,919 31 3,092 33 +6% 37 Missouri 5,878 18 6,430 19 +9% 27 Montana 958 44 1,045 44 +9% 28 Nebraska 1,775 38 1,820 38 +3% 43 Nevada 2,565 35 4,282 28 +67% 2 New Hampshire 1,316 41 1,646 40 +25% 14 New Jersey 8,686 11 9,802 13 +13% 24 New Mexico 1,970 36 2,100 36 +7% 35 New York 19,298 3 19,477 4 +1% 44 North Carolina 9,061 10 12,228 7 +35% 5 North Dakota 640 48 607 49 -5% 50 Ohio 11,467 7 11,551 9 +1% 45 Oklahoma 3,617 28 3,913 29 +8% 31 Oregon 3,747 27 4,834 25 +29% 9 Pennsylvania 12,433 6 12,768 6 +3% 42 Rhode Island 1,058 43 1,153 43 +9% 29 South Carolina 4,408 24 5,149 23 +17% 20 South Dakota 796 46 800 47 +1% 46 Tennessee 6,157 17 7,381 15 +20% 17 Texas 23,904 2 33,318 2 +39% 4 Utah 2,645 34 3,485 31 +32% 7 Vermont 621 49 712 48 +15% 21 Virginia 7,712 12 9,825 12 +27% 10 Washington 6,468 13 8,625 14 +33% 6 West Virginia 1,812 37 1,720 39 -5% 49 Wisconsin 5,602 20 6,151 21 +10% 26 Wyoming 523 51 523 50 +0% 47 United States 301,621 363,584 +21% Note: The highest data value within each ranking is indicated by a rank of 1. 26 Population & Projections Population, Age 50-64, 2007 Population, Age 50-64, 2030 Value Percent of Value Percent of (Millions) Total Population Rank (Millions) Total Population Rank Alabama 853 18.4% 20 880 18.0% 8 Alaska 126 18.4% 20 100 11.6% 51 Arizona 1,045 16.5% 48 1,762 16.4% 34 Arkansas 515 18.2% 29 574 17.7% 12 California 5,966 16.3% 49 7,069 15.2% 44 Colorado 875 18.0% 35 881 15.2% 44 Connecticut 664 18.9% 10 611 16.6% 30 Delaware 160 18.4% 20 189 18.7% 4 District of Columbia 99 16.8% 47 63 14.5% 49 Florida 3,331 18.3% 26 5,120 17.8% 11 Georgia 1,609 16.9% 46 1,992 16.6% 30 Hawaii 241 18.7% 12 217 14.8% 48 Idaho 262 17.5% 43 336 17.1% 19 Illinois 2,216 17.2% 45 2,188 16.3% 36 Indiana 1,140 18.0% 35 1,123 16.5% 33 Iowa 550 18.4% 20 517 17.5% 13 Kansas 492 17.7% 41 474 16.1% 39 Kentucky 792 18.7% 12 814 17.9% 9 Louisiana 767 17.9% 37 781 16.3% 36 Maine 280 21.3% 2 266 18.9% 3 Maryland 1,033 18.4% 20 1,056 15.0% 46 Massachusetts 1,198 18.6% 17 1,193 17.0% 23 Michigan 1,886 18.7% 12 1,851 17.3% 15 Minnesota 940 18.1% 33 1,018 16.1% 39 Mississippi 509 17.4% 44 579 18.7% 4 Missouri 1,072 18.2% 29 1,057 16.4% 34 Montana 198 20.7% 3 192 18.4% 6 Nebraska 313 17.6% 42 289 15.9% 41 Nevada 457 17.8% 39 821 19.2% 2 New Hampshire 264 20.1% 5 282 17.1% 19 New Jersey 1,589 18.3% 26 1,711 17.5% 13 New Mexico 352 17.9% 37 360 17.2% 17 New York 3,498 18.1% 33 3,246 16.7% 28 North Carolina 1,648 18.2% 29 2,092 17.1% 19 North Dakota 117 18.3% 26 101 16.7% 28 Ohio 2,143 18.7% 12 1,950 16.9% 25 Oklahoma 645 17.8% 39 632 16.2% 38 Oregon 740 19.7% 7 814 16.8% 27 Pennsylvania 2,384 19.2% 8 2,190 17.2% 17 Rhode Island 196 18.5% 19 196 17.0% 23 South Carolina 834 18.9% 10 924 17.9% 9 South Dakota 146 18.4% 20 133 16.6% 30 Tennessee 1,150 18.7% 12 1,245 16.9% 25 Texas 3,787 15.8% 50 5,002 15.0% 46 Utah 359 13.6% 51 494 14.2% 50 Vermont 134 21.5% 1 122 17.1% 19 Virginia 1,403 18.2% 29 1,553 15.8% 42 Washington 1,228 19.0% 9 1,358 15.7% 43 West Virginia 374 20.6% 4 354 20.6% 1 Wisconsin 1,040 18.6% 17 1,064 17.3% 15 Wyoming 104 19.9% 6 94 18.1% 7 United States 53,725 17.8% 59,928 16.5% Note: The highest data value within each ranking is indicated by a rank of 1. 27 Population & Projections Percent Change in Population, Population, Age 65+, 2007 Age 50-64, 2007-2030 Value Percent of Value Rank (Millions) Total Population Rank Alabama +3% 21 626 13.5% 14 Alaska -20% 50 48 7.0% 51 Arizona +69% 2 820 12.9% 28 Arkansas +11% 12 397 14.0% 9 California +18% 10 4,004 11.0% 46 Colorado +1% 27 493 10.1% 47 Connecticut -8% 41 472 13.5% 14 Delaware +19% 9 118 13.6% 12 District of Columbia -36% 51 70 11.9% 40 Florida +54% 3 3,098 17.0% 1 Georgia +24% 8 943 9.9% 49 Hawaii -10% 48 184 14.3% 7 Idaho +28% 6 175 11.7% 43 Illinois -1% 30 1,549 12.1% 39 Indiana -1% 30 795 12.5% 33 Iowa -6% 39 438 14.7% 5 Kansas -4% 36 360 13.0% 24 Kentucky +3% 21 550 13.0% 24 Louisiana +2% 23 522 12.2% 35 Maine -5% 37 195 14.8% 4 Maryland +2% 23 662 11.8% 41 Massachusetts +0% 28 859 13.3% 18 Michigan -2% 33 1,280 12.7% 30 Minnesota +8% 17 636 12.2% 35 Mississippi +14% 11 365 12.5% 33 Missouri -1% 30 788 13.4% 17 Montana -3% 35 134 13.9% 10 Nebraska -8% 41 237 13.3% 18 Nevada +80% 1 286 11.1% 45 New Hampshire +7% 20 166 12.6% 32 New Jersey +8% 17 1,135 13.1% 22 New Mexico +2% 23 250 12.7% 30 New York -7% 40 2,546 13.2% 21 North Carolina +27% 7 1,103 12.2% 35 North Dakota -13% 49 93 14.6% 6 Ohio -9% 44 1,545 13.5% 14 Oklahoma -2% 33 480 13.3% 18 Oregon +10% 16 489 13.0% 24 Pennsylvania -8% 41 1,890 15.2% 3 Rhode Island +0% 28 147 13.9% 10 South Carolina +11% 12 573 13.0% 24 South Dakota -9% 44 114 14.3% 7 Tennessee +8% 17 793 12.9% 28 Texas +32% 5 2,394 10.0% 48 Utah +37% 4 234 8.8% 50 Vermont -9% 44 84 13.6% 12 Virginia +11% 12 910 11.8% 41 Washington +11% 12 758 11.7% 43 West Virginia -5% 37 281 15.5% 2 Wisconsin +2% 23 736 13.1% 22 Wyoming -9% 44 64 12.2% 35 United States +12% 37,888 12.6% Note: The highest data value within each ranking is indicated by a rank of 1. 28 Population & Projections Population, Age 65+, 2030 Percent Change in Population, Value Percent of Age 65+, 2007-2030 (Millions) Total Population Rank Value Rank Alabama 1,039 21.3% 19 +66% 34 Alaska 127 14.7% 49 +165% 3 Arizona 2,371 22.1% 14 +189% 1 Arkansas 656 20.3% 25 +65% 35 California 8,288 17.8% 43 +107% 9 Colorado 956 16.5% 46 +94% 20 Connecticut 794 21.5% 16 +68% 32 Delaware 238 23.5% 9 +102% 14 District of Columbia 58 13.4% 50 -16% 51 Florida 7,769 27.1% 1 +151% 4 Georgia 1,908 15.9% 47 +102% 14 Hawaii 327 22.3% 13 +78% 27 Idaho 361 18.3% 38 +106% 10 Illinois 2,412 18.0% 42 +56% 44 Indiana 1,232 18.1% 40 +55% 45 Iowa 663 22.4% 12 +51% 50 Kansas 593 20.2% 26 +65% 35 Kentucky 903 19.8% 30 +64% 38 Louisiana 944 19.7% 31 +81% 24 Maine 374 26.5% 2 +92% 21 Maryland 1,236 17.6% 45 +87% 23 Massachusetts 1,463 20.9% 21 +70% 31 Michigan 2,081 19.5% 32 +63% 39 Minnesota 1,193 18.9% 35 +88% 22 Mississippi 634 20.5% 23 +74% 29 Missouri 1,302 20.2% 26 +65% 35 Montana 270 25.8% 5 +102% 14 Nebraska 376 20.6% 22 +59% 42 Nevada 797 18.6% 37 +179% 2 New Hampshire 353 21.4% 17 +113% 8 New Jersey 1,960 20.0% 29 +73% 30 New Mexico 555 26.4% 4 +122% 5 New York 3,917 20.1% 28 +54% 46 North Carolina 2,173 17.8% 43 +97% 18 North Dakota 152 25.1% 6 +63% 39 Ohio 2,357 20.4% 24 +53% 47 Oklahoma 758 19.4% 33 +58% 43 Oregon 882 18.2% 39 +80% 25 Pennsylvania 2,890 22.6% 11 +53% 47 Rhode Island 247 21.4% 17 +68% 32 South Carolina 1,134 22.0% 15 +98% 17 South Dakota 185 23.1% 10 +63% 39 Tennessee 1,418 19.2% 34 +79% 26 Texas 5,186 15.6% 48 +117% 6 Utah 461 13.2% 51 +97% 18 Vermont 174 24.4% 8 +106% 10 Virginia 1,844 18.8% 36 +103% 13 Washington 1,564 18.1% 40 +106% 10 West Virginia 426 24.8% 7 +52% 49 Wisconsin 1,312 21.3% 19 +78% 27 Wyoming 139 26.5% 2 +117% 6 United States 71,453 19.7% +89% Note: The highest data value within each ranking is indicated by a rank of 1. 29 Population & Projections Population, Age 65-74, 2007 Population, Age 65-74, 2030 Value Percent of Value Percent of (Millions) Total Population Rank (Millions) Total Population Rank Alabama 333 7.2% 5 559 11.5% 14 Alaska 29 4.3% 51 64 7.4% 49 Arizona 421 6.6% 22 1,318 12.3% 9 Arkansas 207 7.3% 4 360 11.1% 18 California 2,049 5.6% 46 4,332 9.3% 42 Colorado 265 5.5% 47 491 8.5% 47 Connecticut 229 6.5% 25 395 10.7% 26 Delaware 62 7.1% 8 131 12.9% 5 District of Columbia 36 6.1% 41 29 6.8% 51 Florida 1,479 8.1% 1 4,306 15.0% 1 Georgia 524 5.5% 47 1,068 8.9% 46 Hawaii 87 6.8% 15 159 10.9% 22 Idaho 92 6.1% 41 188 9.6% 39 Illinois 785 6.1% 41 1,259 9.4% 41 Indiana 408 6.4% 32 648 9.5% 40 Iowa 207 6.9% 13 330 11.2% 17 Kansas 174 6.3% 39 301 10.2% 34 Kentucky 295 7.0% 10 497 10.9% 22 Louisiana 277 6.4% 32 500 10.4% 29 Maine 99 7.5% 3 190 13.5% 2 Maryland 350 6.2% 40 647 9.2% 44 Massachusetts 415 6.4% 32 764 10.9% 22 Michigan 655 6.5% 25 1,090 10.2% 34 Minnesota 317 6.1% 41 627 9.9% 36 Mississippi 193 6.6% 22 355 11.5% 14 Missouri 402 6.8% 15 694 10.8% 25 Montana 69 7.2% 5 134 12.8% 6 Nebraska 114 6.4% 32 189 10.4% 29 Nevada 163 6.4% 32 471 11.0% 20 New Hampshire 85 6.5% 25 189 11.5% 14 New Jersey 569 6.5% 25 1,027 10.5% 28 New Mexico 132 6.7% 18 284 13.5% 2 New York 1,282 6.6% 22 2,003 10.3% 31 North Carolina 592 6.5% 25 1,199 9.8% 38 North Dakota 43 6.7% 18 76 12.5% 8 Ohio 781 6.8% 15 1,225 10.6% 27 Oklahoma 251 6.9% 13 403 10.3% 31 Oregon 249 6.7% 18 444 9.2% 44 Pennsylvania 896 7.2% 5 1,485 11.6% 12 Rhode Island 68 6.4% 32 127 11.0% 20 South Carolina 311 7.1% 8 613 11.9% 11 South Dakota 54 6.7% 18 93 11.6% 12 Tennessee 429 7.0% 10 761 10.3% 31 Texas 1,278 5.3% 49 2,838 8.5% 47 Utah 124 4.7% 50 242 6.9% 50 Vermont 44 7.0% 10 87 12.3% 9 Virginia 490 6.4% 32 974 9.9% 36 Washington 394 6.1% 41 806 9.3% 42 West Virginia 146 8.0% 2 221 12.8% 6 Wisconsin 365 6.5% 25 685 11.1% 18 Wyoming 34 6.5% 25 68 13.1% 4 United States 19,352 6.4% 37,948 10.4% Note: The highest data value within each ranking is indicated by a rank of 1. 30 Population & Projections Percent Change in Population, Population, Age 75-84, 2007 Age 65-74, 2007-2030 Value Percent of Value Rank (Millions) Total Population Rank Alabama +68% 39 210 4.5% 22 Alaska +119% 6 14 2.1% 51 Arizona +213% 1 287 4.5% 22 Arkansas +74% 34 133 4.7% 10 California +111% 9 1,370 3.7% 45 Colorado +85% 24 163 3.3% 47 Connecticut +73% 35 166 4.7% 10 Delaware +112% 8 41 4.7% 10 District of Columbia -18% 51 23 3.9% 41 Florida +191% 2 1,126 6.2% 1 Georgia +104% 10 300 3.1% 49 Hawaii +84% 26 68 5.3% 4 Idaho +104% 10 58 3.9% 41 Illinois +60% 45 530 4.1% 35 Indiana +59% 46 273 4.3% 28 Iowa +59% 46 154 5.1% 6 Kansas +73% 35 125 4.5% 22 Kentucky +68% 39 182 4.3% 28 Louisiana +81% 29 177 4.1% 35 Maine +92% 21 68 5.1% 6 Maryland +85% 24 222 4.0% 40 Massachusetts +84% 26 304 4.7% 10 Michigan +66% 41 443 4.4% 26 Minnesota +98% 17 215 4.1% 35 Mississippi +84% 26 121 4.2% 33 Missouri +73% 35 268 4.6% 17 Montana +95% 20 45 4.7% 10 Nebraska +66% 41 83 4.7% 10 Nevada +188% 3 92 3.6% 46 New Hampshire +122% 4 56 4.3% 28 New Jersey +81% 29 397 4.6% 17 New Mexico +116% 7 85 4.3% 28 New York +56% 49 880 4.6% 17 North Carolina +103% 13 369 4.1% 35 North Dakota +77% 32 33 5.2% 5 Ohio +57% 48 542 4.7% 10 Oklahoma +61% 44 161 4.5% 22 Oregon +78% 31 166 4.4% 26 Pennsylvania +66% 41 692 5.6% 2 Rhode Island +86% 23 53 5.0% 8 South Carolina +97% 18 189 4.3% 28 South Dakota +73% 35 40 5.0% 8 Tennessee +77% 32 261 4.2% 33 Texas +122% 4 798 3.3% 47 Utah +96% 19 79 3.0% 50 Vermont +100% 14 29 4.6% 17 Virginia +99% 16 302 3.9% 41 Washington +104% 10 252 3.9% 41 West Virginia +52% 50 98 5.4% 3 Wisconsin +88% 22 256 4.6% 17 Wyoming +100% 14 21 4.1% 35 United States +96% 13,024 4.3% Note: The highest data value within each ranking is indicated by a rank of 1. 31 Population & Projections Percent Change in Population, Population, Age 75-84, 2030 Age 75-84, 2007-2030 Value Percent of Value Rank (Millions) Total Population Rank (Millions) Alabama 348 7.1% 21 +66% 30 Alaska 45 5.2% 47 +218% 1 Arizona 788 7.4% 14 +175% 2 Arkansas 214 6.6% 26 +61% 36 California 2,797 6.0% 41 +104% 16 Colorado 333 5.8% 44 +105% 13 Connecticut 267 7.2% 16 +61% 36 Delaware 78 7.7% 11 +92% 20 District of Columbia 20 4.6% 50 -14% 51 Florida 2,519 8.8% 6 +124% 6 Georgia 615 5.1% 48 +105% 13 Hawaii 119 8.1% 9 +76% 27 Idaho 126 6.4% 36 +116% 8 Illinois 801 6.0% 41 +51% 46 Indiana 415 6.1% 40 +52% 45 Iowa 228 7.7% 11 +49% 47 Kansas 204 7.0% 22 +63% 32 Kentucky 301 6.6% 26 +65% 31 Louisiana 318 6.6% 26 +80% 26 Maine 131 9.3% 3 +94% 19 Maryland 412 5.9% 43 +85% 23 Massachusetts 487 7.0% 22 +60% 39 Michigan 703 6.6% 26 +59% 40 Minnesota 398 6.3% 37 +85% 23 Mississippi 205 6.6% 26 +69% 29 Missouri 433 6.7% 25 +62% 33 Montana 98 9.4% 2 +118% 7 Nebraska 131 7.2% 16 +58% 41 Nevada 244 5.7% 46 +164% 3 New Hampshire 119 7.2% 16 +110% 12 New Jersey 641 6.5% 32 +62% 33 New Mexico 196 9.3% 3 +131% 5 New York 1,292 6.6% 26 +47% 49 North Carolina 707 5.8% 44 +92% 20 North Dakota 54 8.8% 6 +62% 33 Ohio 809 7.0% 22 +49% 47 Oklahoma 255 6.5% 32 +58% 41 Oregon 316 6.5% 32 +90% 22 Pennsylvania 989 7.7% 11 +43% 50 Rhode Island 83 7.2% 16 +55% 44 South Carolina 380 7.4% 14 +101% 17 South Dakota 64 8.0% 10 +61% 36 Tennessee 477 6.5% 32 +82% 25 Texas 1,710 5.1% 48 +114% 11 Utah 159 4.6% 50 +100% 18 Vermont 62 8.7% 8 +115% 9 Virginia 620 6.3% 37 +105% 13 Washington 542 6.3% 37 +115% 9 West Virginia 152 8.9% 5 +56% 43 Wisconsin 444 7.2% 16 +73% 28 Wyoming 51 9.7% 1 +140% 4 United States 23,903 6.6% +84% Note: The highest data value within each ranking is indicated by a rank of 1. 32 Population & Projections Population, Age 85+, 2007 Population, Age 85+, 2030 Value Percent of Value Percent of (Millions) Total Population Rank (Millions) Total Population Rank Alabama 82 1.8% 25 132 2.7% 23 Alaska 5 0.7% 51 18 2.1% 46 Arizona 113 1.8% 25 265 2.5% 31 Arkansas 57 2.0% 16 82 2.5% 31 California 585 1.6% 38 1,159 2.5% 31 Colorado 65 1.3% 46 132 2.3% 43 Connecticut 78 2.2% 9 132 3.6% 4 Delaware 15 1.8% 25 29 2.9% 21 District of Columbia 11 1.8% 25 9 2.0% 47 Florida 494 2.7% 1 944 3.3% 10 Georgia 118 1.2% 48 225 1.9% 48 Hawaii 29 2.3% 7 48 3.3% 10 Idaho 25 1.6% 38 47 2.4% 40 Illinois 234 1.8% 25 352 2.6% 29 Indiana 115 1.8% 25 169 2.5% 31 Iowa 77 2.6% 3 105 3.6% 4 Kansas 61 2.2% 9 88 3.0% 17 Kentucky 72 1.7% 33 106 2.3% 43 Louisiana 69 1.6% 38 126 2.6% 29 Maine 28 2.1% 12 52 3.7% 2 Maryland 89 1.6% 38 177 2.5% 31 Massachusetts 140 2.2% 9 212 3.0% 17 Michigan 182 1.8% 25 287 2.7% 23 Minnesota 105 2.0% 16 168 2.7% 23 Mississippi 51 1.7% 33 74 2.4% 40 Missouri 118 2.0% 16 174 2.7% 23 Montana 20 2.1% 12 37 3.6% 4 Nebraska 40 2.3% 7 56 3.1% 15 Nevada 30 1.2% 48 83 1.9% 48 New Hampshire 24 1.8% 25 45 2.7% 23 New Jersey 169 1.9% 21 291 3.0% 17 New Mexico 34 1.7% 33 76 3.6% 4 New York 385 2.0% 16 622 3.2% 13 North Carolina 143 1.6% 38 267 2.2% 45 North Dakota 17 2.7% 1 23 3.8% 1 Ohio 222 1.9% 21 322 2.8% 22 Oklahoma 68 1.9% 21 100 2.5% 31 Oregon 73 2.0% 16 122 2.5% 31 Pennsylvania 302 2.4% 5 415 3.3% 10 Rhode Island 25 2.4% 5 37 3.2% 13 South Carolina 72 1.6% 38 141 2.7% 23 South Dakota 20 2.5% 4 28 3.5% 8 Tennessee 102 1.7% 33 180 2.4% 40 Texas 318 1.3% 46 639 1.9% 48 Utah 31 1.2% 48 59 1.7% 51 Vermont 12 1.9% 21 25 3.5% 8 Virginia 117 1.5% 45 250 2.5% 31 Washington 111 1.7% 33 216 2.5% 31 West Virginia 37 2.1% 12 53 3.1% 15 Wisconsin 115 2.1% 12 183 3.0% 17 Wyoming 9 1.6% 38 19 3.7% 2 United States 5,512 1.8% 9,603 2.6% Note: The highest data value within each ranking is indicated by a rank of 1. 33 Population & Projections Percent Change in Population, People of Color, Asian Age 65+ (%), 2007 Age 85+, 2007-2030 Age 65+ (%), 2007 Value Rank Value Rank Value Rank Alabama +61% 30 20.3% 17 0.6% 41 Alaska +297% 1 27.5% 6 6.2% 4 Arizona +135% 3 16.6% 20 1.8% 18 Arkansas +45% 41 12.2% 26 0.6% 41 California +98% 10 36.2% 4 13.6% 2 Colorado +104% 8 15.3% 22 2.2% 14 Connecticut +70% 26 11.6% 27 1.6% 19 Delaware +89% 18 16.2% 21 1.6% 19 District of Columbia -17% 51 70.8% 2 2.2% 14 Florida +91% 15 21.4% 15 1.4% 21 Georgia +91% 15 24.6% 11 1.9% 17 Hawaii +64% 28 77.5% 1 78.5% 1 Idaho +91% 15 5.1% 43 1.0% 28 Illinois +51% 35 19.4% 18 3.0% 10 Indiana +48% 36 8.5% 33 0.7% 37 Iowa +36% 49 2.8% 48 0.6% 41 Kansas +45% 41 8.3% 34 1.1% 26 Kentucky +48% 36 6.9% 38 0.5% 46 Louisiana +84% 23 26.1% 9 1.0% 28 Maine +87% 20 1.7% 51 0.5% 46 Maryland +98% 10 27.4% 7 4.0% 8 Massachusetts +52% 34 8.8% 32 2.5% 12 Michigan +58% 33 13.0% 24 1.2% 24 Minnesota +61% 30 4.2% 45 1.4% 21 Mississippi +45% 41 26.5% 8 0.6% 41 Missouri +48% 36 10.0% 30 0.9% 32 Montana +88% 19 5.2% 41 0.5% 46 Nebraska +40% 46 5.2% 41 0.7% 37 Nevada +176% 2 22.4% 13 7.0% 3 New Hampshire +87% 20 2.5% 49 0.9% 32 New Jersey +72% 25 21.9% 14 4.5% 7 New Mexico +123% 5 39.4% 3 1.1% 26 New York +62% 29 25.5% 10 4.9% 6 North Carolina +87% 20 19.0% 19 1.0% 28 North Dakota +34% 50 3.0% 47 0.3% 50 Ohio +45% 41 10.7% 29 0.9% 32 Oklahoma +46% 39 14.6% 23 1.0% 28 Oregon +66% 27 7.2% 37 2.6% 11 Pennsylvania +37% 48 9.4% 31 1.2% 24 Rhode Island +46% 39 7.6% 36 1.4% 21 South Carolina +95% 12 22.6% 12 0.8% 35 South Dakota +39% 47 4.6% 44 0.3% 50 Tennessee +76% 24 12.5% 25 0.7% 37 Texas +101% 9 31.3% 5 2.4% 13 Utah +92% 14 7.8% 35 2.2% 14 Vermont +106% 7 2.3% 50 0.6% 41 Virginia +114% 6 20.9% 16 3.3% 9 Washington +94% 13 11.4% 28 5.8% 5 West Virginia +43% 45 4.1% 46 0.5% 46 Wisconsin +59% 32 5.3% 40 0.8% 35 Wyoming +126% 4 6.6% 39 0.7% 37 United States +74% 19.3% 3.6% Note: The highest data value within each ranking is indicated by a rank of 1. 34 Population & Projections Black Age 65+ (%), 2007 Hispanic Age 65+ (%), 2007 Value Rank Value Rank Alabama 18.2% 7 0.9% 39 Alaska 2.3% 34 2.3% 22 Arizona 2.1% 36 10.5% 5 Arkansas 9.5% 16 1.2% 35 California 5.5% 25 16.8% 3 Colorado 2.8% 31 9.8% 6 Connecticut 6.0% 22 4.0% 12 Delaware 12.5% 11 1.7% 29 District of Columbia 65.1% 1 3.9% 13 Florida 7.6% 19 12.6% 4 Georgia 20.5% 5 2.1% 25 Hawaii 1.0% 40 2.7% 16 Idaho 0.2% 48 2.7% 16 Illinois 11.2% 12 5.0% 10 Indiana 6.0% 22 1.5% 30 Iowa 1.0% 40 0.9% 39 Kansas 3.6% 29 2.6% 18 Kentucky 5.2% 26 0.7% 46 Louisiana 22.4% 3 2.2% 24 Maine 0.3% 46 0.5% 50 Maryland 21.0% 4 2.3% 22 Massachusetts 3.8% 28 2.6% 18 Michigan 9.9% 15 1.4% 31 Minnesota 1.3% 39 0.9% 39 Mississippi 24.6% 2 0.9% 39 Missouri 7.4% 20 1.0% 37 Montana 0.2% 48 1.0% 37 Nebraska 2.2% 35 1.8% 28 Nevada 5.8% 24 8.9% 8 New Hampshire 0.4% 45 0.9% 39 New Jersey 10.0% 14 7.7% 9 New Mexico 1.7% 38 31.4% 1 New York 12.8% 10 9.0% 7 North Carolina 15.8% 8 1.3% 32 North Dakota 0.1% 51 0.4% 51 Ohio 8.6% 18 0.9% 39 Oklahoma 4.7% 27 1.9% 27 Oregon 1.0% 40 2.4% 21 Pennsylvania 6.8% 21 1.3% 32 Rhode Island 3.0% 30 3.3% 15 South Carolina 20.5% 5 1.1% 36 South Dakota 0.2% 48 0.7% 46 Tennessee 10.4% 13 0.9% 39 Texas 8.7% 17 19.8% 2 Utah 0.5% 43 4.4% 11 Vermont 0.3% 46 0.7% 46 Virginia 15.4% 9 2.0% 26 Washington 1.9% 37 2.5% 20 West Virginia 2.5% 33 0.6% 49 Wisconsin 2.7% 32 1.3% 32 Wyoming 0.5% 43 3.8% 14 United States 8.7% 6.6% Note: The highest data value within each ranking is indicated by a rank of 1. 35 Population & Characteristics Men per 100 Women Persons Age 75+ Non-Metropolitan Age 85+ Living Alone Population, 2007/2008 Value Rank Value Rank Value Rank Alabama 43 37 36% 10 40% 18 Alaska 56 8 28% 47 37% 20 Arizona 62 2 28% 47 16% 35 Arkansas 48 16 34% 24 42% 14 California 53 10 30% 44 3% 44 Colorado 48 16 34% 24 NA Connecticut 44 32 34% 24 5% 42 Delaware 49 14 33% 33 30% 24 District of Columbia 41 50 40% 1 0% 45 Florida 61 4 30% 44 6% 40 Georgia 41 50 32% 36 19% 33 Hawaii 62 2 23% 51 27% 27 Idaho 57 6 32% 36 38% 19 Illinois 43 37 35% 16 15% 37 Indiana 43 37 34% 24 27% 27 Iowa 43 37 39% 2 52% 9 Kansas 44 32 35% 16 44% 12 Kentucky 43 37 35% 16 54% 8 Louisiana 45 22 32% 36 NA Maine 45 22 37% 6 61% 7 Maryland 45 22 32% 36 6% 40 Massachusetts 42 48 35% 16 4% 43 Michigan 46 20 35% 16 18% 34 Minnesota 45 22 38% 4 31% 23 Mississippi 43 37 36% 10 63% 6 Missouri 43 37 36% 10 30% 24 Montana 53 10 32% 36 70% 3 Nebraska 44 32 37% 6 47% 10 Nevada 65 1 27% 49 NA New Hampshire 44 32 31% 42 42% 14 New Jersey 45 22 33% 33 0% 45 New Mexico 57 6 31% 42 37% 20 New York 45 22 34% 24 10% 39 North Carolina 43 37 34% 24 44% 12 North Dakota 49 14 38% 4 66% 4 Ohio 43 37 36% 10 24% 31 Oklahoma 46 20 36% 10 41% 17 Oregon 54 9 35% 16 33% 22 Pennsylvania 43 37 34% 24 20% 32 Rhode Island 42 48 35% 16 0% 45 South Carolina 45 22 33% 33 42% 14 South Dakota 48 16 39% 2 65% 5 Tennessee 43 37 34% 24 27% 27 Texas 48 16 30% 44 16% 35 Utah 59 5 27% 49 NA Vermont 45 22 35% 16 74% 2 Virginia 44 32 36% 10 26% 30 Washington 52 12 34% 24 11% 38 West Virginia 45 22 37% 6 46% 11 Wisconsin 45 22 37% 6 29% 26 Wyoming 51 13 32% 36 77% 1 United States 48 33% 20% Note: The highest data value within each ranking is indicated by a rank of 1. 36 Population & Characteristics Bachelor-Level Education or Persons Age 60+ Raising Median Household Income, Higher, Age 65+, 2007 G ­ randchildren, 2007 Age 65+, 2007 Value Rank Value Rank Value Rank Alabama 15% 39 2.1% 11 $27,112 45 Alaska 21% 17 2.9% 1 $41,109 3 Arizona 23% 11 1.7% 21 $35,480 15 Arkansas 14% 46 2.3% 8 $26,189 47 California 24% 5 1.8% 17 $38,154 6 Colorado 27% 2 1.4% 26 $36,759 13 Connecticut 24% 5 1.1% 35 $37,965 8 Delaware 21% 17 1.6% 23 $37,445 10 District of Columbia 34% 1 2.4% 5 $39,186 4 Florida 21% 17 1.3% 31 $33,469 17 Georgia 17% 33 2.4% 5 $31,143 26 Hawaii 22% 13 2.4% 5 $52,393 1 Idaho 19% 24 1.1% 35 $30,813 28 Illinois 18% 31 1.5% 24 $32,731 19 Indiana 14% 46 1.3% 31 $30,931 27 Iowa 15% 39 0.7% 46 $29,228 38 Kansas 19% 24 1.1% 35 $31,634 24 Kentucky 13% 49 1.8% 17 $25,834 48 Louisiana 15% 39 2.7% 3 $26,344 46 Maine 20% 22 1.0% 39 $29,101 39 Maryland 25% 4 1.7% 21 $41,707 2 Massachusetts 24% 5 0.9% 42 $33,332 18 Michigan 16% 37 1.2% 33 $31,513 25 Minnesota 19% 24 0.8% 44 $32,714 20 Mississippi 14% 46 2.9% 1 $23,892 51 Missouri 15% 39 1.4% 26 $29,833 35 Montana 22% 13 1.8% 17 $30,767 30 Nebraska 17% 33 0.7% 46 $30,468 31 Nevada 20% 22 2.1% 11 $38,993 5 New Hampshire 24% 5 0.8% 44 $37,156 11 New Jersey 21% 17 1.2% 33 $37,507 9 New Mexico 22% 13 2.0% 14 $30,441 32 New York 21% 17 1.4% 26 $31,734 23 North Carolina 18% 31 1.9% 15 $28,535 41 North Dakota 11% 51 0.9% 42 $25,658 50 Ohio 15% 39 1.4% 26 $30,117 34 Oklahoma 17% 33 2.2% 9 $29,327 37 Oregon 22% 13 1.0% 39 $33,565 16 Pennsylvania 15% 39 1.0% 39 $28,937 40 Rhode Island 19% 24 0.5% 50 $28,250 42 South Carolina 19% 24 1.8% 17 $29,791 36 South Dakota 17% 33 1.1% 35 $28,244 43 Tennessee 15% 39 2.1% 11 $27,740 44 Texas 19% 24 2.6% 4 $31,918 22 Utah 24% 5 2.2% 9 $38,022 7 Vermont 27% 2 0.5% 50 $30,784 29 Virginia 23% 11 1.5% 24 $36,561 14 Washington 24% 5 1.4% 26 $36,908 12 West Virginia 12% 50 1.9% 15 $25,795 49 Wisconsin 16% 37 0.7% 46 $30,184 33 Wyoming 19% 24 0.6% 49 $32,280 21 United States 19% 1.6% $32,158 Note: The highest data value within each ranking is indicated by a rank of 1. 37 Population & Characteristics Pct of Age 65+ Below Pct of Age 65+ Below Pct of Age 65+ Below Pct of Women Age 75+ Poverty, 2007 200% of Poverty, 2007 300% of Poverty, 2007 Below Poverty, 2007 Value Rank Value Rank Value Rank Value Rank Alabama 11.9% 12 39% 7 59% 6 16% 11 Alaska 5.4% 50 25% 46 38% 50 6% 51 Arizona 8.6% 26 29% 39 48% 36 10% 43 Arkansas 12.1% 7 40% 4 60% 4 17% 6 California 8.2% 33 30% 35 47% 37 10% 43 Colorado 8.5% 27 28% 40 45% 40 13% 24 Connecticut 6.4% 48 24% 48 41% 48 9% 46 Delaware 7.8% 41 28% 40 45% 40 10% 43 District of Columbia 13.7% 2 33% 21 43% 45 16% 11 Florida 9.4% 19 31% 29 50% 32 12% 28 Georgia 12.1% 7 35% 15 53% 22 18% 4 Hawaii 6.3% 49 21% 51 36% 51 9% 46 Idaho 8.0% 37 32% 25 55% 14 14% 19 Illinois 8.5% 27 31% 29 51% 29 11% 35 Indiana 7.8% 41 32% 25 54% 19 11% 35 Iowa 7.7% 43 34% 18 56% 11 13% 24 Kansas 8.1% 36 30% 35 49% 35 12% 28 Kentucky 12.9% 5 40% 4 61% 3 17% 6 Louisiana 13.3% 3 40% 4 59% 6 18% 4 Maine 9.2% 23 39% 7 57% 9 14% 19 Maryland 8.2% 33 24% 48 40% 49 12% 28 Massachusetts 9.3% 20 30% 35 47% 37 12% 28 Michigan 8.0% 37 31% 29 53% 22 11% 35 Minnesota 8.0% 37 30% 35 50% 32 13% 24 Mississippi 14.9% 1 44% 1 63% 2 19% 2 Missouri 9.3% 20 35% 15 55% 14 14% 19 Montana 10.0% 18 33% 21 52% 26 16% 11 Nebraska 8.3% 31 31% 29 52% 26 14% 19 Nevada 6.8% 45 27% 43 44% 44 9% 46 New Hampshire 6.5% 47 25% 46 43% 45 9% 46 New Jersey 8.4% 29 26% 44 43% 45 12% 28 New Mexico 13.3% 3 37% 10 56% 11 17% 6 New York 11.7% 13 33% 21 51% 29 15% 16 North Carolina 11.0% 15 37% 10 55% 14 16% 11 North Dakota 12.6% 6 41% 2 60% 4 20% 1 Ohio 8.2% 33 32% 25 54% 19 11% 35 Oklahoma 10.1% 17 36% 12 55% 14 14% 19 Oregon 8.4% 29 31% 29 50% 32 12% 28 Pennsylvania 8.7% 25 34% 18 56% 11 12% 28 Rhode Island 9.3% 20 34% 18 53% 22 11% 35 South Carolina 12.0% 9 36% 12 55% 14 17% 6 South Dakota 11.5% 14 36% 12 58% 8 19% 2 Tennessee 12.0% 9 38% 9 57% 9 17% 6 Texas 12.0% 9 35% 15 53% 22 16% 11 Utah 6.8% 45 24% 48 46% 39 9% 46 Vermont 7.5% 44 32% 25 51% 29 11% 35 Virginia 9.2% 23 28% 40 45% 40 15% 16 Washington 7.9% 40 26% 44 45% 40 11% 35 West Virginia 10.4% 16 41% 2 64% 1 15% 16 Wisconsin 8.3% 31 33% 21 54% 19 13% 24 Wyoming 5.3% 51 31% 29 52% 26 11% 35 United States 9.5% 32% 51% 13% Note: The highest data value within each ranking is indicated by a rank of 1. 38 Population & Characteristics Persons Age 65+ w/ Sensory Disability, 2007 Persons Age 65+ w/ Physical Disability, 2007 Value Percent of Value Percent of (Thousands) Age 65+ Rank (Thousands) Age 65+ Rank Alabama 125 21% 4 237 40% 2 Alaska 11 23% 1 16 35% 10 Arizona 132 16% 25 237 29% 30 Arkansas 82 22% 2 147 39% 3 California 628 16% 25 1,213 31% 17 Colorado 75 16% 25 126 26% 46 Connecticut 63 14% 43 116 26% 46 Delaware 16 14% 43 32 28% 35 District of Columbia 9 14% 43 19 29% 30 Florida 460 15% 34 873 29% 30 Georgia 158 17% 18 313 35% 10 Hawaii 26 14% 43 51 28% 35 Idaho 30 18% 13 50 30% 24 Illinois 213 14% 43 440 30% 24 Indiana 120 16% 25 229 31% 17 Iowa 61 15% 34 107 26% 46 Kansas 52 16% 25 99 30% 24 Kentucky 110 21% 4 201 39% 3 Louisiana 97 20% 8 184 37% 6 Maine 35 19% 10 58 31% 17 Maryland 85 13% 50 177 28% 35 Massachusetts 120 15% 34 224 28% 35 Michigan 198 16% 25 381 31% 17 Minnesota 85 14% 43 153 26% 46 Mississippi 76 22% 2 146 42% 1 Missouri 125 17% 18 245 33% 14 Montana 25 20% 8 39 31% 17 Nebraska 32 15% 34 59 27% 42 Nevada 41 15% 34 79 28% 35 New Hampshire 25 16% 25 40 26% 46 New Jersey 136 13% 50 298 27% 42 New Mexico 51 21% 4 88 36% 8 New York 365 15% 34 738 30% 24 North Carolina 182 17% 18 359 34% 13 North Dakota 15 17% 18 25 30% 24 Ohio 224 15% 34 438 30% 24 Oklahoma 89 19% 10 167 37% 6 Oregon 84 18% 13 151 32% 16 Pennsylvania 266 15% 34 514 29% 30 Rhode Island 21 16% 25 39 28% 35 South Carolina 92 17% 18 185 33% 14 South Dakota 18 17% 18 29 27% 42 Tennessee 144 19% 10 266 35% 10 Texas 418 18% 13 819 36% 8 Utah 38 17% 18 64 28% 35 Vermont 13 16% 25 22 27% 42 Virginia 128 15% 34 266 31% 17 Washington 131 18% 13 227 31% 17 West Virginia 57 21% 4 103 38% 5 Wisconsin 96 14% 43 181 26% 46 Wyoming 10 18% 13 17 29% 30 United States 5,893 16% 11,285 31% Note: The highest data value within each ranking is indicated by a rank of 1. 39 Population & Characteristics Persons Age 65+ w/ Mobility Disability, 2007 Persons Age 65+ w/ Self-Care Disability, 2007 Value Percent of Value Percent of (Thousands) Age 65+ Rank (Thousands) Age 65+ Rank Alabama 135 22% 2 83 14% 2 Alaska 9 19% 10 5 12% 7 Arizona 127 16% 27 73 9% 30 Arkansas 72 19% 10 43 11% 13 California 749 19% 10 457 12% 7 Colorado 72 15% 35 41 9% 30 Connecticut 70 16% 27 39 9% 30 Delaware 16 14% 41 10 9% 30 District of Columbia 12 19% 10 8 11% 13 Florida 473 16% 27 269 9% 30 Georgia 182 20% 7 105 12% 7 Hawaii 32 18% 16 18 10% 19 Idaho 24 15% 35 14 8% 40 Illinois 247 17% 20 140 10% 19 Indiana 121 16% 27 72 10% 19 Iowa 51 13% 48 29 7% 48 Kansas 46 14% 41 26 8% 40 Kentucky 113 22% 2 65 13% 4 Louisiana 106 21% 5 68 14% 2 Maine 26 14% 41 15 8% 40 Maryland 102 16% 27 60 9% 30 Massachusetts 125 15% 35 72 9% 30 Michigan 212 17% 20 123 10% 19 Minnesota 78 13% 48 43 7% 48 Mississippi 80 23% 1 52 15% 1 Missouri 132 18% 16 77 10% 19 Montana 19 15% 35 10 8% 40 Nebraska 31 14% 41 18 8% 40 Nevada 41 15% 35 24 9% 30 New Hampshire 21 14% 41 12 8% 40 New Jersey 185 17% 20 112 10% 19 New Mexico 49 20% 7 32 13% 4 New York 455 19% 10 271 11% 13 North Carolina 190 18% 16 114 11% 13 North Dakota 11 13% 48 5 6% 51 Ohio 241 16% 27 142 10% 19 Oklahoma 80 18% 16 49 11% 13 Oregon 81 17% 20 50 11% 13 Pennsylvania 292 16% 27 162 9% 30 Rhode Island 21 15% 35 13 10% 19 South Carolina 103 19% 10 64 12% 7 South Dakota 13 12% 51 7 7% 48 Tennessee 153 20% 7 92 12% 7 Texas 471 21% 5 306 13% 4 Utah 35 16% 27 19 9% 30 Vermont 11 14% 41 7 8% 40 Virginia 149 17% 20 87 10% 19 Washington 122 17% 20 75 10% 19 West Virginia 58 22% 2 33 12% 7 Wisconsin 101 14% 41 56 8% 40 Wyoming 10 17% 20 6 10% 19 United States 6,354 18% 3,772 10% Note: The highest data value within each ranking is indicated by a rank of 1. 40 Population & Characteristics Persons Age 65+ w/ Cognitive/Mental Disability, 2007 Persons Age 65+ w/ Any Disability, 2007 Value Percent of Value Percent of (Thousands) Age 65+ Rank (Thousands) Age 65+ Rank Alabama 99 16% 2 298 50% 2 Alaska 8 16% 2 22 48% 5 Arizona 95 12% 21 313 39% 27 Arkansas 61 16% 2 188 50% 2 California 534 14% 11 1,582 41% 19 Colorado 49 10% 34 175 37% 40 Connecticut 44 10% 34 159 36% 43 Delaware 11 10% 34 42 38% 34 District of Columbia 9 13% 17 25 38% 34 Florida 348 12% 21 1,157 38% 34 Georgia 137 15% 6 405 45% 11 Hawaii 24 13% 17 69 38% 34 Idaho 18 11% 27 66 40% 23 Illinois 158 11% 27 567 39% 27 Indiana 83 11% 27 303 40% 23 Iowa 35 9% 45 147 36% 43 Kansas 32 10% 34 133 40% 23 Kentucky 86 16% 2 254 49% 4 Louisiana 77 15% 6 236 47% 7 Maine 20 11% 27 79 43% 13 Maryland 69 11% 27 235 37% 40 Massachusetts 80 10% 34 294 36% 43 Michigan 142 12% 21 501 41% 19 Minnesota 51 9% 45 210 35% 49 Mississippi 66 19% 1 182 53% 1 Missouri 94 13% 17 315 42% 16 Montana 15 12% 21 53 42% 16 Nebraska 20 9% 45 79 36% 43 Nevada 28 10% 34 102 36% 43 New Hampshire 14 9% 45 56 36% 43 New Jersey 108 10% 34 384 35% 49 New Mexico 36 15% 6 113 46% 9 New York 297 12% 21 954 39% 27 North Carolina 148 14% 11 458 43% 13 North Dakota 7 9% 45 34 40% 23 Ohio 166 11% 27 576 39% 27 Oklahoma 63 14% 11 212 47% 7 Oregon 66 14% 11 200 42% 16 Pennsylvania 182 10% 34 688 39% 27 Rhode Island 14 10% 34 52 38% 34 South Carolina 76 14% 11 239 43% 13 South Dakota 10 9% 45 39 38% 34 Tennessee 113 15% 6 347 46% 9 Texas 333 15% 6 1,032 45% 11 Utah 26 11% 27 88 39% 27 Vermont 8 10% 34 30 37% 40 Virginia 102 12% 21 343 39% 27 Washington 97 13% 17 299 41% 19 West Virginia 38 14% 11 130 48% 5 Wisconsin 62 9% 45 247 35% 49 Wyoming 6 10% 34 24 41% 19 United States 4,467 12% 14,735 41% Note: The highest data value within each ranking is indicated by a rank of 1. 41 Population & Characteristics Persons Age 65+ w/ Cognitive/Mental + Any Other Disability, 2007 Persons Age 18-64 w/ Any Disability, 2007 Value Percent of Value Percent of (Thousands) Age 65+ Rank (Thousands) Age 65+ Rank Alabama 89 15% 3 491 17% 2 Alaska 6 14% 4 61 14% 10 Arizona 86 11% 20 407 11% 27 Arkansas 54 14% 4 297 17% 2 California 480 12% 13 2,193 10% 34 Colorado 43 9% 34 310 10% 34 Connecticut 38 9% 34 204 9% 46 Delaware 9 8% 44 59 11% 27 District of Columbia 8 11% 20 41 10% 34 Florida 312 10% 27 1,183 11% 27 Georgia 123 14% 4 676 11% 27 Hawaii 21 12% 13 78 10% 34 Idaho 17 10% 27 104 12% 20 Illinois 140 10% 27 732 9% 46 Indiana 73 10% 27 483 12% 20 Iowa 29 7% 49 205 11% 27 Kansas 29 9% 34 184 11% 27 Kentucky 81 16% 2 462 17% 2 Louisiana 70 14% 4 384 15% 8 Maine 16 9% 34 135 16% 6 Maryland 61 10% 27 341 10% 34 Massachusetts 71 9% 34 421 10% 34 Michigan 132 11% 20 807 13% 11 Minnesota 41 7% 49 309 9% 46 Mississippi 60 18% 1 301 17% 2 Missouri 86 12% 13 489 13% 11 Montana 14 11% 20 71 12% 20 Nebraska 18 8% 44 106 10% 34 Nevada 26 9% 34 159 10% 34 New Hampshire 13 9% 34 86 10% 34 New Jersey 98 9% 34 455 8% 51 New Mexico 31 13% 8 158 13% 11 New York 268 11% 20 1,265 10% 34 North Carolina 135 13% 8 752 13% 11 North Dakota 6 7% 49 37 9% 46 Ohio 149 10% 27 903 13% 11 Oklahoma 54 12% 13 341 16% 6 Oregon 58 12% 13 301 13% 11 Pennsylvania 163 9% 34 931 12% 20 Rhode Island 12 9% 34 81 12% 20 South Carolina 69 12% 13 365 13% 11 South Dakota 8 8% 44 56 12% 20 Tennessee 100 13% 8 582 15% 8 Texas 302 13% 8 1,621 11% 27 Utah 25 11% 20 150 9% 46 Vermont 6 8% 44 49 12% 20 Virginia 95 11% 20 485 10% 34 Washington 84 12% 13 525 13% 11 West Virginia 36 13% 8 222 20% 1 Wisconsin 55 8% 44 359 10% 34 Wyoming 6 10% 27 42 13% 11 United States 4,010 11% 21,460 11% Note: The highest data value within each ranking is indicated by a rank of 1. 42 Population & Characteristics Persons Age 18-64 w/ Cognitive/Mental + Persons Age 65+ w/ Alzheimer’s Disease, 2010 Any Other Disability, 2007 Value Percent of Value Percent of (Thousands) Age 65+ Rank (Thousands) Age 65+ Rank Alabama 147 5.2% 5 91 14% 13 Alaska 14 3.1% 28 5 9% 50 Arizona 122 3.2% 25 97 11% 46 Arkansas 91 5.3% 4 60 15% 3 California 611 2.7% 35 480 11% 46 Colorado 84 2.7% 35 72 14% 13 Connecticut 52 2.4% 43 70 14% 13 Delaware 13 2.5% 39 14 11% 46 District of Columbia 8 2.1% 51 9 15% 3 Florida 329 3.0% 31 450 13% 31 Georgia 194 3.2% 25 120 12% 39 Hawaii 20 2.4% 43 27 14% 13 Idaho 30 3.3% 21 26 14% 13 Illinois 193 2.4% 43 210 13% 31 Indiana 126 3.2% 25 120 15% 3 Iowa 57 3.1% 28 69 15% 3 Kansas 49 2.9% 32 53 14% 13 Kentucky 144 5.4% 3 80 14% 13 Louisiana 109 4.2% 9 83 14% 13 Maine 38 4.6% 6 25 12% 39 Maryland 87 2.4% 43 86 12% 39 Massachusetts 116 2.8% 33 120 13% 31 Michigan 240 3.8% 11 180 13% 31 Minnesota 76 2.3% 49 94 14% 13 Mississippi 97 5.5% 2 53 14% 13 Missouri 136 3.8% 11 110 13% 31 Montana 21 3.5% 19 21 14% 13 Nebraska 27 2.5% 39 37 15% 3 Nevada 38 2.4% 43 29 9% 50 New Hampshire 21 2.5% 39 22 12% 39 New Jersey 126 2.3% 49 150 12% 39 New Mexico 43 3.6% 16 31 11% 46 New York 340 2.8% 33 320 12% 39 North Carolina 202 3.6% 16 170 15% 3 North Dakota 11 2.6% 37 18 19% 1 Ohio 262 3.7% 14 230 14% 13 Oklahoma 99 4.5% 8 74 15% 3 Oregon 86 3.6% 16 76 15% 3 Pennsylvania 262 3.4% 20 280 14% 13 Rhode Island 22 3.3% 21 24 15% 3 South Carolina 110 4.0% 10 80 13% 31 South Dakota 18 3.8% 11 19 17% 2 Tennessee 178 4.6% 6 120 14% 13 Texas 447 3.1% 28 340 13% 31 Utah 39 2.4% 43 32 14% 13 Vermont 13 3.3% 21 11 12% 39 Virginia 123 2.5% 39 130 13% 31 Washington 153 3.7% 14 110 14% 13 West Virginia 75 6.7% 1 44 15% 3 Wisconsin 91 2.6% 37 110 14% 13 Wyoming 11 3.3% 21 10 14% 13 United States 6,002 3.2% 5,300 13% Note: The highest data value within each ranking is indicated by a rank of 1. 43 Population & Characteristics Ratio of Economic Value of Family ­ Number of Family Economic Value of Family Caregiving, 2007 Caregiving to Medicaid Long-Term Caregivers 2007 Care Spending, 2007 (Thousands) Value (Millions) Per Hour Rank Value Rank Alabama 570 $5,200 $8.49 48 4.2 18 Alaska 74 $1,050 $13.10 1 3.1 34 Arizona 610 $6,900 $10.50 20 5.6 9 Arkansas 360 $3,500 $8.80 46 3.5 29 California 4,000 $48,000 $11.05 13 5.0 11 Colorado 540 $6,500 $11.04 14 5.8 5 Connecticut 370 $4,900 $12.37 2 2.2 48 Delaware 105 $1,280 $11.31 9 4.4 15 District of Columbia 57 $670 $10.82 16 1.8 50 Florida 1,800 $19,200 $9.89 29 4.6 13 Georgia 1,330 $13,000 $9.07 44 8.7 3 Hawaii 113 $1,450 $11.92 4 3.9 22 Idaho 162 $1,600 $9.13 43 4.3 16 Illinois 1,490 $17,100 $10.60 19 5.7 6 Indiana 720 $7,800 $9.91 28 4.7 12 Iowa 300 $3,400 $10.25 25 2.9 42 Kansas 270 $2,700 $9.24 40 3.1 34 Kentucky 530 $5,400 $9.51 37 4.2 18 Louisiana 560 $4,900 $8.13 51 3.7 26 Maine 153 $1,840 $11.18 10 2.8 43 Maryland 600 $6,600 $10.12 26 3.8 24 Massachusetts 690 $8,800 $11.86 5 3.0 37 Michigan 1,280 $14,400 $10.41 22 6.3 4 Minnesota 590 $7,100 $11.11 12 2.6 44 Mississippi 460 $4,000 $8.18 50 3.7 26 Missouri 590 $6,300 $9.84 31 4.0 20 Montana 111 $1,140 $9.53 36 3.9 22 Nebraska 177 $2,000 $10.48 21 3.2 33 Nevada 280 $3,300 $10.81 17 10.2 1 New Hampshire 147 $1,830 $11.55 6 3.5 29 New Jersey 980 $11,800 $11.16 11 3.4 31 New Mexico 210 $2,100 $9.36 39 3.0 37 New York 2,200 $25,000 $10.61 18 1.4 51 North Carolina 1,110 $11,600 $9.63 35 4.0 20 North Dakota 56 $580 $9.74 33 1.9 49 Ohio 1,320 $14,200 $9.92 27 3.0 37 Oklahoma 380 $3,700 $9.15 42 3.4 31 Oregon 410 $4,800 $10.91 15 4.5 14 Pennsylvania 1,390 $15,600 $10.39 23 2.5 46 Rhode Island 114 $1,470 $11.94 3 2.6 44 South Carolina 580 $5,700 $8.99 45 5.7 6 South Dakota 87 $920 $9.87 30 3.6 28 Tennessee 780 $7,800 $9.23 41 3.8 24 Texas 2,800 $26,000 $8.76 47 5.3 10 Utah 340 $3,500 $9.68 34 9.8 2 Vermont 55 $680 $11.45 7 2.3 47 Virginia 910 $9,200 $9.38 38 5.7 6 Washington 640 $7,900 $11.43 8 4.3 16 West Virginia 280 $2,500 $8.23 49 3.0 37 Wisconsin 590 $6,600 $10.32 24 3.1 34 Wyoming 55 $580 $9.84 31 3.0 37 United States 34,000 $375,000 $10.10 3.7 Note: The highest data value within each ranking is indicated by a rank of 1. 44 Long-Term Care Financing Total Medicaid Medicaid HCBS for Older Medicaid LTC Expenditures for Older People ­ E ­ xpenditures, 2007 People and Adults w/ Physical ­ and Adults w/ Physical Disabilites, 2007 ­ Value Disabilites, % of LTC, 2007 Value Per Person (Millions) Rank Value Rank (Millions) in State Rank Alabama $4,122 26 9% 44 $953 $206 23 Alaska $954 47 51% 4 $255 $373 4 Arizona $6,596 15 40% 7 $654 $103 49 Arkansas $3,159 29 21% 27 $683 $241 18 California $31,045 2 51% 4 $7,477 $205 24 Colorado $2,959 30 22% 25 $661 $136 44 Connecticut $4,348 24 9% 44 $1,355 $387 3 Delaware $991 46 10% 43 $180 $208 22 District of Columbia $1,354 40 34% 12 $261 $443 2 Florida $13,742 5 14% 35 $2,767 $152 40 Georgia $7,170 12 18% 30 $1,003 $105 48 Hawaii $1,116 43 17% 33 $261 $203 25 Idaho $1,100 44 39% 9 $237 $158 38 Illinois $12,651 7 23% 24 $1,757 $137 43 Indiana $5,141 19 5% 48 $840 $132 45 Iowa $2,649 32 14% 35 $523 $175 37 Kansas $2,147 35 34% 12 $526 $189 32 Kentucky $4,588 23 8% 46 $825 $194 29 Louisiana $4,840 22 24% 22 $670 $156 39 Maine $2,116 36 26% 19 $322 $245 16 Maryland $5,540 18 11% 39 $1,077 $192 30 Massachusetts $10,230 8 24% 22 $2,117 $328 6 Michigan $9,215 10 18% 30 $1,807 $179 35 Minnesota $6,195 16 44% 6 $1,485 $286 9 Mississippi $3,286 28 11% 39 $785 $269 14 Missouri $6,598 14 31% 15 $1,098 $187 33 Montana $733 48 26% 19 $200 $209 21 Nebraska $1,535 38 18% 30 $401 $226 19 Nevada $1,239 41 34% 12 $236 $92 50 New Hampshire $1,193 42 13% 38 $364 $277 12 New Jersey $8,879 11 20% 28 $2,226 $256 15 New Mexico $2,609 33 61% 1 $441 $224 20 New York $41,397 1 29% 16 $9,480 $491 1 North Carolina $9,744 9 39% 9 $1,839 $203 25 North Dakota $515 50 5% 48 $178 $279 10 Ohio $13,007 6 17% 33 $3,188 $278 11 Oklahoma $3,361 27 27% 18 $691 $191 31 Oregon $2,907 31 56% 2 $671 $179 35 Pennsylvania $15,856 4 11% 39 $4,322 $348 5 Rhode Island $1,755 37 11% 39 $338 $320 7 South Carolina $4,164 25 22% 25 $626 $142 42 South Dakota $620 49 7% 47 $146 $184 34 Tennessee $7,107 13 1% 51 $1,199 $195 28 Texas $20,615 3 40% 7 $3,160 $132 45 Utah $1,405 39 5% 48 $172 $65 51 Vermont $1,041 45 35% 11 $171 $276 13 Virginia $4,968 21 26% 19 $979 $127 47 Washington $5,700 17 55% 3 $1,312 $203 25 West Virginia $2,176 34 19% 29 $521 $288 8 Wisconsin $5,037 20 28% 17 $1,373 $245 16 Wyoming $433 51 14% 35 $79 $151 41 United States $311,848 27% $64,168 $213 Note: The highest data value within each ranking is indicated by a rank of 1. 45 Long-Term Care Financing Medicaid Nursing Facility Medicaid HCBS Expenditures for Older People and Expenditures, 2007 Adults w/ Physical Disabilites, 2007 Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $871 $188 15 $82 $18 45 Alaska $126 $184 18 $129 $188 1 Arizona $392 $62 49 $262 $41 24 Arkansas $541 $191 14 $142 $50 22 California $3,657 $100 41 $3,820 $105 7 Colorado $517 $106 39 $144 $30 38 Connecticut $1,233 $352 1 $122 $35 30 Delaware $163 $188 15 $18 $20 42 District of Columbia $173 $294 4 $88 $149 2 Florida $2,393 $131 31 $374 $20 42 Georgia $821 $86 46 $183 $19 44 Hawaii $215 $167 25 $46 $36 28 Idaho $146 $97 42 $91 $61 15 Illinois $1,355 $105 40 $402 $31 34 Indiana $794 $125 35 $46 $7 49 Iowa $448 $150 28 $75 $25 39 Kansas $349 $126 34 $177 $64 13 Kentucky $759 $179 20 $66 $16 46 Louisiana $509 $119 37 $160 $37 26 Maine $240 $182 19 $82 $62 14 Maryland $955 $170 23 $123 $22 40 Massachusetts $1,613 $250 7 $504 $78 11 Michigan $1,483 $147 29 $324 $32 33 Minnesota $835 $161 26 $650 $125 5 Mississippi $695 $238 9 $90 $31 34 Missouri $760 $129 33 $338 $58 16 Montana $149 $155 27 $52 $54 18 Nebraska $328 $185 17 $72 $41 24 Nevada $155 $60 51 $81 $31 34 New Hampshire $318 $242 8 $46 $35 30 New Jersey $1,780 $205 12 $445 $51 20 New Mexico $174 $88 45 $268 $136 4 New York $6,750 $350 2 $2,729 $141 3 North Carolina $1,126 $124 36 $713 $79 10 North Dakota $168 $263 6 $10 $15 47 Ohio $2,643 $230 11 $545 $48 23 Oklahoma $506 $140 30 $186 $51 20 Oregon $292 $78 48 $379 $101 8 Pennsylvania $3,868 $311 3 $454 $37 26 Rhode Island $300 $284 5 $38 $36 28 South Carolina $490 $111 38 $136 $31 34 South Dakota $136 $170 23 $11 $13 48 Tennessee $1,183 $192 13 $16 $3 50 Texas $1,887 $79 47 $1,273 $53 19 Utah $163 $62 49 $9 $3 50 Vermont $111 $179 20 $60 $97 9 Virginia $720 $93 43 $258 $34 32 Washington $595 $92 44 $717 $111 6 West Virginia $421 $232 10 $101 $55 17 Wisconsin $989 $176 22 $385 $69 12 Wyoming $68 $130 32 $11 $21 41 United States $46,980 $156 $17,188 $57 Note: The highest data value within each ranking is indicated by a rank of 1. 46 Long-Term Care Financing Medicaid Personal Care Services Medicaid Aged/Disabled Waiver Services Expenditures, 2007 Expenditures, 2007 Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama NA NA $82 $18 33 Alaska $75 $110 2 $53 $78 1 Arizona $262 $41 10 NA NA Arkansas $68 $24 19 $69 $24 29 California $3,711 $102 4 $110 $3 47 Colorado NA NA $132 $27 25 Connecticut NA NA $122 $35 14 Delaware NA NA $18 $20 31 District of Columbia $56 $95 5 $32 $54 7 Florida $27 $1 33 $321 $18 33 Georgia $12 $1 33 $171 $18 33 Hawaii NA NA $46 $36 12 Idaho $25 $17 24 $66 $44 10 Illinois NA NA $402 $31 18 Indiana NA NA $46 $7 43 Iowa NA NA $75 $25 28 Kansas $18 $6 27 $159 $57 6 Kentucky NA NA $66 $16 37 Louisiana $113 $26 17 $48 $11 41 Maine $47 $36 14 $35 $27 25 Maryland $32 $6 27 $91 $16 37 Massachusetts $476 $74 6 $28 $4 45 Michigan $236 $23 20 $88 $9 42 Minnesota $314 $60 7 $335 $65 4 Mississippi $4 $1 33 $86 $29 21 Missouri $241 $41 10 $97 $17 36 Montana $26 $27 16 $25 $26 27 Nebraska $14 $8 26 $59 $33 16 Nevada $67 $26 17 $13 $5 44 New Hampshire $6 $5 29 $40 $30 20 New Jersey $319 $37 13 $126 $15 39 New Mexico $206 $105 3 $61 $31 18 New York $2,690 $139 1 $39 $2 50 North Carolina $449 $50 8 $264 $29 21 North Dakota $7 $11 25 $3 $4 45 Ohio NA NA $545 $48 8 Oklahoma $11 $3 30 $175 $48 8 Oregon $81 $22 22 $275 $73 2 Pennsylvania NA NA $454 $37 11 Rhode Island NA NA $38 $36 12 South Carolina $7 $2 31 $129 $29 21 South Dakota $1 $2 31 $9 $12 40 Tennessee NA NA $16 $3 47 Texas $447 $19 23 $482 $20 31 Utah $1 $1 33 $8 $3 47 Vermont $17 $28 15 $43 $69 3 Virginia NA NA $258 $34 15 Washington $318 $49 9 $399 $62 5 West Virginia $42 $23 20 $59 $32 17 Wisconsin $226 $40 12 $158 $28 24 Wyoming NA NA $11 $21 30 United States $10,396 $34 $6,340 $21 Note: The highest data value within each ranking is indicated by a rank of 1. 47 Long-Term Care Financing Medicaid HCBS Expenditures Medicaid Institutional LTC Expenditures for All Populations, 2007 for All Populations, 2007 Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $1,211 $262 37 $903 $195 23 Alaska $337 $492 6 $126 $185 25 Arizona $1,226 $193 48 $416 $66 51 Arkansas $936 $330 22 $688 $243 12 California $9,551 $261 38 $4,434 $121 42 Colorado $986 $203 46 $541 $111 44 Connecticut $2,084 $595 3 $1,473 $421 3 Delaware $285 $329 23 $189 $219 18 District of Columbia $378 $642 2 $258 $439 2 Florida $3,993 $219 44 $2,722 $149 36 Georgia $1,410 $148 49 $918 $96 47 Hawaii $371 $289 32 $224 $174 31 Idaho $362 $242 40 $208 $139 40 Illinois $2,957 $230 41 $2,061 $160 34 Indiana $1,574 $248 39 $1,110 $175 29 Iowa $1,079 $361 20 $724 $242 14 Kansas $873 $314 25 $413 $149 36 Kentucky $1,192 $281 35 $909 $214 19 Louisiana $1,312 $306 27 $854 $199 21 Maine $644 $489 7 $315 $239 15 Maryland $1,666 $297 30 $1,015 $181 26 Massachusetts $2,895 $449 11 $1,819 $282 9 Michigan $2,268 $225 42 $1,528 $152 35 Minnesota $2,648 $509 5 $1,011 $194 24 Mississippi $1,077 $369 16 $950 $326 6 Missouri $1,574 $268 36 $870 $148 38 Montana $280 $292 31 $159 $166 33 Nebraska $612 $345 21 $395 $223 17 Nevada $319 $125 51 $176 $69 50 New Hampshire $523 $398 14 $320 $243 12 New Jersey $3,393 $391 15 $2,409 $277 10 New Mexico $717 $364 19 $195 $99 46 New York $16,340 $847 1 $9,466 $491 1 North Carolina $2,769 $306 27 $1,595 $176 28 North Dakota $311 $486 9 $233 $363 4 Ohio $4,625 $403 13 $3,338 $291 7 Oklahoma $1,082 $299 29 $633 $175 29 Oregon $1,070 $286 33 $292 $78 49 Pennsylvania $6,065 $488 8 $4,426 $356 5 Rhode Island $560 $530 4 $308 $291 7 South Carolina $981 $223 43 $647 $147 39 South Dakota $249 $313 26 $156 $196 22 Tennessee $2,021 $328 24 $1,416 $230 16 Texas $4,709 $197 47 $2,836 $119 43 Utah $350 $132 50 $221 $84 48 Vermont $293 $471 10 $112 $181 26 Virginia $1,602 $208 45 $971 $126 41 Washington $1,828 $283 34 $709 $110 45 West Virginia $788 $435 12 $478 $264 11 Wisconsin $2,058 $367 17 $1,139 $203 20 Wyoming $192 $367 17 $88 $168 32 United States $97,295 $323 $58,993 $196 Note: The highest data value within each ranking is indicated by a rank of 1. 48 Long-Term Care Financing Medicaid HCBS Expenditures Medicaid HCBS Waiver Expenditures for All Populations, 2007 for All Populations, 2007 ­ Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $308 $67 46 $308 $67 41 Alaska $210 $308 3 $135 $198 7 Arizona $810 $128 21 $547 $86 31 Arkansas $248 $88 38 $176 $62 44 California $5,117 $140 18 $1,406 $38 50 Colorado $444 $91 37 $432 $89 30 Connecticut $611 $175 11 $611 $175 9 Delaware $96 $110 33 $96 $110 24 District of Columbia $120 $204 9 $64 $109 26 Florida $1,272 $70 44 $1,219 $67 41 Georgia $492 $52 49 $480 $50 45 Hawaii $148 $115 30 $148 $115 19 Idaho $154 $103 35 $129 $86 31 Illinois $896 $70 44 $896 $70 40 Indiana $464 $73 42 $464 $73 39 Iowa $355 $119 27 $355 $119 18 Kansas $460 $166 15 $442 $159 11 Kentucky $282 $67 46 $282 $67 41 Louisiana $458 $107 34 $346 $81 34 Maine $329 $249 6 $282 $214 5 Maryland $651 $116 29 $619 $110 24 Massachusetts $1,076 $167 14 $600 $93 29 Michigan $740 $73 42 $504 $50 45 Minnesota $1,637 $315 2 $1,323 $254 2 Mississippi $126 $43 51 $123 $42 49 Missouri $703 $120 26 $462 $79 36 Montana $120 $126 22 $94 $98 27 Nebraska $217 $122 25 $203 $114 21 Nevada $143 $56 48 $76 $30 51 New Hampshire $203 $154 17 $196 $149 12 New Jersey $985 $113 31 $666 $77 37 New Mexico $522 $265 5 $316 $160 10 New York $6,874 $356 1 $4,185 $217 4 North Carolina $1,175 $130 20 $725 $80 35 North Dakota $79 $123 24 $72 $112 22 Ohio $1,286 $112 32 $1,286 $112 22 Oklahoma $449 $124 23 $439 $121 17 Oregon $778 $208 8 $674 $180 8 Pennsylvania $1,639 $132 19 $1,639 $132 14 Rhode Island $252 $239 7 $252 $239 3 South Carolina $334 $76 41 $327 $74 38 South Dakota $93 $117 28 $92 $115 19 Tennessee $605 $98 36 $605 $98 27 Texas $1,873 $78 40 $1,081 $45 48 Utah $129 $49 50 $127 $48 47 Vermont $181 $291 4 $163 $263 1 Virginia $631 $82 39 $631 $82 33 Washington $1,119 $173 12 $801 $124 15 West Virginia $310 $171 13 $269 $148 13 Wisconsin $919 $164 16 $693 $124 15 Wyoming $104 $199 10 $104 $199 6 United States $38,303 $127 $27,455 $91 Note: The highest data value within each ranking is indicated by a rank of 1. 49 Long-Term Care Financing E Medicaid HCBS ­ xpenditures for Older Medicaid Home Health Medicaid Nursing Facility ­ People and Adults w/ E ­ xpenditures, 2007 E ­ xpenditures per Person Physical Disabilities per Value Per Person Served, 2005 Person Served, 2005 (Millions) in State Rank Value Rank Value Rank Alabama $49 $11 14 $29,278 13 $7,870 27 Alaska $1 $1 43 $63,932 1 $16,551 4 Arizona NA NA $38,023 NA $15,024 NA Arkansas $48 $17 6 $15,856 50 $4,600 46 California $160 $4 33 $25,833 29 $9,001 22 Colorado $133 $27 4 $27,718 16 $6,336 36 Connecticut $200 $57 2 $26,973 20 $8,617 23 Delaware $8 $9 19 $43,231 3 $10,429 16 District of Columbia $5 $9 19 $35,399 5 $5,143 44 Florida $158 $9 19 $23,856 34 $7,183 32 Georgia $76 $8 26 $20,618 42 $6,153 38 Hawaii $1 $1 43 $35,393 6 $17,602 2 Idaho $7 $5 28 $26,547 25 $7,711 28 Illinois $48 $4 33 $20,062 46 $6,625 34 Indiana $89 $14 9 $20,374 44 $8,404 25 Iowa $83 $28 3 $20,546 43 $6,215 37 Kansas $13 $5 28 $19,675 48 $9,333 18 Kentucky $111 $26 5 $25,519 30 $4,795 45 Louisiana $26 $6 27 $20,643 41 $10,436 15 Maine $5 $4 33 $26,369 26 $7,480 31 Maryland $57 $10 18 $32,977 7 $11,456 11 Massachusetts $73 $11 14 $30,792 11 $12,602 7 Michigan $24 $2 40 $27,005 19 $4,395 48 Minnesota $79 $15 7 $23,724 35 $12,242 8 Mississippi $12 $4 33 $28,059 15 $6,616 35 Missouri $5 $1 43 $20,102 45 $4,483 47 Montana $10 $11 14 $26,720 22 $9,131 20 Nebraska $22 $12 12 $24,669 31 $9,464 17 Nevada $3 $1 43 $26,632 24 $6,818 33 New Hampshire $7 $5 28 $26,678 23 $8,525 24 New Jersey $27 $3 39 $36,112 4 $12,118 10 New Mexico $1 $0 48 $27,170 18 $16,632 3 New York $1,640 $85 1 $32,134 9 $19,551 1 North Carolina $126 $14 9 $25,887 28 $8,205 26 North Dakota $1 $2 40 $31,253 10 $5,341 43 Ohio $150 $13 11 $26,836 21 $11,332 12 Oklahoma $18 $5 28 $19,911 47 $5,943 39 Oregon $0 $0 48 $23,713 36 $7,572 30 Pennsylvania $109 $9 19 $29,431 12 $13,468 6 Rhode Island $5 $5 28 $46,247 2 $7,648 29 South Carolina $10 $2 40 $28,117 14 $5,813 40 South Dakota $7 $9 19 $21,627 40 $3,883 49 Tennessee $0 $0 48 $27,582 17 $5,599 42 Texas $227 $9 19 $19,471 49 $9,070 21 Utah $11 $4 33 $24,376 32 $2,357 50 Vermont $7 $11 14 $26,066 27 $10,525 14 Virginia $5 $1 43 $24,222 33 $12,172 9 Washington $27 $4 33 $22,970 38 $10,624 13 West Virginia $28 $15 7 $32,513 8 $9,241 19 Wisconsin $53 $9 19 $23,169 37 $14,089 5 Wyoming $6 $12 12 $22,187 39 $5,755 41 United States $3,966 $13 $26,096 $9,459 Note: The highest data value within each ranking is indicated by a rank of 1. 50 Long-Term Care Financing Medicaid PCS Expenditures Medicaid Aged/Disabled Waiver Medicaid HCBS Waiver per Person Served, 2005 Expenditures per Person Served, E ­ xpenditures for all Populations ­ 2005 per Person Served, 2005 Value Rank Value Rank Value Rank Alabama NA $7,870 28 $18,964 30 Alaska $15,227 6 $18,097 3 $31,865 9 Arizona $15,024 NA NA $25,990 NA Arkansas $3,956 25 $5,736 43 $10,373 48 California $9,103 11 $6,870 32 $17,008 33 Colorado NA $6,336 36 $14,015 41 Connecticut NA $8,617 25 $28,655 14 Delaware NA $10,429 17 $26,630 18 District of Columbia $4,642 21 $7,405 31 $9,799 49 Florida $2,390 27 $9,783 20 $15,235 38 Georgia NA $6,153 38 $13,217 43 Hawaii NA $17,602 5 $27,226 15 Idaho $7,581 12 $7,771 29 $11,715 45 Illinois NA $6,625 33 $11,002 47 Indiana NA $8,404 27 $30,537 11 Iowa NA $6,215 37 $15,293 36 Kansas NA $9,333 22 $15,087 39 Kentucky NA $4,795 46 $15,069 40 Louisiana NA $10,436 16 $29,634 12 Maine $5,907 17 $15,781 7 $55,642 2 Maryland $4,436 22 $20,233 2 $34,067 6 Massachusetts $17,087 4 $3,866 48 $33,860 7 Michigan $4,302 23 $4,958 45 $22,322 24 Minnesota $18,169 3 $10,130 18 $26,868 17 Mississippi NA $6,616 34 $8,383 50 Missouri $4,840 19 $3,743 49 $11,714 46 Montana $7,490 13 $11,896 13 $20,015 28 Nebraska $6,317 14 $10,481 15 $21,240 26 Nevada $10,319 10 $4,002 47 $11,911 44 New Hampshire $20,438 2 $8,410 26 $31,951 8 New Jersey $12,894 7 $9,775 21 $26,068 19 New Mexico $15,657 5 $20,472 1 $45,135 3 New York $24,268 1 $1,326 50 $45,129 4 North Carolina $5,641 18 $17,696 4 $25,472 20 North Dakota $3,902 26 $9,286 23 $17,997 32 Ohio NA $11,332 14 $18,108 31 Oklahoma $4,702 20 $6,484 35 $15,287 37 Oregon $1,110 29 $8,736 24 $15,561 35 Pennsylvania NA $13,468 10 $29,201 13 Rhode Island NA $7,648 30 $43,032 5 South Carolina NA $5,813 40 $13,295 42 South Dakota $1,484 28 $6,061 39 $20,591 27 Tennessee NA $5,599 44 $57,822 1 Texas $5,908 16 $15,382 9 $19,381 29 Utah $617 30 $5,805 41 $23,912 22 Vermont $4,300 24 $15,998 6 $31,726 10 Virginia NA $12,172 11 $21,797 25 Washington $11,649 8 $10,016 19 $15,765 34 West Virginia $6,286 15 $11,953 12 $27,174 16 Wisconsin $11,511 9 $15,443 8 $22,623 23 Wyoming NA $5,755 42 $24,465 21 United States $9,666 $9,176 $21,681 Note: The highest data value within each ranking is indicated by a rank of 1. 51 Long-Term Care Financing Federal Medical Assistance Medicaid Personal Needs State-Funded HCBS for Older P ­ ercentage (FMAP), 2007 A ­ llowance (per Month), 2007 People, 2007 Value Rank Value Rank Value (Millions) Rank Alabama 68.5% 12 $30 46 $0.0 48 Alaska 51.1% 38 $75 3 $4.6 36 Arizona 66.5% 14 $93 1 $16.2 15 Arkansas 73.4% 2 $40 35 $7.7 24 California 50.0% 40 $49 28 $13.3 19 Colorado 50.0% 40 $50 16 $7.0 26 Connecticut 50.0% 40 $63 6 $42.9 8 Delaware 50.0% 40 $44 33 $1.5 44 District of Columbia 70.0% 7 $70 4 $16.8 14 Florida 58.2% 29 $35 43 $67.2 5 Georgia 62.0% 21 $50 16 $16.0 16 Hawaii 57.6% 31 $50 16 $7.0 26 Idaho 70.4% 5 $40 35 $1.3 45 Illinois 50.0% 40 $30 46 $155.2 3 Indiana 62.6% 20 $52 15 $48.8 6 Iowa 62.0% 21 $50 16 $12.7 20 Kansas 60.3% 26 $60 7 $6.8 28 Kentucky 69.6% 9 $40 35 $29.8 11 Louisiana 69.7% 8 $38 42 $6.0 30 Maine 63.3% 18 $40 35 $9.5 23 Maryland 50.0% 40 $66 5 $4.9 34 Massachusetts 50.0% 40 $60 7 $171.5 2 Michigan 56.4% 33 $60 7 $31.1 10 Minnesota 50.0% 40 $82 2 $48.2 7 Mississippi 75.9% 1 $44 33 $0.0 48 Missouri 61.6% 23 $30 46 $12.2 21 Montana 69.1% 11 $50 16 $0.0 48 Nebraska 57.9% 30 $50 16 $3.6 39 Nevada 53.9% 35 $35 43 $1.9 42 New Hampshire 50.0% 40 $56 13 $0.4 47 New Jersey 50.0% 40 $35 43 $20.8 13 New Mexico 71.9% 4 $58 12 $24.0 12 New York 50.0% 40 $50 16 $95.3 4 North Carolina 64.5% 16 $30 46 $34.2 9 North Dakota 64.7% 15 $50 16 $7.3 25 Ohio 59.7% 27 $40 35 $14.7 17 Oklahoma 68.1% 13 $50 16 $3.3 40 Oregon 61.1% 24 $30 46 $6.0 30 Pennsylvania 54.4% 34 $45 30 $182.2 1 Rhode Island 52.4% 37 $50 16 $3.8 38 South Carolina 69.5% 10 $30 46 $1.2 46 South Dakota 62.9% 19 $60 7 $6.7 29 Tennessee 63.7% 17 $40 35 $5.1 32 Texas 60.8% 25 $60 7 $4.8 35 Utah 70.1% 6 $45 30 $4.0 37 Vermont 58.9% 28 $47.66 29 $5.0 33 Virginia 50.0% 40 $40 35 $10.6 22 Washington 50.1% 39 $55.45 14 $14.4 18 West Virginia 72.8% 3 $50 16 $1.8 43 Wisconsin 57.5% 32 $45 30 $0.0 48 Wyoming 52.9% 36 $50 16 $3.2 41 United States $50 $1,192.4 Note: The highest data value within each ranking is indicated by a rank of 1. 52 Long-Term Care Utilization Medicare Beneficiaries Receiving Home Health Medicare Home Health Medicaid HCBS Participants, 2005 Services (%), 2006 Visits per User, 2006 Per 1,000 Value Rank Value Rank Value Population Rank Alabama 8.6% 14 36 9 13,572 3.0 44 Alaska 4.2% 49 22 40 6,307 9.4 7 Arizona 4.8% 46 21 45 32,348 5.4 28 Arkansas 6.7% 33 38 8 27,583 10.0 5 California 7.3% 27 32 14 394,373 11.0 3 Colorado 7.2% 29 26 27 25,575 5.5 26 Connecticut 10.1% 7 34 12 18,272 5.2 30 Delaware 7.2% 29 23 39 2,642 3.1 43 District of Columbia 7.9% 19 22 40 3,306 5.7 23 Florida 11.7% 3 50 5 73,131 4.1 37 Georgia 7.3% 27 30 18 24,686 2.7 45 Hawaii 2.7% 51 18 50 4,363 3.4 41 Idaho 6.6% 34 29 21 13,215 9.3 8 Illinois 9.1% 12 27 24 68,953 5.4 28 Indiana 6.1% 37 31 16 13,484 2.2 49 Iowa 4.8% 46 25 30 18,060 6.1 22 Kansas 5.3% 40 26 27 23,348 8.5 12 Kentucky 7.9% 19 31 16 14,922 3.6 40 Louisiana 12.7% 2 57 1 9,414 2.1 50 Maine 8.2% 17 25 30 11,922 9.1 9 Maryland 6.9% 32 21 45 19,109 3.4 41 Massachusetts 11.3% 4 34 12 32,793 5.1 32 Michigan 10.2% 6 27 24 72,607 7.2 20 Minnesota 5.0% 42 22 40 54,096 10.6 4 Mississippi 9.8% 8 40 7 14,540 5.0 33 Missouri 7.7% 22 25 30 81,505 14.1 1 Montana 4.9% 43 22 40 7,121 7.6 18 Nebraska 5.2% 41 22 40 9,732 5.5 26 Nevada 7.7% 22 30 18 5,878 2.4 48 New Hampshire 8.5% 16 30 18 4,924 3.8 38 New Jersey 7.7% 22 24 35 38,243 4.4 36 New Mexico 6.6% 34 32 14 15,630 8.2 15 New York 8.2% 17 35 11 162,387 8.4 13 North Carolina 7.7% 22 24 35 72,221 8.3 14 North Dakota 4.9% 43 19 48 4,990 7.8 16 Ohio 7.8% 21 28 22 52,110 4.5 35 Oklahoma 10.7% 5 55 2 27,621 7.8 16 Oregon 6.2% 36 18 50 42,377 11.7 2 Pennsylvania 9.4% 11 24 35 46,247 3.7 39 Rhode Island 9.5% 10 25 30 5,568 5.2 30 South Carolina 7.0% 31 26 27 20,341 4.8 34 South Dakota 3.7% 50 20 47 4,426 5.7 23 Tennessee 9.1% 12 41 6 6,485 1.1 51 Texas 12.8% 1 55 2 130,871 5.7 23 Utah 8.6% 14 52 4 6,782 2.7 45 Vermont 9.6% 9 36 9 5,343 8.6 11 Virginia 7.7% 22 27 24 19,436 2.6 47 Washington 5.5% 39 19 48 59,762 9.5 6 West Virginia 5.9% 38 24 35 13,126 7.3 19 Wisconsin 4.9% 43 25 30 48,208 8.7 10 Wyoming 4.6% 48 28 22 3,391 6.7 21 United States 8.4% 35 1,854,998 6.3 Note: The highest data value within each ranking is indicated by a rank of 1. 53 Long-Term Care Utilization Medicaid Personal Care Services Participants, 2005 Medicaid HCBS Waiver Participants, 2005 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama NA NA 13,572 3.0 35 Alaska 2,742 4.1 9 3,565 5.3 15 Arizona 15,352 2.6 14 16,996 2.9 37 Arkansas 15,452 5.6 5 12,131 4.4 24 California 313,893 8.7 1 80,480 2.2 43 Colorado NA NA 25,575 5.5 12 Connecticut NA NA 18,272 5.2 16 Delaware NA NA 2,642 3.1 32 District of Columbia 2,352 4.0 10 954 1.6 49 Florida 13,980 0.8 27 59,151 3.3 31 Georgia NA NA 24,686 2.7 38 Hawaii NA NA 4,363 3.4 30 Idaho 3,601 2.5 15 9,614 6.7 4 Illinois NA NA 68,953 5.4 14 Indiana NA NA 13,484 2.2 43 Iowa NA NA 18,060 6.1 8 Kansas NA NA 23,348 8.5 3 Kentucky NA NA 14,922 3.6 29 Louisiana NA NA 9,414 2.1 45 Maine 7,861 6.0 3 4,061 3.1 32 Maryland 4,643 0.8 27 14,466 2.6 39 Massachusetts 13,767 2.1 19 19,026 3.0 35 Michigan 55,158 5.5 6 17,449 1.7 48 Minnesota 9,940 1.9 23 44,156 8.6 2 Mississippi NA NA 14,540 5.0 18 Missouri 49,481 8.5 2 32,024 5.5 12 Montana 3,124 3.3 12 3,997 4.3 25 Nebraska 1,549 0.9 26 8,183 4.7 21 Nevada 2,038 0.8 27 3,840 1.6 49 New Hampshire 25 0.0 31 4,899 3.8 27 New Jersey 20,884 2.4 18 17,359 2.0 46 New Mexico 9,614 5.0 7 6,016 3.1 32 New York 84,270 4.4 8 78,117 4.1 26 North Carolina 50,818 5.9 4 21,403 2.5 41 North Dakota 1,362 2.1 19 3,628 5.7 11 Ohio NA NA 52,110 4.5 22 Oklahoma 7,000 2.0 21 20,621 5.8 10 Oregon 5,086 1.4 24 37,291 10.3 1 Pennsylvania NA NA 46,247 3.7 28 Rhode Island NA NA 5,568 5.2 16 South Carolina NA NA 20,341 4.8 19 South Dakota 901 1.2 25 3,525 4.5 22 Tennessee NA NA 6,485 1.1 51 Texas 77,725 3.4 11 53,146 2.3 42 Utah 1,755 0.7 30 5,027 2.0 46 Vermont 1,534 2.5 15 3,809 6.1 8 Virginia NA NA 19,436 2.6 39 Washington 18,429 2.9 13 41,333 6.6 7 West Virginia 4,535 2.5 15 8,591 4.8 19 Wisconsin 11,123 2.0 21 37,085 6.7 4 Wyoming NA NA 3,391 6.7 4 United States 794,642 2.7 1,060,356 3.6 Note: The highest data value within each ranking is indicated by a rank of 1. 54 Long-Term Care Utilization Medicaid Aged/Disabled Waiver Medicaid Aged/Disabled Waiver Participants, 2005 P ­ articipants per 100 Beneficiaries ­ sing U Per 1,000 Nursing Facilities, 2005 Value Population Rank Value Rank Alabama 8,373 1.8 26 32 28 Alaska 2,347 3.5 11 221 2 Arizona NA NA NA Arkansas 8,749 3.2 15 32 28 California 14,985 0.4 48 13 43 Colorado 15,219 3.3 12 94 5 Connecticut 11,675 3.3 12 28 33 Delaware 1,312 1.6 30 36 24 District of Columbia 521 0.9 41 11 46 Florida 25,773 1.5 34 27 34 Georgia 15,418 1.7 27 32 28 Hawaii 2,195 1.7 27 41 21 Idaho 7,733 5.4 3 153 3 Illinois 51,831 4.1 7 67 10 Indiana 3,836 0.6 47 7 49 Iowa 6,268 2.1 23 31 32 Kansas 14,193 5.2 4 87 6 Kentucky 12,165 2.9 17 43 18 Louisiana 4,009 0.9 41 13 43 Maine 1,489 1.1 37 16 39 Maryland 3,714 0.7 46 14 42 Massachusetts 7,068 1.1 37 12 45 Michigan 9,144 0.9 41 17 37 Minnesota 27,893 5.5 2 83 7 Mississippi 11,884 4.1 7 55 13 Missouri 23,817 4.1 7 60 11 Montana 1,853 2.0 24 36 24 Nebraska 4,792 2.7 20 43 18 Nevada 2,534 1.1 37 44 16 New Hampshire 2,590 2.0 24 34 26 New Jersey 6,915 0.8 44 15 40 New Mexico 2,442 1.3 35 34 26 New York 21,809 1.1 37 11 46 North Carolina 13,729 1.6 30 32 28 North Dakota 497 0.8 44 9 48 Ohio 38,013 3.3 12 38 22 Oklahoma 16,048 4.5 6 72 9 Oregon 28,222 7.8 1 279 1 Pennsylvania 20,131 1.6 30 21 36 Rhode Island 2,788 2.6 22 25 35 South Carolina 13,672 3.2 15 81 8 South Dakota 992 1.3 35 17 37 Tennessee 964 0.2 50 3 50 Texas 38,943 1.7 27 37 23 Utah 886 0.4 48 15 40 Vermont 1,745 2.8 19 44 16 Virginia 12,424 1.6 30 45 15 Washington 31,139 5.0 5 138 4 West Virginia 4,942 2.7 20 42 20 Wisconsin 21,173 3.8 10 58 12 Wyoming 1,488 2.9 17 53 14 United States 582,342 2.0 34 Note: The highest data value within each ranking is indicated by a rank of 1. 55 Long-Term Care Utilization Persons in Assisted Living / Residential Care Covered ­ by Medicaid or State Funding, 2007 Medicaid Home Health Participants, 2005 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama 0 0.00 40 6,757 1.5 25 Alaska 730 1.07 9 304 0.5 47 Arizona 4,034 0.64 16 NA NA Arkansas 211 0.07 36 6,788 2.4 17 California 205 0.01 39 87,027 2.4 17 Colorado 3,800 0.78 14 8,687 1.9 24 Connecticut 439 0.13 33 21,753 6.2 4 Delaware 217 0.25 24 989 1.2 30 District of Columbia 0 0.00 40 2,124 3.6 11 Florida 11,389 0.62 18 21,192 1.2 30 Georgia 2,300 0.24 26 14,014 1.5 25 Hawaii 1,400 1.09 8 1,300 1.0 35 Idaho 2,231 1.49 6 3,326 2.3 19 Illinois 4,681 0.36 21 74,236 5.8 6 Indiana 0 0.00 40 8,879 1.4 28 Iowa 497 0.17 30 24,558 8.3 1 Kansas 0 0.00 40 5,865 2.1 22 Kentucky 0 0.00 40 22,415 5.4 9 Louisiana 0 0.00 40 12,187 2.7 15 Maine 4,571 3.47 1 2,875 2.2 20 Maryland 2,326 0.41 19 4,393 0.8 39 Massachusetts 0 0.00 40 17,875 2.8 14 Michigan 10,300 1.02 10 6,573 0.7 43 Minnesota 3,486 0.67 15 5,229 1.0 35 Mississippi 200 0.07 36 8,834 3.0 13 Missouri 6,000 1.02 10 7,739 1.3 29 Montana 614 0.64 16 437 0.5 47 Nebraska 1,693 0.95 13 6,292 3.6 11 Nevada 380 0.15 32 1,551 0.6 44 New Hampshire 243 0.18 29 2,841 2.2 20 New Jersey 2,966 0.34 22 10,219 1.2 30 New Mexico 254 0.13 33 431 0.2 50 New York 3,335 0.17 30 109,244 5.7 8 North Carolina 20,442 2.26 3 38,668 4.5 10 North Dakota 0 0.00 40 521 0.8 39 Ohio 235 0.02 38 84,374 7.4 3 Oklahoma 0 0.00 40 5,129 1.5 25 Oregon 5,983 1.60 4 2,245 0.6 44 Pennsylvania 0 0.00 40 9,359 0.8 39 Rhode Island 411 0.39 20 1,000 0.9 38 South Carolina 829 0.19 28 11,100 2.6 16 South Dakota 1,098 1.38 7 4,729 6.1 5 Tennessee 0 0.00 40 12,539 2.1 22 Texas 2,393 0.10 35 187,099 8.2 2 Utah 548 0.21 27 2,121 0.8 39 Vermont 1,484 2.39 2 3,611 5.8 6 Virginia NA NA 3,299 0.4 49 Washington 6,193 0.96 12 3,597 0.6 44 West Virginia 475 0.26 23 1,749 1.0 35 Wisconsin 8,542 1.52 5 5,903 1.1 33 Wyoming 130 0.25 24 565 1.1 33 United States 117,265 0.39 924,259 3.1 Note: The highest data value within each ranking is indicated by a rank of 1. 56 Long-Term Care Utilization Total Nursing Facility Residents, 2007 Total Nursing Facility Per 100 Per 100 Stays, 2006 Value Rank Age 65+ Rank Age 75+ Rank Value Rank Alabama 23,588 24 3.8 28 8.1 28 49,922 22 Alaska 628 51 1.3 51 3.4 49 1,335 51 Arizona 12,574 33 1.5 50 3.1 51 40,229 26 Arkansas 18,746 28 4.7 15 9.9 15 33,370 31 California 104,779 2 2.6 41 5.4 42 254,793 1 Colorado 16,820 30 3.4 35 7.4 34 37,557 27 Connecticut 27,257 19 5.8 3 11.2 3 61,463 20 Delaware 4,015 46 3.4 35 7.2 36 8,942 46 District of Columbia 2,804 49 4.0 24 8.3 24 5,755 49 Florida 72,447 7 2.3 46 4.5 46 203,903 3 Georgia 35,682 14 3.8 28 8.5 23 65,045 18 Hawaii 3,965 47 2.2 47 4.1 47 8,231 47 Idaho 4,533 45 2.6 41 5.5 41 12,558 41 Illinois 77,779 6 5.0 12 10.2 11 166,511 7 Indiana 40,322 11 5.1 10 10.4 9 85,348 12 Iowa 27,042 20 6.2 2 11.7 1 49,441 23 Kansas 20,170 26 5.6 6 10.8 6 35,465 30 Kentucky 23,657 23 4.3 20 9.3 17 49,438 24 Louisiana 26,460 21 5.1 10 10.8 6 43,012 25 Maine 6,546 39 3.4 35 6.8 38 18,043 36 Maryland 25,555 22 3.9 27 8.2 25 64,388 19 Massachusetts 45,172 9 5.3 9 10.2 11 101,292 9 Michigan 41,833 10 3.3 38 6.7 39 97,667 10 Minnesota 32,052 17 5.0 12 10.0 14 69,791 16 Mississippi 16,762 31 4.6 16 9.8 16 28,018 32 Missouri 38,791 12 4.9 14 10.1 13 77,243 13 Montana 5,281 43 4.0 24 8.1 28 11,762 43 Nebraska 13,484 32 5.7 5 11.0 4 26,663 34 Nevada 4,724 44 1.7 48 3.9 48 11,908 42 New Hampshire 7,063 37 4.3 20 8.8 21 15,215 39 New Jersey 45,860 8 4.0 24 8.1 28 114,190 8 New Mexico 5,981 40 2.4 44 5.0 44 13,198 40 New York 111,313 1 4.4 18 8.8 21 224,233 2 North Carolina 38,282 13 3.5 34 7.5 33 85,873 11 North Dakota 5,926 41 6.4 1 11.7 1 10,710 45 Ohio 82,702 4 5.4 8 10.8 6 185,482 4 Oklahoma 21,113 25 4.4 18 9.2 18 37,458 28 Oregon 8,208 35 1.7 48 3.4 49 26,786 33 Pennsylvania 80,792 5 4.3 20 8.1 28 178,338 6 Rhode Island 8,207 36 5.6 6 10.4 9 16,826 38 South Carolina 16,856 29 2.9 40 6.4 40 36,282 29 South Dakota 6,553 38 5.8 3 10.9 5 11,586 44 Tennessee 33,059 16 4.2 23 9.1 19 70,818 15 Texas 91,980 3 3.8 28 8.2 25 180,123 5 Utah 5,544 42 2.4 44 5.0 44 17,591 37 Vermont 3,127 48 3.7 32 7.7 32 6,800 48 Virginia 28,778 18 3.2 39 6.9 37 68,224 17 Washington 19,641 27 2.6 41 5.4 42 57,490 21 West Virginia 9,977 34 3.6 33 7.4 34 21,659 35 Wisconsin 33,483 15 4.5 17 9.0 20 73,192 14 Wyoming 2,445 50 3.8 28 8.2 25 4,952 50 United States 1,440,358 3.8 7.8 3,176,119 Note: The highest data value within each ranking is indicated by a rank of 1. 57 Long-Term Care Costs Nursing Facility ­ esidents Nursing Facility Residents R Nursing Facility Residents Nursing Facility ­ esidents R w/ Medicaid as Primary w/ Medicare as Primary w/ “Other” as Primary w/ Dementia, 2007 Payer, 2007 Payer, 2007 Payer, 2007 Value Rank Value Rank Value Rank Value Rank Alabama 69% 10 14% 18 18% 39 51% 10 Alaska 73% 5 12% 33 15% 45 52% 6 Arizona 61% 32 13% 27 26% 13 42% 40 Arkansas 70% 8 11% 37 19% 35 40% 48 California 65% 19 13% 27 22% 28 39% 49 Colorado 58% 40 12% 33 30% 8 46% 25 Connecticut 66% 14 16% 7 18% 39 47% 20 Delaware 58% 40 15% 14 27% 11 47% 20 District of Columbia 80% 1 10% 43 10% 50 49% 16 Florida 58% 40 20% 1 23% 23 45% 30 Georgia 74% 3 11% 37 15% 45 49% 16 Hawaii 70% 8 9% 46 21% 31 53% 5 Idaho 59% 38 16% 7 26% 13 41% 46 Illinois 63% 26 14% 18 24% 21 42% 40 Indiana 62% 30 15% 14 23% 23 45% 30 Iowa 48% 51 7% 50 45% 1 46% 25 Kansas 53% 49 9% 46 38% 2 46% 25 Kentucky 67% 11 15% 14 18% 39 48% 18 Louisiana 74% 3 11% 37 15% 45 43% 37 Maine 66% 14 16% 7 18% 39 59% 1 Maryland 61% 32 16% 7 23% 23 43% 37 Massachusetts 65% 19 14% 18 22% 28 51% 10 Michigan 64% 24 17% 3 19% 35 56% 2 Minnesota 57% 45 10% 43 33% 6 41% 46 Mississippi 77% 2 14% 18 10% 50 52% 6 Missouri 61% 32 13% 27 26% 13 44% 36 Montana 58% 40 11% 37 32% 7 42% 40 Nebraska 54% 48 10% 43 36% 4 42% 40 Nevada 58% 40 14% 18 28% 10 38% 50 New Hampshire 65% 19 15% 14 20% 33 55% 4 New Jersey 63% 26 17% 3 20% 33 42% 40 New Mexico 64% 24 11% 37 25% 18 45% 30 New York 72% 6 13% 27 15% 45 46% 25 North Carolina 67% 11 16% 7 17% 44 46% 25 North Dakota 55% 47 8% 49 37% 3 52% 6 Ohio 63% 26 14% 18 23% 23 48% 18 Oklahoma 66% 14 12% 33 23% 23 42% 40 Oregon 61% 32 13% 27 26% 13 45% 30 Pennsylvania 63% 26 12% 33 25% 18 47% 20 Rhode Island 66% 14 9% 46 26% 13 47% 20 South Carolina 65% 19 16% 7 19% 35 56% 2 South Dakota 57% 45 7% 50 36% 4 50% 13 Tennessee 66% 14 16% 7 18% 39 50% 13 Texas 65% 19 14% 18 21% 31 43% 37 Utah 53% 49 20% 1 27% 11 38% 50 Vermont 67% 11 14% 18 19% 35 52% 6 Virginia 60% 36 17% 3 22% 28 45% 30 Washington 60% 36 17% 3 24% 21 50% 13 West Virginia 72% 6 14% 18 14% 49 51% 10 Wisconsin 62% 30 13% 27 25% 18 47% 20 Wyoming 59% 38 11% 37 30% 8 45% 30 United States 64% 14% 22% 46% Note: The highest data value within each ranking is indicated by a rank of 1. 58 Long-Term Care Costs Medicaid Payment per Day Medicare Payment per Day Average Private Pay Rate Average Private Pay Rate for Nursing Facility Care, for Nursing Facility Care, per Day in Nursing ­ acility, F per Month in ­ ssisted A 2007 2006 2008 Living, 2008 Value Rank Value Rank Value Rank Value Rank Alabama $158 22 $263 47 $158 39 $2,440 43 Alaska $384 1 $466 1 $515 1 $4,567 2 Arizona $145 31 $312 24 $203 21 $2,617 36 Arkansas $132 38 $248 51 $137 48 $1,981 51 California $150 27 $372 2 $238 10 $3,098 19 Colorado $164 20 $335 13 $202 22 $3,249 12 Connecticut $211 3 $325 20 $345 2 $3,928 6 Delaware $208 5 $306 28 $210 18 $3,774 7 District of Columbia $234 2 $327 18 $216 15 $4,027 5 Florida $173 13 $319 22 $213 16 $2,642 35 Georgia $122 42 $276 39 $158 39 $2,340 45 Hawaii $205 6 $339 10 $295 5 $3,443 9 Idaho $169 18 $306 28 $185 26 $2,749 30 Illinois $104 49 $304 30 $178 30 $3,732 8 Indiana $137 35 $283 36 $190 25 $2,732 31 Iowa $114 45 $352 5 $137 48 $2,614 37 Kansas $129 40 $330 15 $133 50 $2,468 41 Kentucky $152 24 $269 44 $177 31 $2,793 28 Louisiana $114 45 $251 50 $125 51 $2,528 39 Maine $173 13 $333 14 $233 11 $4,103 4 Maryland $193 8 $317 23 $221 13 $3,144 16 Massachusetts $187 9 $329 16 $296 4 $4,187 3 Michigan $148 28 $303 31 $209 19 $2,825 26 Minnesota $147 29 $337 12 $156 44 $3,204 13 Mississippi NA $273 40 $174 33 $2,277 47 Missouri $112 47 $269 44 $162 35 $2,806 27 Montana $146 30 $312 24 $163 34 $2,826 25 Nebraska $131 39 $328 17 $156 44 $2,335 46 Nevada $169 18 $349 7 $211 17 $2,504 40 New Hampshire $176 12 $347 8 $259 7 $3,426 10 New Jersey $187 9 $370 3 $276 6 $4,682 1 New Mexico $152 24 $279 38 $162 35 $2,981 22 New York $210 4 $307 26 $319 3 $3,295 11 North Carolina $135 37 $273 40 $184 28 $2,730 32 North Dakota $160 21 $294 34 $139 47 $2,236 48 Ohio $201 7 $296 33 $191 24 $2,932 23 Oklahoma $117 44 $262 48 $141 46 $2,138 50 Oregon $173 13 $360 4 $207 20 $3,114 18 Pennsylvania $185 11 $287 35 $247 9 $3,186 14 Rhode Island $173 13 $327 18 $248 8 $3,136 17 South Carolina $136 36 $270 43 $158 39 $2,669 34 South Dakota $120 43 $352 5 $157 42 $2,191 49 Tennessee $142 33 $261 49 $162 35 $2,857 24 Texas $106 48 $273 40 $160 38 $2,764 29 Utah $139 34 $307 26 $157 42 $2,433 44 Vermont $152 24 $339 10 $232 12 $2,569 38 Virginia $145 31 $282 37 $180 29 $3,013 21 Washington $155 23 $341 9 $220 14 $3,033 20 West Virginia $170 17 $267 46 $185 26 $2,717 33 Wisconsin $129 40 $325 20 $198 23 $3,170 15 Wyoming NA $298 32 $176 32 $2,449 42 United States $158 $305 $209 $3,008 Note: The highest data value within each ranking is indicated by a rank of 1. 59 Long-Term Care Costs Average Private Average Private Average Private Medicare ­ eimbursement R Pay Hourly Rate for Pay Hourly Rate for Pay Daily Rate for per Home Health Visit, Home Health Aide, M ­ edicare-Certified Home Adult Day Care, 2006 2008 Health Aide, 2008 2008 Value Rank Value Rank Value Rank Value Rank Alabama $130 38 $15 48 $76 1 $32 49 Alaska $191 2 $24 1 $74 2 $99 1 Arizona $159 12 $19 21 $37 22 $46 41 Arkansas $109 48 $16 46 $26 43 $43 44 California $162 9 $21 7 $51 10 $77 4 Colorado $142 24 $20 12 $34 24 $56 24 Connecticut $124 41 $21 7 $28 36 $70 9 Delaware $147 16 $20 12 $43 14 $67 11 District of Columbia $165 6 $19 21 $22 47 $62 17 Florida $106 50 $18 33 $22 47 $52 31 Georgia $145 20 $17 37 $66 6 $49 37 Hawaii $198 1 $20 12 $45 13 $59 20 Idaho $132 35 $17 37 $33 25 $66 13 Illinois $170 5 $20 12 $39 19 $56 24 Indiana $129 39 $19 21 $24 46 $51 34 Iowa $116 46 $20 12 $36 23 $66 13 Kansas $135 30 $17 37 $27 40 $72 7 Kentucky $133 33 $16 46 $62 7 $56 24 Louisiana $118 45 $14 49 $69 4 $52 31 Maine $138 27 $21 7 $54 8 $44 43 Maryland $164 7 $19 21 $29 33 $69 10 Massachusetts $133 33 $23 3 $32 26 $56 24 Michigan $162 9 $19 21 $32 26 $50 35 Minnesota $147 16 $23 3 $28 36 $58 22 Mississippi $132 35 $14 49 $74 2 $43 44 Missouri $140 26 $18 33 $31 30 $60 18 Montana $146 18 $20 12 $27 40 $67 11 Nebraska $144 22 $19 21 $26 43 $55 28 Nevada $163 8 $20 12 $53 9 $73 5 New Hampshire $136 29 $24 1 $39 19 $58 22 New Jersey $154 13 $19 21 $32 26 $81 3 New Mexico $135 30 $18 33 $28 36 $23 50 New York $120 44 $19 21 $30 31 $72 7 North Carolina $153 14 $17 37 $39 19 $45 42 North Dakota $124 41 $19 21 $29 33 $73 5 Ohio $131 37 $18 33 $18 51 $47 40 Oklahoma $109 48 $17 37 $41 16 $48 38 Oregon $179 4 $20 12 $46 12 $83 2 Pennsylvania $143 23 $19 21 $28 36 $63 16 Rhode Island $145 20 $22 5 $22 47 $64 15 South Carolina $162 9 $17 37 $41 16 $50 35 South Dakota $149 15 $19 21 $21 50 $15 51 Tennessee $134 32 $17 37 $42 15 $48 38 Texas $128 40 $17 37 $40 18 $39 47 Utah $101 51 $21 7 $27 40 $37 48 Vermont $115 47 $22 5 $26 43 $59 20 Virginia $141 25 $17 37 $32 26 $52 31 Washington $189 3 $21 7 $68 5 $55 28 West Virginia $146 18 $14 49 $49 11 $42 46 Wisconsin $137 28 $20 12 $30 31 $53 30 Wyoming $121 43 $19 21 $29 33 $60 18 United States $134 $19 $38 $59 Note: The highest data value within each ranking is indicated by a rank of 1. 60 Long-Term Care Resources Medicare-Certified Home Health Agencies, 2006 Adult Day Facilities, 2001/2002 Value Per 1,000 Age 65+ Rank Value Per 1,000 Age 65+ Rank Alabama 145 0.23 23 40 0.06 36 Alaska 16 0.33 9 11 0.23 4 Arizona 80 0.10 45 22 0.03 45 Arkansas 174 0.44 2 33 0.08 28 California 621 0.16 33 467 0.12 17 Colorado 128 0.26 17 42 0.09 25 Connecticut 79 0.17 31 68 0.14 12 Delaware 16 0.14 40 15 0.13 15 District of Columbia 21 0.30 11 9 0.13 15 Florida 735 0.24 22 165 0.05 38 Georgia 97 0.10 45 62 0.07 29 Hawaii 13 0.07 49 27 0.15 9 Idaho 50 0.29 12 4 0.02 48 Illinois 422 0.27 14 88 0.06 36 Indiana 172 0.22 24 68 0.09 25 Iowa 172 0.39 6 71 0.16 8 Kansas 133 0.37 7 19 0.05 38 Kentucky 101 0.18 30 119 0.22 5 Louisiana 217 0.42 4 12 0.02 48 Maine 28 0.14 40 42 0.22 5 Maryland 50 0.08 47 81 0.12 17 Massachusetts 119 0.14 40 133 0.15 9 Michigan 327 0.26 17 85 0.07 29 Minnesota 196 0.31 10 66 0.10 22 Mississippi 56 0.15 35 12 0.03 45 Missouri 165 0.21 27 59 0.07 29 Montana 36 0.27 14 56 0.42 1 Nebraska 65 0.27 14 21 0.09 25 Nevada 63 0.22 24 6 0.02 48 New Hampshire 35 0.21 27 23 0.14 12 New Jersey 50 0.04 51 114 0.10 22 New Mexico 66 0.26 17 18 0.07 29 New York 178 0.07 49 175 0.07 29 North Carolina 165 0.15 35 107 0.10 22 North Dakota 26 0.28 13 22 0.24 2 Ohio 409 0.26 17 106 0.07 29 Oklahoma 210 0.44 2 25 0.05 38 Oregon 61 0.12 43 20 0.04 43 Pennsylvania 275 0.15 35 208 0.11 21 Rhode Island 22 0.15 35 18 0.12 17 South Carolina 67 0.12 43 83 0.14 12 South Dakota 39 0.34 8 6 0.05 38 Tennessee 136 0.17 31 28 0.04 43 Texas 1,700 0.71 1 297 0.12 17 Utah 59 0.25 21 8 0.03 45 Vermont 13 0.15 35 20 0.24 2 Virginia 174 0.19 29 47 0.05 38 Washington 59 0.08 47 50 0.07 29 West Virginia 63 0.22 24 6 0.02 48 Wisconsin 117 0.16 33 111 0.15 9 Wyoming 27 0.42 4 12 0.19 7 United States 8,448 0.22 3,407 0.09 Note: The highest data value within each ranking is indicated by a rank of 1. 61 Long-Term Care Resources Assisted Living and Residential Care Assisted Living and Residential Care Facilities, 2007 Units, 2007 Value Per 1,000 Age 65+ Rank Value Per 1,000 Age 65+ Rank Alabama 307 0.5 36 9,509 15 38 Alaska 229 4.8 1 1,912 40 6 Arizona 1,951 2.4 5 27,000 33 15 Arkansas 119 0.3 44 5,018 13 43 California 7,471 1.9 9 161,586 40 6 Colorado 495 1.0 19 14,237 29 22 Connecticut 263 0.6 30 2,808 6 49 Delaware 32 0.3 44 1,804 15 38 District of Columbia 22 0.3 44 509 7 48 Florida 2,400 0.8 23 75,450 24 28 Georgia 1,860 2.0 8 26,500 28 23 Hawaii 490 2.7 4 4,284 23 30 Idaho 278 1.6 11 6,819 39 8 Illinois 346 0.2 48 16,800 11 46 Indiana 461 0.6 30 33,313 42 5 Iowa 248 0.6 30 13,072 30 19 Kansas 239 0.7 28 10,726 30 19 Kentucky 289 0.5 36 6,802 12 45 Louisiana 123 0.2 48 5,357 10 47 Maine 681 3.5 3 8,703 45 1 Maryland 1,366 2.1 7 20,093 30 19 Massachusetts 285 0.3 44 14,869 17 36 Michigan 4,706 3.7 2 46,095 36 12 Minnesota 1,239 1.9 9 NA NA Mississippi 185 0.5 36 5,133 14 41 Missouri 616 0.8 23 21,166 27 26 Montana 184 1.4 12 4,351 33 15 Nebraska 276 1.2 15 10,063 43 3 Nevada 258 0.9 20 3,941 14 41 New Hampshire 142 0.9 20 4,283 26 27 New Jersey 222 0.2 48 17,761 16 37 New Mexico 284 1.1 18 NA NA New York 500 0.2 48 39,170 15 38 North Carolina 1,307 1.2 15 41,642 38 9 North Dakota 111 1.2 15 3,472 37 11 Ohio 1,205 0.8 23 44,005 28 23 Oklahoma 206 0.4 40 9,302 19 34 Oregon 429 0.9 20 22,130 45 1 Pennsylvania 1,550 0.8 23 71,831 38 9 Rhode Island 63 0.4 40 3,574 24 28 South Carolina 480 0.8 23 16,279 28 23 South Dakota 157 1.4 12 3,578 32 17 Tennessee 328 0.4 40 16,289 21 33 Texas 1,433 0.6 30 45,853 19 34 Utah 151 0.6 30 5,256 22 31 Vermont 118 1.4 12 2,610 31 18 Virginia 577 0.6 30 31,964 35 13 Washington 551 0.7 28 26,829 35 13 West Virginia 120 0.4 40 3,510 13 43 Wisconsin 1,617 2.2 6 31,782 43 3 Wyoming 35 0.5 36 1,436 22 31 United States 39,005 1.0 1,000,476 26 Note: The highest data value within each ranking is indicated by a rank of 1. 62 Long-Term Care Resources Personal and Home Care Aides, 2007 Median Hourly Wage, Personal and Home Care Aides, 2007 Value Per 1,000 Age 65+ Rank Value Rank Alabama 2,580 4 47 $7.47 46 Alaska 3,980 83 1 $12.91 1 Arizona 13,780 17 17 $10.06 12 Arkansas 5,480 14 22 $7.57 45 California 39,770 10 35 $9.87 17 Colorado 10,850 22 7 $8.97 31 Connecticut 6,660 14 22 $9.89 15 Delaware 520 4 47 $10.83 5 District of Columbia 970 14 22 $9.89 15 Florida 9,820 3 49 $8.98 29 Georgia 8,710 9 39 $9.01 28 Hawaii 3,410 19 15 $9.09 27 Idaho 2,050 12 30 $8.49 40 Illinois 19,490 13 26 $8.36 41 Indiana 11,280 14 22 $9.41 21 Iowa 5,620 13 26 $9.50 19 Kansas 9,270 26 5 $8.72 34 Kentucky 3,730 7 43 $8.19 42 Louisiana 10,290 20 12 $7.16 48 Maine 5,110 26 5 $8.98 29 Maryland 4,570 7 43 $10.28 10 Massachusetts 13,030 15 20 $11.24 2 Michigan 12,400 10 35 $9.45 20 Minnesota 28,290 44 3 $10.95 3 Mississippi 1,980 5 46 $6.87 49 Missouri 15,940 20 12 $8.51 39 Montana 3,000 22 7 $8.86 32 Nebraska 1,320 6 45 $9.21 25 Nevada 2,850 10 35 $10.16 11 New Hampshire 2,470 15 20 $10.36 9 New Jersey 9,380 8 41 $10.89 4 New Mexico 10,140 41 4 $8.86 32 New York 54,160 21 11 $10.39 8 North Carolina 17,170 16 19 $8.64 37 North Dakota 1,690 18 16 $9.24 23 Ohio 13,780 9 39 $9.15 26 Oklahoma 9,610 20 12 $8.10 43 Oregon 6,130 13 26 $9.96 14 Pennsylvania 20,650 11 32 $9.37 22 Rhode Island 1,600 11 32 $10.68 6 South Carolina 4,380 8 41 $8.71 36 South Dakota 1,470 13 26 $8.72 34 Tennessee 8,900 11 32 $8.63 38 Texas 123,910 52 2 $6.63 50 Utah NA NA $9.22 24 Vermont NA NA NA Virginia 9,100 10 35 $7.77 44 Washington 16,740 22 7 $10.61 7 West Virginia 4,770 17 17 $7.26 47 Wisconsin 16,310 22 7 $9.57 18 Wyoming 770 12 30 $10.02 13 United States 595,350 16 $8.89 Note: The highest data value within each ranking is indicated by a rank of 1. 63 Long-Term Care Resources Home Health Aides, 2007 Median Hourly Wage, Home Medicaid Aged/Disabled Health Aides, 2007 Waiver Waiting List, 2007 Value Per 1,000 Age 65+ Rank Value Rank Value Rank Alabama 10,070 16 31 $8.05 48 1,985 9 Alaska 1,500 31 4 $13.35 1 0 22 Arizona 15,400 19 20 $9.97 23 0 22 Arkansas 5,430 14 37 $8.27 47 0 22 California 48,820 12 44 $9.56 29 1,942 10 Colorado 7,910 16 31 $10.68 10 0 22 Connecticut 12,180 26 9 $12.76 2 71 19 Delaware 1,920 16 31 $11.50 6 0 22 District of Columbia 1,210 17 26 $10.43 15 0 22 Florida 29,720 10 46 $9.54 30 7,410 4 Georgia 10,010 11 45 $8.61 46 763 12 Hawaii 1,630 9 47 $11.79 5 100 18 Idaho 3,820 22 15 $8.85 41 0 22 Illinois 24,040 16 31 $9.85 24 0 22 Indiana 11,910 15 36 $9.59 28 1,299 11 Iowa 10,140 23 13 $10.14 19 0 22 Kansas 8,300 23 13 $9.04 38 0 22 Kentucky 3,710 7 50 $10.10 20 0 22 Louisiana 9,040 17 26 $7.61 50 9,209 3 Maine 4,860 25 10 $10.52 13 107 17 Maryland 11,280 17 26 $10.49 14 7,200 5 Massachusetts 18,190 21 17 $11.89 4 0 22 Michigan 32,210 25 10 $9.26 35 3,404 7 Minnesota 28,200 44 3 $10.75 9 0 22 Mississippi 3,240 9 47 $8.80 42 0 22 Missouri 11,290 14 37 $8.76 45 39 21 Montana 2,390 18 22 $9.31 33 600 13 Nebraska 4,040 17 26 $10.64 11 0 22 Nevada 3,600 13 41 $10.54 12 488 14 New Hampshire 2,780 17 26 $10.97 7 0 22 New Jersey 20,020 18 22 $10.91 8 0 22 New Mexico 6,650 27 6 $9.03 39 0 22 New York 145,490 57 2 $10.04 22 0 22 North Carolina 73,770 67 1 $9.18 36 0 22 North Dakota 1,890 20 18 $9.74 26 0 22 Ohio 48,350 31 4 $9.39 32 2,107 8 Oklahoma 7,850 16 31 $8.78 43 0 22 Oregon 9,770 20 18 $9.51 31 0 22 Pennsylvania 50,690 27 6 $9.60 27 0 22 Rhode Island NA NA $11.90 3 111 16 South Carolina 10,340 18 22 $8.78 43 4,642 6 South Dakota 870 8 49 $9.85 24 0 22 Tennessee 10,720 14 37 $9.00 40 0 22 Texas 52,200 22 15 $7.76 49 36,412 1 Utah 4,350 19 20 $9.30 34 62 20 Vermont 2,300 27 6 $10.42 16 0 22 Virginia 12,250 13 41 $9.11 37 0 22 Washington 9,640 13 41 $10.23 18 0 22 West Virginia 5,130 18 22 $7.35 51 0 22 Wisconsin 17,680 24 12 $10.05 21 11,777 2 Wyoming 900 14 37 $10.25 17 210 15 United States 834,580 22 $9.62 89,938 Note: The highest data value within each ranking is indicated by a rank of 1. 64 Long-Term Care Resources Total Nursing Facilities, 2007 Total Nursing Facility Beds, 2007 Value Per 1,000 Age 65+ Rank Value Per 1,000 Age 65+ Rank Alabama 232 0.37 35 26,696 43 29 Alaska 15 0.31 41 725 15 51 Arizona 137 0.17 50 16,218 20 49 Arkansas 253 0.64 10 26,166 66 5 California 1,283 0.32 39 123,228 31 43 Colorado 214 0.43 28 20,093 41 32 Connecticut 244 0.52 21 29,612 63 10 Delaware 45 0.38 33 4,714 40 33 District of Columbia 20 0.29 44 2,982 43 29 Florida 684 0.22 49 81,966 26 46 Georgia 362 0.38 33 40,159 43 29 Hawaii 48 0.26 47 4,185 23 48 Idaho 79 0.45 27 6,090 35 39 Illinois 810 0.52 21 98,594 64 9 Indiana 523 0.66 9 49,709 62 11 Iowa 466 1.06 1 33,693 77 1 Kansas 363 1.01 2 23,849 66 5 Kentucky 295 0.54 19 26,186 48 21 Louisiana 289 0.55 17 35,821 69 2 Maine 112 0.57 15 7,196 37 38 Maryland 235 0.36 36 29,250 44 28 Massachusetts 457 0.53 20 50,037 58 14 Michigan 438 0.34 37 48,078 38 37 Minnesota 397 0.62 12 34,892 55 16 Mississippi 206 0.56 16 18,652 51 20 Missouri 534 0.68 8 52,404 66 5 Montana 96 0.72 7 7,299 55 16 Nebraska 228 0.96 4 16,297 69 2 Nevada 48 0.17 50 5,643 20 49 New Hampshire 83 0.50 23 7,877 48 21 New Jersey 367 0.32 39 51,401 45 27 New Mexico 72 0.29 44 6,808 27 45 New York 654 0.26 47 120,629 47 24 North Carolina 425 0.39 31 43,580 39 36 North Dakota 83 0.89 5 6,430 69 2 Ohio 983 0.64 10 94,459 61 12 Oklahoma 356 0.74 6 31,740 66 5 Oregon 140 0.29 44 12,625 26 46 Pennsylvania 728 0.39 31 88,736 47 24 Rhode Island 88 0.60 14 8,877 60 13 South Carolina 177 0.31 41 18,059 32 42 South Dakota 110 0.97 3 6,553 58 14 Tennessee 330 0.42 29 37,576 47 24 Texas 1,197 0.50 23 125,753 53 18 Utah 95 0.41 30 8,000 34 41 Vermont 41 0.49 25 3,389 40 33 Virginia 282 0.31 41 31,485 35 39 Washington 247 0.33 38 22,688 30 44 West Virginia 133 0.47 26 11,093 40 33 Wisconsin 402 0.55 17 38,250 52 19 Wyoming 39 0.61 13 3,052 48 21 United States 16,145 0.43 1,699,494 45 Note: The highest data value within each ranking is indicated by a rank of 1. 65 Long-Term Care Resources Nursing Facilities w/ Deficiency Nursing Facility Occupancy Rate, Direct Care Nursing Hours per for Actual Harm or Jeopardy of 2007 Patient Day, 2007 Residents (%), 2007 Value Rank Value Rank Value Rank Alabama 88% 20 4.1 7 14% 33 Alaska 87% 27 5.5 1 7% 47 Arizona 78% 41 3.5 42 15% 28 Arkansas 72% 46 4.0 9 15% 28 California 85% 31 3.8 19 12% 36 Colorado 84% 34 3.7 26 43% 2 Connecticut 92% 4 3.7 26 41% 3 Delaware 85% 31 4.0 9 39% 4 District of Columbia 94% 2 4.2 5 44% 1 Florida 88% 20 4.6 2 8% 44 Georgia 89% 18 3.4 46 16% 22 Hawaii 95% 1 3.8 19 7% 47 Idaho 74% 42 4.5 3 34% 6 Illinois 79% 40 3.3 49 25% 11 Indiana 81% 37 3.6 34 35% 5 Iowa 80% 38 3.3 49 14% 33 Kansas 85% 31 3.6 34 28% 9 Kentucky 90% 13 4.0 9 7% 47 Louisiana 74% 42 3.4 46 12% 36 Maine 91% 10 4.3 4 7% 47 Maryland 87% 27 3.8 19 16% 22 Massachusetts 90% 13 3.8 19 17% 20 Michigan 87% 27 3.7 26 30% 8 Minnesota 92% 4 3.6 34 15% 28 Mississippi 90% 13 3.9 14 12% 36 Missouri 74% 42 3.6 34 16% 22 Montana 72% 46 4.0 9 19% 18 Nebraska 83% 36 3.7 26 25% 11 Nevada 84% 34 3.5 42 15% 28 New Hampshire 90% 13 3.9 14 11% 39 New Jersey 89% 18 3.6 34 16% 22 New Mexico 88% 20 3.4 46 27% 10 New York 92% 4 3.6 34 18% 19 North Carolina 88% 20 3.7 26 10% 42 North Dakota 92% 4 4.2 5 11% 39 Ohio 88% 20 3.8 19 15% 28 Oklahoma 67% 49 3.6 34 20% 16 Oregon 65% 50 3.9 14 16% 22 Pennsylvania 91% 10 3.9 14 11% 39 Rhode Island 92% 4 3.5 42 4% 51 South Carolina 93% 3 3.9 14 9% 43 South Dakota NA 3.3 49 24% 14 Tennessee 88% 20 3.6 34 16% 22 Texas 73% 45 3.5 42 14% 33 Utah 69% 48 4.1 7 8% 44 Vermont 92% 4 3.8 19 8% 44 Virginia 91% 10 3.7 26 17% 20 Washington 87% 27 3.8 19 25% 11 West Virginia 90% 13 3.7 26 20% 16 Wisconsin 88% 20 3.7 26 31% 7 Wyoming 80% 38 4.0 9 24% 14 United States 85% 3.7 18% Note: The highest data value within each ranking is indicated by a rank of 1. 66 Long-Term Care Resources Nursing Facilities Visited by Nursing Facility Residents Long-Term Care Facility Beds per Ombudsman at Least Quarterly, w/ Physical Restraints (%), 2007 FTE Ombudsman, 2006 2006 Value Rank Value Rank Value Rank Alabama 3% 34 1,849 27 100% 1 Alaska 5% 18 859 49 80% 34 Arizona 5% 18 2,743 19 99% 20 Arkansas 12% 1 2,637 20 100% 1 California 11% 2 1,472 33 88% 30 Colorado 7% 7 1,219 40 100% 1 Connecticut 5% 18 6,407 4 100% 1 Delaware 5% 18 1,181 41 100% 1 District of Columbia 2% 44 879 47 0% 51 Florida 7% 7 7,319 2 26% 49 Georgia 6% 13 1,373 36 98% 21 Hawaii 4% 28 2,849 17 96% 23 Idaho 4% 28 1,175 42 100% 1 Illinois 4% 28 1,503 31 91% 29 Indiana 5% 18 4,751 6 100% 1 Iowa 2% 44 9,781 1 19% 50 Kansas 3% 34 3,193 13 100% 1 Kentucky 6% 13 914 45 94% 25 Louisiana 11% 2 1,554 29 100% 1 Maine 3% 34 2,083 26 100% 1 Maryland 4% 28 1,124 44 95% 24 Massachusetts 5% 18 1,505 30 100% 1 Michigan 5% 18 4,592 7 69% 40 Minnesota 3% 34 5,885 5 60% 42 Mississippi 9% 6 1,356 37 100% 1 Missouri 6% 13 4,306 9 72% 37 Montana 2% 44 795 50 100% 1 Nebraska 2% 44 4,512 8 45% 46 Nevada 10% 5 863 48 63% 41 New Hampshire 2% 44 2,419 24 92% 28 New Jersey 5% 18 3,881 11 94% 25 New Mexico 6% 13 1,489 32 100% 1 New York 5% 18 3,077 15 33% 48 North Carolina 7% 7 2,935 16 100% 1 North Dakota 2% 44 2,104 25 80% 34 Ohio 6% 13 1,718 28 51% 44 Oklahoma 11% 2 1,472 33 100% 1 Oregon 4% 28 6,958 3 72% 37 Pennsylvania 4% 28 2,446 23 94% 25 Rhode Island 3% 34 1,153 43 56% 43 South Carolina 7% 7 1,258 39 100% 1 South Dakota 3% 34 3,942 10 98% 21 Tennessee 7% 7 3,466 12 81% 33 Texas 5% 18 2,774 18 100% 1 Utah 7% 7 1,421 35 82% 32 Vermont 2% 44 754 51 49% 45 Virginia 3% 34 2,465 22 71% 39 Washington 3% 34 2,483 21 78% 36 West Virginia 3% 34 1,335 38 87% 31 Wisconsin 2% 44 3,136 14 42% 47 Wyoming 3% 34 893 46 100% 1 United States 6% 2,192 79% Note: The highest data value within each ranking is indicated by a rank of 1. 67 Trends Medicaid HCBS Participants, Older People Medicaid Aged/Disabled and Adults w/ Physical Disabilities Waiver Participants 2000 2005 % Change Rank 2000 2005 % Change Rank Alabama 6,205 8,373 +35% 30 6,205 8,373 +35% 24 Alaska 2,879 5,089 +77% 17 1,423 2,347 +65% 14 Arizona 8,407 15,352 +83% 13 NA NA NA Arkansas 26,534 24,201 -9% 49 8,818 8,749 -1% 44 California 223,042 328,878 +47% 26 11,423 14,985 +31% 26 Colorado 13,006 15,219 +17% 39 13,006 15,219 +17% 37 Connecticut 9,740 11,675 +20% 36 9,740 11,675 +20% 32 Delaware 805 1,312 +63% 22 805 1,312 +63% 16 District of Columbia 1,704 2,873 +69% 20 79 521 +559% 2 Florida 27,404 39,753 +45% 27 17,941 25,773 +44% 22 Georgia 12,636 15,418 +22% 34 12,636 15,418 +22% 29 Hawaii 991 2,195 +121% 12 991 2,195 +121% 7 Idaho 4,910 11,334 +131% 11 2,989 7,733 +159% 6 Illinois 33,831 51,831 +53% 24 33,831 51,831 +53% 19 Indiana 2,345 3,836 +64% 21 2,345 3,836 +64% 15 Iowa 4,691 6,268 +34% 31 4,691 6,268 +34% 25 Kansas 11,746 14,193 +21% 35 11,746 14,193 +21% 30 Kentucky 14,399 12,165 -16% 51 14,399 12,165 -16% 48 Louisiana 902 4,009 +344% 3 902 4,009 +344% 3 Maine 3,266 9,350 +186% 7 1,977 1,489 -25% 50 Maryland 4,834 8,357 +73% 19 157 3,714 +2266% 1 Massachusetts 11,718 20,835 +78% 16 6,052 7,068 +17% 37 Michigan 57,650 64,302 +12% 43 11,341 9,144 -19% 49 Minnesota 21,539 37,833 +76% 18 14,222 27,893 +96% 9 Mississippi 4,124 11,884 +188% 5 4,124 11,884 +188% 5 Missouri 63,005 73,298 +16% 40 23,802 23,817 +0% 43 Montana 4,420 4,977 +13% 42 1,626 1,853 +14% 39 Nebraska 3,466 6,341 +83% 13 2,357 4,792 +103% 8 Nevada 1,928 4,572 +137% 9 1,479 2,534 +71% 13 New Hampshire 1,753 2,615 +49% 25 1,629 2,590 +59% 17 New Jersey 26,410 27,799 +5% 46 5,818 6,915 +19% 34 New Mexico 2,234 12,056 +440% 1 1,351 2,442 +81% 10 New York 109,071 106,079 -3% 47 20,283 21,809 +8% 40 North Carolina 22,663 64,547 +185% 8 11,427 13,729 +20% 32 North Dakota 380 1,859 +389% 2 380 497 +31% 26 Ohio 29,225 38,013 +30% 33 29,225 38,013 +30% 28 Oklahoma 16,515 23,048 +40% 28 9,042 16,048 +77% 12 Oregon 31,275 33,308 +7% 45 29,205 28,222 -3% 45 Pennsylvania 6,740 20,131 +199% 4 6,740 20,131 +199% 4 Rhode Island 2,358 2,788 +18% 37 2,358 2,788 +18% 35 South Carolina 14,522 13,672 -6% 48 14,522 13,672 -6% 47 South Dakota 1,713 1,893 +11% 44 719 992 +38% 23 Tennessee 535 964 +80% 15 535 964 +80% 11 Texas 102,428 116,668 +14% 41 32,144 38,943 +21% 30 Utah 1,126 2,641 +135% 10 847 886 +5% 42 Vermont 1,140 3,279 +188% 5 1,140 1,745 +53% 19 Virginia 10,498 12,424 +18% 37 10,498 12,424 +18% 35 Washington 35,692 49,568 +39% 29 29,178 31,139 +7% 41 West Virginia 11,031 9,477 -14% 50 5,182 4,942 -5% 46 Wisconsin 24,392 32,296 +32% 32 13,884 21,173 +52% 21 Wyoming 953 1,488 +56% 23 953 1,488 +56% 18 United States 1,026,374 1,376,984 +34% 448,167 582,342 +30% Note: The highest data value within each ranking is indicated by a rank of 1. 68 Trends Medicare Home Health Visits per User 2001 Rank 2006 Rank % Change Rank Alabama 38 9 36 9 -6% 34 Alaska 19 48 22 40 +19% 5 Arizona 21 46 21 45 +2% 18 Arkansas 35 12 38 8 +9% 9 California 26 31 32 14 +21% 4 Colorado 27 24 26 27 -2% 24 Connecticut 38 9 34 12 -12% 42 Delaware 27 24 23 39 -16% 47 District of Columbia 26 31 22 40 -15% 45 Florida 30 17 50 5 +67% 1 Georgia 34 13 30 18 -11% 40 Hawaii 19 48 18 50 -5% 33 Idaho 23 41 29 21 +24% 3 Illinois 25 37 27 24 +8% 11 Indiana 28 20 31 16 +10% 8 Iowa 25 37 25 30 +2% 18 Kansas 27 24 26 27 -3% 27 Kentucky 37 11 31 16 -16% 47 Louisiana 57 1 57 1 +1% 20 Maine 33 14 25 30 -24% 51 Maryland 22 44 21 45 -6% 34 Massachusetts 39 7 34 12 -13% 44 Michigan 28 20 27 24 -4% 29 Minnesota 22 44 22 40 +0% 21 Mississippi 41 4 40 7 -3% 27 Missouri 26 31 25 30 -2% 24 Montana 26 31 22 40 -16% 47 Nebraska 23 41 22 40 -6% 34 Nevada 28 20 30 18 +9% 9 New Hampshire 33 14 30 18 -11% 40 New Jersey 27 24 24 35 -10% 39 New Mexico 27 24 32 14 +18% 6 New York 33 14 35 11 +5% 14 North Carolina 26 31 24 35 -7% 37 North Dakota 23 41 19 48 -19% 50 Ohio 27 24 28 22 +6% 12 Oklahoma 49 2 55 2 +14% 7 Oregon 18 51 18 50 +3% 16 Pennsylvania 25 37 24 35 -4% 29 Rhode Island 29 18 25 30 -15% 45 South Carolina 27 24 26 27 -4% 29 South Dakota 21 46 20 47 -2% 24 Tennessee 39 7 41 6 +5% 14 Texas 41 4 55 2 +33% 2 Utah 49 2 52 4 +6% 12 Vermont 41 4 36 9 -12% 42 Virginia 28 20 27 24 -4% 29 Washington 19 48 19 48 +3% 16 West Virginia 26 31 24 35 -8% 38 Wisconsin 25 37 25 30 +0% 21 Wyoming 29 18 28 22 -1% 23 United States 31 35 +13% Note: The highest data value within each ranking is indicated by a rank of 1. 69 Trends Nursing Facility Residents Nursing Facility Beds 2002 2007 % Change Rank 2002 2007 % Change Rank Alabama 21,189 23,588 +11% 2 23,354 26,696 +14% 2 Alaska 628 628 +0% 28 703 725 +3% 21 Arizona 13,462 12,574 -7% 46 15,904 16,218 +2% 25 Arkansas 17,827 18,746 +5% 12 24,438 26,166 +7% 9 California 97,954 104,779 +7% 7 115,516 123,228 +7% 9 Colorado 16,543 16,820 +2% 23 20,213 20,093 -1% 32 Connecticut 29,343 27,257 -7% 46 31,412 29,612 -6% 44 Delaware 3,913 4,015 +3% 18 4,262 4,714 +11% 5 District of Columbia 2,834 2,804 -1% 30 3,114 2,982 -4% 37 Florida 67,822 72,447 +7% 7 78,810 81,966 +4% 18 Georgia 33,620 35,682 +6% 10 36,836 40,159 +9% 7 Hawaii 3,881 3,965 +2% 23 4,089 4,185 +2% 25 Idaho 4,407 4,533 +3% 18 5,675 6,090 +7% 9 Illinois 81,719 77,779 -5% 38 100,344 98,594 -2% 34 Indiana 42,166 40,322 -4% 36 53,292 49,709 -7% 45 Iowa 30,151 27,042 -10% 49 35,550 33,693 -5% 41 Kansas 21,508 20,170 -6% 41 24,862 23,849 -4% 37 Kentucky 21,875 23,657 +8% 6 23,857 26,186 +10% 6 Louisiana 33,282 26,460 -20% 51 42,323 35,821 -15% 51 Maine 6,917 6,546 -5% 38 7,575 7,196 -5% 41 Maryland 24,576 25,555 +4% 14 28,261 29,250 +3% 21 Massachusetts 46,397 45,172 -3% 34 51,173 50,037 -2% 34 Michigan 40,422 41,833 +3% 18 46,320 48,078 +4% 18 Minnesota 35,799 32,052 -10% 49 38,385 34,892 -9% 48 Mississippi 15,656 16,762 +7% 7 17,854 18,652 +4% 18 Missouri 38,391 38,791 +1% 25 51,865 52,404 +1% 28 Montana 5,617 5,281 -6% 41 7,230 7,299 +1% 28 Nebraska 14,116 13,484 -4% 36 15,972 16,297 +2% 25 Nevada 4,297 4,724 +10% 3 5,286 5,643 +7% 9 New Hampshire 6,796 7,063 +4% 14 7,485 7,877 +5% 16 New Jersey 43,601 45,860 +5% 12 50,062 51,401 +3% 21 New Mexico 5,948 5,981 +1% 25 7,051 6,808 -3% 36 New York 105,315 111,313 +6% 10 113,116 120,629 +7% 9 North Carolina 37,213 38,282 +3% 18 41,299 43,580 +6% 15 North Dakota 6,277 5,926 -6% 41 6,681 6,430 -4% 37 Ohio 79,273 82,702 +4% 14 92,014 94,459 +3% 21 Oklahoma 20,895 21,113 +1% 25 30,099 31,740 +5% 16 Oregon 7,910 8,208 +4% 14 11,228 12,625 +12% 4 Pennsylvania 80,395 80,792 +0% 28 89,924 88,736 -1% 32 Rhode Island 8,704 8,207 -6% 41 9,575 8,877 -7% 45 South Carolina 14,290 16,856 +18% 1 15,595 18,059 +16% 1 South Dakota 6,750 6,553 -3% 34 7,336 6,553 -11% 49 Tennessee 34,981 33,059 -5% 38 38,980 37,576 -4% 37 Texas 88,925 91,980 +3% 18 115,495 125,753 +9% 7 Utah 5,092 5,544 +9% 4 7,100 8,000 +13% 3 Vermont 3,311 3,127 -6% 41 3,679 3,389 -8% 47 Virginia 26,508 28,778 +9% 4 29,291 31,485 +7% 9 Washington 20,054 19,641 -2% 31 23,784 22,688 -5% 41 West Virginia 10,179 9,977 -2% 31 11,057 11,093 +0% 31 Wisconsin 36,886 33,483 -9% 48 43,403 38,250 -12% 50 Wyoming 2,502 2,445 -2% 31 3,015 3,052 +1% 28 United States 1,428,117 1,440,358 +1% 1,671,744 1,699,494 +2% Note: The highest data value within each ranking is indicated by a rank of 1. 70 Trends Nursing Facility Occupancy Rate 2002 Rank 2007 Rank Change Rank Alabama 91% 11 88% 20 -2% 30 Alaska 89% 22 87% 27 -3% 38 Arizona 85% 32 78% 41 -7% 49 Arkansas 73% 48 72% 46 -1% 24 California 85% 32 85% 31 +0% 17 Colorado 82% 39 84% 34 +2% 4 Connecticut 93% 3 92% 4 -1% 24 Delaware 92% 6 85% 31 -7% 49 District of Columbia 91% 11 94% 2 +3% 1 Florida 86% 30 88% 20 +2% 4 Georgia 91% 11 89% 18 -2% 30 Hawaii 95% 1 95% 1 +0% 17 Idaho 78% 44 74% 42 -3% 38 Illinois 81% 40 79% 40 -3% 38 Indiana 79% 42 81% 37 +2% 4 Iowa 85% 32 80% 38 -5% 44 Kansas 87% 26 85% 31 -2% 30 Kentucky 92% 6 90% 13 -1% 24 Louisiana 79% 42 74% 42 -5% 44 Maine 91% 11 91% 10 +0% 17 Maryland 87% 26 87% 27 +0% 17 Massachusetts 91% 11 90% 13 +0% 17 Michigan 87% 26 87% 27 +0% 17 Minnesota 93% 3 92% 4 -1% 24 Mississippi 88% 24 90% 13 +2% 4 Missouri 74% 47 74% 42 +0% 17 Montana 78% 44 72% 46 -5% 44 Nebraska 88% 24 83% 36 -6% 48 Nevada 81% 40 84% 34 +2% 4 New Hampshire 91% 11 90% 13 -1% 24 New Jersey 87% 26 89% 18 +2% 4 New Mexico 84% 36 88% 20 +3% 1 New York 93% 3 92% 4 -1% 24 North Carolina 90% 18 88% 20 -2% 30 North Dakota 94% 2 92% 4 -2% 30 Ohio 86% 30 88% 20 +1% 15 Oklahoma 69% 51 67% 49 -3% 38 Oregon 70% 50 65% 50 -5% 44 Pennsylvania 89% 22 91% 10 +2% 4 Rhode Island 91% 11 92% 4 +2% 4 South Carolina 92% 6 93% 3 +2% 4 South Dakota 92% 6 NA NA Tennessee 90% 18 88% 20 -2% 30 Texas 77% 46 73% 45 -4% 43 Utah 72% 49 69% 48 -2% 30 Vermont 90% 18 92% 4 +2% 4 Virginia 90% 18 91% 10 +1% 15 Washington 84% 36 87% 27 +2% 4 West Virginia 92% 6 90% 13 -2% 30 Wisconsin 85% 32 88% 20 +3% 1 Wyoming 83% 38 80% 38 -3% 38 United States 85% 85% -1% Note: The highest data value within each ranking is indicated by a rank of 1. 71 Trends Total Medicaid Spending (Millions) Medicaid LTC Spending for Older People and Adults w/ Physical Disabilities (Millions) 2002 2007 % Change Rank 2002 2007 % Change Rank Alabama $3,123 $4,122 +32% 23 $746 $953 +28% 22 Alaska $700 $954 +36% 19 $139 $255 +84% 1 Arizona $3,535 $6,596 +87% 1 $434 $654 +51% 6 Arkansas $2,250 $3,159 +40% 15 $595 $683 +15% 33 California $23,523 $31,045 +32% 23 $4,729 $7,477 +58% 4 Colorado $2,326 $2,959 +27% 28 $488 $661 +35% 12 Connecticut $3,577 $4,348 +22% 33 $1,084 $1,355 +25% 27 Delaware $636 $991 +56% 2 $134 $180 +35% 12 District of Columbia $1,035 $1,354 +31% 25 $186 $261 +40% 10 Florida $9,957 $13,742 +38% 17 $2,021 $2,767 +37% 11 Georgia $6,400 $7,170 +12% 45 $942 $1,003 +6% 43 Hawaii $750 $1,116 +49% 9 $196 $261 +33% 16 Idaho $799 $1,100 +38% 17 $184 $237 +29% 19 Illinois $8,947 $12,651 +41% 14 $1,707 $1,757 +3% 45 Indiana $4,415 $5,141 +16% 38 $884 $840 -5% 48 Iowa $2,313 $2,649 +15% 41 $525 $523 +0% 46 Kansas $1,852 $2,147 +16% 38 $471 $526 +12% 35 Kentucky $3,815 $4,588 +20% 36 $695 $825 +19% 31 Louisiana $4,925 $4,840 -2% 51 $607 $670 +10% 38 Maine $1,459 $2,116 +45% 11 $268 $322 +20% 29 Maryland $3,671 $5,540 +51% 6 $810 $1,077 +33% 16 Massachusetts $8,747 $10,230 +17% 37 $1,719 $2,117 +23% 28 Michigan $7,576 $9,215 +22% 33 $2,008 $1,807 -10% 50 Minnesota $4,611 $6,195 +34% 21 $1,147 $1,485 +29% 19 Mississippi $2,905 $3,286 +13% 44 $499 $785 +57% 5 Missouri $5,359 $6,598 +23% 31 $1,008 $1,098 +9% 40 Montana $590 $733 +24% 30 $181 $200 +10% 38 Nebraska $1,377 $1,535 +11% 48 $427 $401 -6% 49 Nevada $824 $1,239 +51% 6 $130 $236 +82% 2 New Hampshire $1,030 $1,193 +16% 38 $259 $364 +41% 9 New Jersey $7,737 $8,879 +15% 41 $1,749 $2,226 +27% 24 New Mexico $1,744 $2,609 +50% 8 $305 $441 +45% 7 New York $36,047 $41,397 +15% 41 $8,883 $9,480 +7% 41 North Carolina $6,803 $9,744 +43% 12 $1,368 $1,839 +34% 15 North Dakota $469 $515 +10% 49 $180 $178 -1% 47 Ohio $9,802 $13,007 +33% 22 $2,842 $3,188 +12% 35 Oklahoma $2,297 $3,361 +46% 10 $547 $691 +26% 26 Oregon $2,590 $2,907 +12% 45 $504 $671 +33% 16 Pennsylvania $12,134 $15,856 +31% 25 $4,067 $4,322 +6% 43 Rhode Island $1,387 $1,755 +27% 28 $286 $338 +18% 32 South Carolina $3,385 $4,164 +23% 31 $487 $626 +28% 22 South Dakota $554 $620 +12% 45 $136 $146 +7% 41 Tennessee $5,804 $7,107 +22% 33 $943 $1,199 +27% 24 Texas $13,389 $20,615 +54% 5 $2,768 $3,160 +14% 34 Utah $1,005 $1,405 +40% 15 $100 $172 +72% 3 Vermont $665 $1,041 +56% 2 $121 $171 +42% 8 Virginia $3,469 $4,968 +43% 12 $816 $979 +20% 29 Washington $5,401 $5,700 +6% 50 $1,173 $1,312 +12% 35 West Virginia $1,598 $2,176 +36% 19 $385 $521 +35% 12 Wisconsin $3,914 $5,037 +29% 27 $1,728 $1,373 -21% 51 Wyoming $277 $433 +56% 2 $61 $79 +29% 19 United States $243,497 $311,848 +28% $54,261 $64,168 +18% Note: The highest data value within each ranking is indicated by a rank of 1. 72 Trends Medicaid HCBS Spending for Older People and Adults Medicaid Nursing Facility Spending (Millions) w/ Physical Disabilities (Millions) 2002 2007 % Change Rank 2002 2007 % Change Rank Alabama $53 $82 +55% 34 $693 $871 +26% 13 Alaska $51 $129 +150% 10 $87 $126 +45% 3 Arizona $143 $262 +83% 25 $290 $392 +35% 5 Arkansas $98 $142 +45% 39 $497 $541 +9% 29 California $1,851 $3,820 +106% 16 $2,878 $3,657 +27% 11 Colorado $90 $144 +60% 31 $398 $517 +30% 9 Connecticut $57 $122 +113% 14 $1,026 $1,233 +20% 22 Delaware $9 $18 +89% 24 $124 $163 +31% 8 District of Columbia $5 $88 +1600% 1 $181 $173 -4% 41 Florida $146 $374 +157% 7 $1,876 $2,393 +28% 10 Georgia $107 $183 +71% 28 $835 $821 -2% 38 Hawaii $27 $46 +67% 29 $169 $215 +27% 11 Idaho $62 $91 +48% 37 $123 $146 +19% 24 Illinois $195 $402 +106% 16 $1,512 $1,355 -10% 45 Indiana $21 $46 +117% 13 $863 $794 -8% 44 Iowa $30 $75 +149% 11 $495 $448 -10% 45 Kansas $132 $177 +34% 47 $340 $349 +3% 33 Kentucky $80 $66 -17% 51 $615 $759 +23% 21 Louisiana $10 $160 +1480% 2 $597 $509 -15% 48 Maine $31 $82 +163% 5 $237 $240 +1% 37 Maryland $48 $123 +157% 7 $762 $955 +25% 16 Massachusetts $301 $504 +67% 29 $1,418 $1,613 +14% 25 Michigan $228 $324 +42% 41 $1,780 $1,483 -17% 50 Minnesota $253 $650 +156% 9 $893 $835 -7% 43 Mississippi $50 $90 +78% 26 $449 $695 +55% 2 Missouri $269 $338 +26% 49 $739 $760 +3% 33 Montana $48 $52 +8% 50 $134 $149 +11% 28 Nebraska $36 $72 +100% 18 $391 $328 -16% 49 Nevada $22 $81 +261% 3 $107 $155 +45% 3 New Hampshire $24 $46 +95% 22 $235 $318 +35% 5 New Jersey $324 $445 +37% 44 $1,424 $1,780 +25% 16 New Mexico $136 $268 +97% 20 $169 $174 +3% 33 New York $2,008 $2,729 +36% 46 $6,875 $6,750 -2% 38 North Carolina $474 $713 +50% 36 $894 $1,126 +26% 13 North Dakota $5 $10 +92% 23 $175 $168 -4% 41 Ohio $342 $545 +59% 32 $2,500 $2,643 +6% 30 Oklahoma $93 $186 +99% 19 $454 $506 +12% 27 Oregon $268 $379 +41% 42 $236 $292 +24% 20 Pennsylvania $134 $454 +240% 4 $3,933 $3,868 -2% 38 Rhode Island $24 $38 +58% 33 $262 $300 +14% 25 South Carolina $97 $136 +41% 42 $390 $490 +25% 16 South Dakota $6 $11 +78% 26 $130 $136 +4% 31 Tennessee $6 $16 +163% 5 $937 $1,183 +26% 13 Texas $957 $1,273 +33% 48 $1,811 $1,887 +4% 31 Utah $5 $9 +96% 21 $96 $163 +70% 1 Vermont $29 $60 +109% 15 $92 $111 +20% 22 Virginia $116 $258 +123% 12 $700 $720 +3% 33 Washington $496 $717 +44% 40 $677 $595 -12% 47 West Virginia $74 $101 +37% 44 $311 $421 +35% 5 Wisconsin $263 $385 +46% 38 $1,465 $989 -33% 51 Wyoming $7 $11 +54% 35 $54 $68 +25% 16 United States $10,204 $17,188 +68% $44,057 $46,980 +7% Note: The highest data value within each ranking is indicated by a rank of 1. 73 Trends Percentage of Medicaid LTC Spending for Older People and Adults w/ Physical Disabilities Going to HCBS 2002 Rank 2007 Rank Change Rank Alabama 7% 38 9% 44 +2% 42 Alaska 37% 5 51% 4 +13% 7 Arizona 33% 9 40% 7 +7% 17 Arkansas 16% 23 21% 27 +4% 29 California 39% 4 51% 4 +12% 9 Colorado 18% 19 22% 25 +3% 35 Connecticut 5% 43 9% 44 +4% 29 Delaware 7% 38 10% 43 +3% 35 District of Columbia 3% 46 34% 12 +31% 1 Florida 7% 38 14% 35 +6% 21 Georgia 11% 30 18% 30 +7% 17 Hawaii 14% 25 17% 33 +4% 29 Idaho 34% 8 39% 9 +5% 26 Illinois 11% 30 23% 24 +11% 12 Indiana 2% 49 5% 48 +3% 35 Iowa 6% 41 14% 35 +9% 16 Kansas 28% 10 34% 12 +6% 21 Kentucky 11% 30 8% 46 -3% 51 Louisiana 2% 49 24% 22 +22% 2 Maine 12% 27 26% 19 +14% 6 Maryland 6% 41 11% 39 +5% 26 Massachusetts 18% 19 24% 22 +6% 21 Michigan 11% 30 18% 30 +7% 17 Minnesota 22% 15 44% 6 +22% 2 Mississippi 10% 34 11% 39 +1% 45 Missouri 27% 11 31% 15 +4% 29 Montana 26% 12 26% 19 -1% 50 Nebraska 8% 36 18% 30 +10% 14 Nevada 17% 21 34% 12 +17% 4 New Hampshire 9% 35 13% 38 +4% 29 New Jersey 19% 17 20% 28 +1% 45 New Mexico 45% 2 61% 1 +16% 5 New York 23% 14 29% 16 +6% 21 North Carolina 35% 6 39% 9 +4% 29 North Dakota 3% 46 5% 48 +3% 35 Ohio 12% 27 17% 33 +5% 26 Oklahoma 17% 21 27% 18 +10% 14 Oregon 53% 1 56% 2 +3% 35 Pennsylvania 3% 46 11% 39 +7% 17 Rhode Island 8% 36 11% 39 +3% 35 South Carolina 20% 16 22% 25 +2% 42 South Dakota 4% 45 7% 47 +3% 35 Tennessee 1% 51 1% 51 +1% 45 Texas 35% 6 40% 7 +6% 21 Utah 5% 43 5% 48 +1% 45 Vermont 24% 13 35% 11 +11% 12 Virginia 14% 25 26% 19 +12% 9 Washington 42% 3 55% 3 +12% 9 West Virginia 19% 17 19% 29 +0% 49 Wisconsin 15% 24 28% 17 +13% 7 Wyoming 12% 27 14% 35 +2% 42 United States 19% 27% +8% Note: The highest data value within each ranking is indicated by a rank of 1. 74