ACROSS THE STATES PROFILES OF LONG-TERM SERVICES AND SUPPORTS EXECUTIVE SUMMARY, STATE DATA, AND RANKINGS 2012 N IN T H E D IT ION ACROSS THE STATES PROFILES OF LONG-TERM SERVICES AND SUPPORTS by Ari Houser Wendy Fox-Grage Kathleen Ujvari EXECUTIVE SUMMARY, STATE DATA, AND RANKINGS ©1994-2012 AARP 2012 NINTH EDITION Introduction Across the States 2012: Profiles of Long-Term Services and Supports is the ninth edition of the AARP Public Policy Institute’s state long-term services and supports reference report. Published for the past 18 years, the Across the States series was developed to help inform policy discussions among public and private sector leaders in long-term services and supports throughout the United States. Across the States 2012 presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single reference. This publication presents up-to-date data and is displayed in easy-to-use maps, graphics, tables, and state profiles. Across the States 2012 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, and the nation as a whole. The full report provides a comprehensive 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 services and supports spending for older people and adults with physical disabilities going to home and community-based services. This permits readers to easily see variations among states. Some of the indicators in Across the States 2012 may be found in prior editions. Please exercise caution when making comparisons with information in earlier editions due to 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. Additional indicators on health care spending, health status, and health care utilization for the age 50+ population can be found in another AARP Public Policy Institute report, Quick Health Facts 2010: Selected State Data on Older Americans. Copies of Across the States 2012 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 be found at http://www.aarp.org/acrossthestates. 3 AARP Public Policy Institute OVERVIEW Across the States 2012: Profiles of Long-Term Services and Supports focuses on comparative state data. Given the aging population, rising demand for long-term services and supports (LTSS), and increasing cost of services, consistent data across all states is essential to understand what is needed to improve the lives of those who need LTSS and their family caregivers. The following key findings were identified from the state and national data.   1:     The age 85 and older population—the age group most likely to need long-term services and supports—is growing at a dramatic rate.     The older population is racially and ethnically diverse and is projected to become 2: even more diverse as our multicultural society ages.       Many older Americans live below 250 percent of the poverty line, and are likely to 3: qualify for need-based long-term services and supports and other publicly funded services.     Family caregivers provided $450 billion worth of unpaid care in 2009, almost four 4: times Medicaid long-term services and supports spending and nearly seven times what people paid privately.   5:     The bulk of Medicaid long-term services and supports dollars still go to nursing facilities rather than home and community-based services.       The number of older people and adults with physical disabilities receiving Medicaid- 6: funded home and community-based services has increased, while the number of nursing facility residents has remained constant.   7:     On average, Medicaid dollars can support roughly three people with home and community-based services for every person in an institution.   8:     At the state level, registered nurse hours per resident day are correlated with better nursing facility quality measures.   9:     The supply of assisted living units is catching up with the total number of nursing facility beds. 4 The age 85 and older population—the age group most likely to need 1: long-term services and supports—is growing at a dramatic rate. Projected Growth in the Older Population in the United States   as a Percentage of 2012 Population, by Age Group 350% Population (% of 2012 Population) 300% 85+ 250% 75-84 200% 65-74 150% 50-64 100% 50% 0% 2010 2015 2020 2025 2030 2035 2040 2045 2050 From 2012 to 2050, the population age 65 and older is projected to more than double, to 89 million. The 107 percent growth rate for the 65+ population is more than five times as fast as that of the age 50–64 population and almost twice as fast as that of the population under age 50. A better barometer for the potential demand for long-term services and supports (LTSS) is the growth in the population age 85 and older, which is expected to increase by 69 percent between 2012 and 2032 and more than triple (+224%) between 2012 and 2050. People age 85 or older not only have much higher rates of disability, but they are also much more likely to be widowed and without someone to provide assistance with daily activities. For the next 20 years (2012–2032), the population age 65–84 and the population age 85+ are projected to grow at similar rates (+75% and +69%, respectively). As the baby boomers begin to turn 85, however, the age 85+ population will grow dramatically while growth among those ages 65–84 will level off. Between 2032 and 2050, the age 85+ population will almost double (+92%), while the age 65–84 population will increase by only 6 percent. In 2012, people age 85 or older make up only 2 percent of the U.S. population. The states with the highest percentage growth are Florida and Hawaii, with 3 percent each. In 2050, the national percentage is projected to be 4.8 percent, and all 50 states will exceed 3 percent, with only the District of Columbia, at 2.9 percent, falling shy of that mark. The age 85+ population is projected to more than quadruple in seven states between 2012 and 2050: Alaska (+650%), Nevada (+474%), Georgia (+375%), Colorado (+369%), Utah (+323%), Texas (+318%), and Virginia (+307%). 5 The older population is racially and ethnically diverse and is 2: projected to become even more diverse as our multicultural   society ages. Race and Ethnicity, Age 65+, 2010 Black: 8.5% Hispanic: 6.9% ic Islander Pacif : 3. sian/ 6% A ultiracial: r/ M 2.9 the % O People of Color: 20.1% Categories do not sum to total People of Color percentage because individuals may belong to more than one racial/ethnic group. In 2010, one out of every five people age 65+ was nonwhite or Hispanic, a percentage that is increasing and will continue to do so in the future. By 2060, it is projected that 46 percent of the age 65+ population will be people of color. The growing ethnic and racial diversity of the older population has enormous implications for meeting diverse LTSS preferences, addressing the role of paid and unpaid caregivers, providing services with cultural sensitivity, and training the paid LTSS workforce in cultural competence. Aging populations of color outnumber whites in Hawaii (64% Asian/Pacific Islander), Puerto Rico (99% Hispanic), and the District of Columbia (62% black). In New Mexico, California, and Texas—the states with the highest proportion of Hispanics—more than 30 percent of people age 65+ are people of color. This report not only highlights diversity in race and ethnicity among older adults, it also demonstrates great disparities related to poverty, education, disability, and living arrangements. Poverty: Approximately 41 percent of people age 65 or older have incomes at or below 250 percent of poverty (about $27,000 for a single person over age 65 or $36,000 for a family of two), an income level that makes them financially vulnerable and unlikely to be able to pay for LTSS out- of-pocket. Education: Level of education is one of the strongest predictors of LTSS need as well as of the economic capacity to pay for services. Those with college educations are less likely to need services and more likely to be able to pay for them. About one out of five (21%) people age 65 or older has a bachelor’s degree or higher. 6 Disability: More than one-third (37%) of people age 65 or older have a sensory, physical, mobility, self-care, or cognitive disability that may affect their ability to accomplish common tasks of everyday living. Among the age 65+ population, 9 percent have self-care difficulty and 10 percent have cognitive difficulty, which are the most likely to result in need for LTSS. Living Alone: One-third (34%) of people age 75 or older 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 LTSS. Many older Americans live below 250 percent of the poverty line, and 3: are likely to qualify for need-based long-term services and supports and other publicly funded services. Percent of Adults Below Poverty Line and Below 250%   of Poverty Line, by Age, 2010 60 54% 54% 48% 50 42% Percent of Population 40 36% 31% 30 20 23% 10 14% 10% 12% 10% 8% 0 0-24 25-44 45-64 65-74 75-84 85+ Age Below 250% of poverty Below poverty line Older people are less likely to be below the poverty line than younger and working-age people. However, the proportion of older people who have income below 250 percent of the poverty line 1 is much higher than for the working-age population. The percentage of Americans living below 250 percent of the poverty line is as high for the age 85+ population, those most likely to need LTSS, as it is for the age 0–24 population. This will have significant ramifications in the future because of the increasing projected growth of the age 85+ population. 1 250 percent of the federal poverty level is slightly higher than 300 percent of Social Security Income, a moderate level of income under which older people and adults with disabilities can qualify for need-based LTSS and other publicly funded services in most states. 7 Family caregivers provided $450 billion worth of unpaid care in 4: 2009, almost four times Medicaid long-term services and supports spending and nearly seven times what people paid privately. Annual Spending in Billions of Dollars $450 $119 $67 Medicaid Economic Private Pay LTSS & Value of LTSS & Home Health Family Home Health Spending Caregiving Spending in 2009 in 2009 in 2009 In the United States, 42 million caregivers were providing unpaid care to friends and family at any given time during 2009. They provided an average of 18.4 hours of care per week, at an average value of $11.16 per hour. Although Medicaid is the largest payer of LTSS, family caregivers are the foundation of the LTSS system. The estimated economic value of contributions was $450 billion in 2009, almost four times as much as total Medicaid LTSS spending and almost seven times the amount of privately paid LTSS and home health care. The estimated economic value of family caregiving exceeded Medicaid LTSS spending in every state. 2 Family caregivers provide personal care and help with everyday tasks as well as health-related interventions such as administering complex medications. They help to contain health and LTSS costs by providing such care and can even delay or prevent the use of more expensive hospital and nursing home care. Although family caregivers usually undertake these tasks willingly, they often experience high levels of emotional, physical and financial stress. Many of them juggle employment with caregiving responsibilities. 2 AARP Public Policy Institute, Valuing the Invaluable: 2011 Update. The Economic Value of Family Caregiving in 2009 (Washington, DC: AARP Public Policy Institute, June 2011). The $119 billion figure does not include several categories of LTSS spending, among them inpatient mental health services. The $67 billion in the figure is from AARP Public Policy Institute analysis of 2009 National Health Expenditure data. 8 sky blue med blue green blue-green blue-grey States Exceeding Federal Requirements for Family and Medical Leave Acts for Adults, 2008 WA MT ND MN ME SD WI VT OR ID MI NH WY NY MA IA NE PA RI IL IN OH NJ CT NV UT CO WV DE KS MO KY VA MD CA DC OK TN NC AZ NM AR SC MS AL GA TX LA AK FL HI Exceeds Federal Requirements Federal Requirements Only The federal Family and Medical Leave Act of 1993 (FMLA) allows covered employees to take up to 12 weeks of unpaid leave to care for a family member with a serious health condition. States can help adults and family caregivers by exceeding the minimum FMLA requirements—by broadening the range of employers that must comply with the requirements, extending the coverage period beyond 12 weeks, and broadening the definition of “family member.” In 2008, 14 states exceeded the federal minimum FMLA requirements for adults. 9 5: The bulk of Medicaid long-term services and supports dollars still go to nursing facilities rather than home and community-based services. Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in the United States, 2009 25% 64% 11% Nursing Facilities Aged/Disabled Waivers Other HCBS Medicaid is the primary payer of formal LTSS in the United States (46% in 2009). Almost two- thirds (64%) of Medicaid LTSS dollars for older people and adults with physical disabilities went to nursing facility care, even though most people prefer to live at home or in their communities. Medicaid nursing facility spending was $51.4 billion, compared to $28.7 billion for home and community-based services (HCBS) for older people and adults with physical disabilities. Nursing facility care is a mandatory entitlement within the Medicaid program. All individuals who qualify financially for Medicaid and qualify by level of disability for nursing facility care must be allowed to receive nursing facility services. Most HCBS are optional; although all states have mechanisms for providing home and community alternatives to nursing homes, Medicaid-eligible older people and adults with disabilities are not necessarily entitled to such services. All state Medicaid programs in the U.S. cover optional HCBS through federal waivers. Also, many states cover personal care services for adults in the home under their Medicaid state plans. There is great state variation in the funding of Medicaid HCBS. In 2009, the percentage of Medicaid LTSS funds for older adults and adults with physical disabilities going toward HCBS ranged from 10 percent to 65 percent. 10 sky blue med blue green blue-green blue-grey Medicaid HCBS Spending as Percentage of LTSS Spending, for Older People and Adults with Physical Disabilities, 2009 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 <30% 30-44% 45-59% 60%+ Only seven states—New Mexico, Washington, Minnesota, Oregon, Alaska, California, and Texas—and the District of Columbia spent more than 45 percent of their Medicaid LTSS funds on HCBS. On the other end of the range, six states—North Dakota, Delaware, Rhode Island, South Dakota, Alabama, and Maryland—spent 15 percent or less on HCBS. Although small compared with Medicaid budgets, non-Medicaid state-funded programs are another source of HCBS public funding. In 2009, state-only HCBS funding totaled $1.5 billion (about 5% of the amount of Medicaid HCBS expenditures) but was significant in several states. State-funded HCBS programs often serve people who are not Medicaid eligible but are at risk of institutionalization. 3 3 Jenna Walls, Kathleen Gifford, Catherine Rudd, Rex O’Rourke, Martha Roherty, Lindsey Copeland, and Wendy Fox- Grage, Weathering the Storm: The Impact of the Great Recession on Long-Term Services and Supports (Washington, DC: AARP Public Policy Institute, January 2011). 11 The supply of assisted living units is catching up with the total 9: number of nursing facility beds. Assisted Living and Nursing Home Supply, 2007 - 2010 1.8 1.70 1.69 1.6 1.4 Unit Supply (Millions) 1.23 1.2 1.05 1.0 0.8 0.6 0.4 0.2 2007 2010 Assisted Living Supply Nursing Facility Supply Depending upon state licensure requirements, assisted living can include a variety of residential care settings, such as adult foster care and personal care homes. Assisted living generally offers services that provide assistance with activities of daily living and instrumental activities of daily living to people in a residential setting. Over the past few years, there has been a dramatic increase in the number of assisted living units across the United States. From 2007 to 2010, supply has increased almost 18 percent, from a total capacity of 1,046,631 units to 1,233,690 units. 6 During the same period, nursing facility bed supply remained constant at about 1.7 million beds. This trend demonstrates consumer preferences for alternatives to nursing facilities. There is almost a sixfold difference in the average supply of assisted living units between the highest five and lowest five states. The average supply in the five highest states (Minnesota, Oregon, Idaho, Wisconsin, and Washington) was 62 units per 1,000 people age 65 or older in the state, compared with 11 units in the five lowest states (District of Columbia, Louisiana, West Virginia, Mississippi, and Nevada). The national average is 31 units. 6 Robert Mollica, Ari Houser, and Kathleen Ujvari, Assisted Living and Residential Care in the States in 2010 (Washington, DC: AARP Public Policy Institute, with support from The SCAN Foundation and The Commonwealth Fund, April 2012). 16 State Variation in Assisted Living Supply 90 Units per 1,000 People Age 65+ 78 80 70 62 60 50 40 30 28 20 11 10 7 0 Number of assisted living and residential care units per 1,000 people age 65+ Highest State Highest 5 states average All states median Lowest 5 states average All Lowest state Assisted living facilities are predominantly private pay, while nursing facilities are largely funded by Medicaid. Only about one-fifth (19%) of assisted living residents have the cost of services covered by Medicaid, compared with almost two-thirds (63%) of nursing facility residents. The national average annual private pay rate for an assisted living unit ($39,135) was slightly more than one-half the cost of a semiprivate room in a nursing facility ($70,445). Conclusion This report provides the latest available data on long-term services and supports in the United States at a time when many states are transforming the delivery and financing of these services. Each state is unique, and the states vary greatly in demographics, service delivery, and financing. This edition 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 services and supports. 17 AARP Public Policy Institute National Long-Term Services and Supports Profile 19 AARP Public Policy Institute UNITED STATES Value % Change % of Total Population & Projections Year (1,000s) from 2012 Population All ages 2012 315,311 2032 376,660 +19% 2050 434,447 +38% Age 50-64 2012 60,506 19.2% 2032 61,753 +2% 16.4% 2050 72,281 +19% 24.0% Age 65+ 2012 42,941 13.6% 2032 74,728 +74% 19.8% 2050 88,820 +107% 20.4% Age 65-74 2012 23,305 7.4% 2032 38,215 +64% 10.1% 2050 39,451 +69% 9.1% Age 75-84 2012 13,210 4.2% 2032 25,647 +94% 6.8% 2050 28,527 +116% 6.6% Age 85+ 2012 6,426 2.0% 2032 10,867 +69% 2.9% 2050 20,482 +224% 4.8% Projected Growth in the Older Population Older People of Color (%), 2010 in United States as a Percentage of   2012 Population, by Age Group 20.1% 400% Asian/Pacific Islander Population (% of 2012 Population) 350% 85+ 3.6% 300% 250% Black 75-84 200% 8.5% 65-74 150% Hispanic 100% 50-64 50% 6.9% 0% 2010 2020 2030 2040 2050 2060 20 Population & Characteristics UNITE D STATES Living Arrangements Value Men per 100 women age 85+, 2010 48 People age 75+ living alone, 2010 34% People age 60+ with grandchildren in household, 2010 5.5% People age 60+ responsible for raising grandchildren, 2010 1.6% Percent of age 65+ households with someone under 18, 2010 7.0% Income & Poverty Value Median household income age 65+, 2010 $34,381 At/below poverty level age 65+, 2010 9.0% At/below 250% of poverty level age 65+, 2010 42% Women age 75+ at/below poverty level, 2010 12.2% Women age 75+ at/below 250% of poverty level, 2010 54% Bachelor level education or higher age 65+, 2010 21% Value Disability Rates (1,000’s) Percent People age 65+ with disabilities, 2010 Self-care difficulty 3,428 8.8% Cognitive difficulty 3,712 9.5% Any disability 14,352 37% People age 18-64 with disabilities, 2010 Self-care difficulty 3,444 1.8% Cognitive difficulty 7,943 4.2% Any disability 19,048 10.0% Per 1,000 Family Caregivers Value Population Family caregivers, 2009 42,100,000 137 Economic value of family caregiving, 2009 (total in millions of $) $450,000 $1,460 Economic value per hour, 2009 $11.16 Ratio of the economic value of family caregiving to Medicaid long-term care spending, 2009 3.8 Per 1,000 Long-Term Care Insurance Value Age 40+ Private long-term care insurance policies in effect, 2010 6,485,598 45 21 Public LTSS Expenditures United States Medicaid Expenditures Value Total Medicaid expenditures (millions), 2009 $368,330 Medicaid home and community-based services (HCBS) as a % of long-term services and supports (LTSS) spending, for older people and adults with physical disabilities, 2009 * 36% Medicaid HCBS spending as a % of LTSS spending, for all populations, 2009 * 44% Medicaid Long-Term Services and Supports Spending for Older People and Adults with Physical Disabilities in the U.S., 2009 United States 11% 25% 64% Nursing Facilities Aged/Disabled Waivers Other HCBS Value   Per 1,000 LTSS & Home Health Expenditures (millions) Population Medicaid LTSS expenditures for older people and adults with physical disabilities, 2009 $80,181 $261 Nursing facilities $51,403 $168 HCBS $28,778 $94 Aged/disabled waiver services $8,821 $29 Personal care services (PCS) $14,983 $45 Home health services $4,861 $16 Other HCBS ** $1,165 $4 Medicaid LTSS expenditures for all populations, 2009 $126,816 $413 Institutional services $71,220 $232 HCBS $55,596 $181 Waiver services (all populations) $34,826 $114 Other HCBS (including PCS and home health) $20,770 $68 State-funded HCBS expenditures for older people and adults with physical disabilities, 2009 $1,481 $4.83 * HCBS and LTSS include home health services for these indicators. This treatment is consistent with most earlier editions of Across the States, but differs from Across the States 2009, in which home health was categorized separately from LTSS. ** “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. 22 Per 1,000 Medicaid HCBS Participants By Type of Service Population United Stat es Value Nursing facilities (NF), 2008 1,614,404 5.3 HCBS (older people and adults with PD), 2008 2,499,867 8.2 Aged/disabled waiver services 674,528 2.2 Personal care services (PCS) 902,943 3.0 Home health services 922,396 3.0 Institutional services (NF and ICF-MR), 2008 1,717,794 5.6 HCBS (all populations), 2008 3,066,750 10.1 Waiver services (all populations) 1,241,411 4.1 Other HCBS (including PCS and home health) 1,825,339 6.0 Adults with disabilities self-directing services, 2011 739,711 2.43 Medicaid Participant LTSS Balance Value Medicaid aged/disabled waiver participants per 100 beneficiaries in nursing facilities, 2008 42 Medicaid HCBS beneficiaries as a % of LTSS users, for older people and adults with PD, 2008 * 61% Medicaid HCBS beneficiaries as a % of LTSS users, for all populations, 2008 * 64% Medicaid Expenditures Per Person Served Value Nursing facility services, 2008 $29,533 HCBS expenditures for older people and adults with physical disabilities per person served, 2008 (excluding home health) $10,957 Aged/disabled waiver services $10,710 Personal care services $11,142 Home health services $5,495 ICF-MR services, 2008 $123,053 MR/DD waiver services, 2008 $42,896 LTSS Costs Public & Private Payment Rates Value Medicaid payment per day for nursing facility care, 2011 $178 Medicare payment per day for nursing facility care, 2010 $398 Medicare reimbursement per home health visit, 2010 $154 Private pay rate per day in nursing facility, 2011 $193 Private pay rate per month in assisted living, 2011 $3,261 Private pay daily rate for adult day care, 2011 $60 Private pay hourly rate for home health aide, 2011 $19 23 LTSS Resources United States Per 1,000  HCBS Resources Value Age 65+ Assisted living and residential care facilities, 2010 58,938 1.46 Assisted living and residential care units, 2010 1,233,690 31 Personal and home care aides, 2010 686,030 17 Median hourly wage, 2010 $9.44 Home health aides, 2010 982,840 24 Median hourly wage, 2010 $9.89 People receiving ACL congregate meals, 2009 * 1,671,670 42 People receiving ACL home delivered meals, 2009 * 869,304 22 Total ACL congregate and home delivered meal expenditures (total in millions of $), 2009 * $1,423 $36 Per 1,000  Nursing Facility Resources & Utilization Value Age 65+ Total nursing facilities, 2010 16,071 0.40 Nursing facility beds, 2010 1,696,721 42 Nursing facility residents, 2010 1,408,886 35 Nursing facility occupancy rate, 2010 83% Direct care nursing hours per patient day, 2010 3.8 RN hours per patient day, 2010 0.64 Nursing facility staffing turnover, 2010 40% Nursing Facility Resident Characteristics Value Residents with dementia, 2010 46% Nursing facility residents with low care needs, 2008 17% Residents with Medicaid as primary payer, 2010 63% Residents with Medicare as primary payer, 2010 14% Residents with “other” as primary payer, 2010 22% Quality & Oversight of Nursing Facilities Value Residents with physical restraints (%), 2008 4% High risk residents with pressure sores, 2008 12% Long-stay residents with a hospital admission, 2008 21% Long-term care facility beds per FTE ombudsman, 2010 2,543 Nursing facilities visited by ombudsman at least quarterly, 2010 76% * These programs were originally administered under AoA. For more information on the Administration for Community Living (ACL), please see http://www.hhs.gov/acl. 24 Trends United Stat es Medicaid HCBS Utilization Year Value Medicaid HCBS participants, older people and adults 2003 1,270,155 with physical disabilities (excluding home health) 2008 1,577,471 % change +24% Nursing Facility Residents Year Value Nursing facility residents 2005 1,460,185 2010 1,408,886 % change -4% Long-Term Care Financing Year Value Total Medicaid spending (millions) 2004 $285,710 2009 $368,330 % change +29% Medicaid LTSS spending for older people and 2004 $62,811 adults with physical disabilities (millions) 2009 $80,181 % change +28% Medicaid nursing facility spending (millions) 2004 $45,842 2009 $51,403 % change +12% Medicaid HCBS spending for older people and 2004 $16,969 adults with physical disabilities (millions) 2009 $28,778 % change +70% Medicaid HCBS as a % of LTSS spending, for older 2004 27% people and adults with physical disabilities 2009 36% change +9% Change in Medicaid LTSS Percent Change in Medicaid LTSS Spending, 2004–2009, by Service Spending, 2004–2009, by Service $9,000 +$8,853 $9,000 +$8,853 100% 100% +$7,982 +$7,982 $7,200 $7,200 80% 80% +77% +77% +67% +67% +$5,561 +$5,561 $5,400 $5,400 60% 60% +54% +54% +$3,827 +$3,827 $3,600 $3,600 40% 40% $1,800 $1,800 20% 20% +$934 +$934 +12% +12% +8% +8% $0 $0 0% 0% ICF-MR MR/DD ICF-MR MR/DD Nursing HCBS PCS HCBS PCS and Nursing and ICF-MR MR/DD ICF-MR MR/DD Nursing HCBS PCS HCBS PCS and Nursing and Waivers Waivers Facilities 1915(c) other Facilities 1915(c) other Waivers Waivers Facilities 1915(c) other Facilities 1915(c) other Waivers HCBS Waivers HCBS Waivers HCBS Waivers HCBS 25 In addition to the national long-term services and supports 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 2012. 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. 26 AARP Public Policy Institute State and Data Rankings 27 Population & Characteristics: Population Projections Population, All Ages, Population, All Ages, Population, All Ages, 2012 2032 2050 Value (Millions) Rank Value (Millions) Rank Value (Millions) Rank Alabama 4,786 23 5,442 24 6,314 24 Alaska 726 47 951 47 985 47 Arizona 6,961 14 9,297 13 11,085 12 Arkansas 2,978 33 3,479 32 4,071 32 California 38,163 1 45,655 1 53,159 1 Colorado 5,252 22 6,890 20 8,042 19 Connecticut 3,536 29 3,912 30 4,290 31 Delaware 912 45 1,105 45 1,259 45 District of Columbia 624 49 763 50 846 49 Florida 19,170 4 24,746 3 29,208 3 Georgia 10,492 8 13,833 7 16,717 7 Hawaii 1,309 42 1,596 40 1,782 41 Idaho 1,625 39 2,047 39 2,393 38 Illinois 13,252 5 15,487 5 17,782 5 Indiana 6,473 17 6,942 19 7,939 20 Iowa 3,036 30 3,418 33 3,898 33 Kansas 2,855 34 3,243 35 3,662 35 Kentucky 4,363 26 4,808 25 5,427 26 Louisiana 4,413 25 4,776 26 5,320 27 Maine 1,332 41 1,582 41 1,827 40 Maryland 5,928 19 7,419 17 8,489 17 Massachusetts 6,766 15 8,100 15 9,188 16 Michigan 9,715 10 9,789 12 10,827 13 Minnesota 5,401 21 6,227 22 7,103 22 Mississippi 2,988 32 3,320 34 3,777 34 Missouri 6,128 18 7,158 18 8,189 18 Montana 1,017 44 1,326 43 1,511 43 Nebraska 1,851 38 2,243 37 2,633 37 Nevada 2,797 35 3,902 31 4,647 30 New Hampshire 1,345 40 1,581 42 1,765 42 New Jersey 8,771 11 10,044 11 11,370 11 New Mexico 2,066 36 2,572 36 2,924 36 New York 19,595 3 22,147 4 24,594 4 North Carolina 9,848 9 12,265 9 14,537 8 North Dakota 673 48 851 48 947 48 Ohio 11,554 7 12,452 8 14,103 9 Oklahoma 3,777 28 4,244 28 4,784 29 Oregon 3,950 27 4,689 27 5,462 25 Pennsylvania 12,828 6 15,193 6 17,309 6 Rhode Island 1,066 43 1,297 44 1,502 44 South Carolina 4,728 24 5,626 23 6,572 23 South Dakota 847 46 1,053 46 1,211 46 Tennessee 6,521 16 7,942 16 9,547 15 Texas 25,783 2 31,365 2 36,298 2 Utah 3,003 31 4,136 29 5,009 28 Vermont 620 50 722 51 803 51 Virginia 8,289 12 10,746 10 12,667 10 Washington 7,014 13 8,924 14 10,221 14 West Virginia 1,861 37 2,180 38 2,386 39 Wisconsin 5,745 20 6,392 21 7,233 21 Wyoming 574 51 786 49 832 50 United States 315,311 376,660 434,447 Note: The highest data value within each ranking is indicated by a rank of 1. 28 Population & Characteristics: Population Projections Percent Change in Population, Percent Change in Population, All Ages, 2012-2032 All Ages, 2012-2050 Value Rank Value Rank Alabama +14% 39 +32% 34 Alaska +31% 6 +36% 27 Arizona +34% 4 +59% 3 Arkansas +17% 32 +37% 25 California +20% 25 +39% 21 Colorado +31% 6 +53% 5 Connecticut +11% 44 +21% 49 Delaware +21% 23 +38% 23 District of Columbia +22% 18 +36% 27 Florida +29% 10 +52% 7 Georgia +32% 5 +59% 3 Hawaii +22% 18 +36% 27 Idaho +26% 13 +47% 10 Illinois +17% 32 +34% 32 Indiana +7% 50 +23% 47 Iowa +13% 41 +28% 39 Kansas +14% 39 +28% 39 Kentucky +10% 47 +24% 46 Louisiana +8% 48 +21% 49 Maine +19% 27 +37% 25 Maryland +25% 14 +43% 14 Massachusetts +20% 25 +36% 27 Michigan +1% 51 +11% 51 Minnesota +15% 37 +32% 34 Mississippi +11% 44 +26% 43 Missouri +17% 32 +34% 32 Montana +30% 8 +49% 8 Nebraska +21% 23 +42% 16 Nevada +40% 1 +66% 2 New Hampshire +18% 30 +31% 36 New Jersey +15% 37 +30% 37 New Mexico +24% 16 +41% 17 New York +13% 41 +26% 43 North Carolina +25% 14 +48% 9 North Dakota +27% 11 +41% 17 Ohio +8% 48 +22% 48 Oklahoma +12% 43 +27% 42 Oregon +19% 27 +38% 23 Pennsylvania +18% 30 +35% 31 Rhode Island +22% 18 +41% 17 South Carolina +19% 27 +39% 21 South Dakota +24% 16 +43% 14 Tennessee +22% 18 +46% 11 Texas +22% 18 +41% 17 Utah +38% 2 +67% 1 Vermont +16% 36 +29% 38 Virginia +30% 8 +53% 5 Washington +27% 11 +46% 11 West Virginia +17% 32 +28% 39 Wisconsin +11% 44 +26% 43 Wyoming +37% 3 +45% 13 United States +19% +38% Note: The highest data value within each ranking is indicated by a rank of 1. 29 Population & Characteristics: Population Projections Population, Age 50-64, 2012 Population, Age 50-64, 2032 Value Percent of Total Value Percent of Total ( Thousands) Population Rank (Thousands) Population Rank Alabama 929 19.4% 27 893 16.4% 22 Alaska 144 19.8% 21 146 15.3% 39 Arizona 1,190 17.1% 49 1,267 13.6% 51 Arkansas 556 18.7% 40 568 16.3% 24 California 6,885 18.0% 44 7,635 16.7% 11 Colorado 1,021 19.4% 27 1,165 16.9% 8 Connecticut 746 21.1% 7 647 16.5% 17 Delaware 178 19.5% 25 176 16.0% 32 District of Columbia 110 17.6% 48 112 14.7% 48 Florida 3,657 19.1% 34 3,873 15.7% 38 Georgia 1,856 17.7% 47 2,288 16.5% 17 Hawaii 250 19.1% 34 256 16.1% 31 Idaho 292 17.9% 45 314 15.3% 39 Illinois 2,525 19.1% 34 2,621 16.9% 8 Indiana 1,268 19.6% 24 1,156 16.7% 11 Iowa 610 20.1% 17 514 15.0% 43 Kansas 550 19.3% 31 482 14.9% 46 Kentucky 869 19.9% 20 800 16.6% 13 Louisiana 860 19.5% 25 777 16.3% 24 Maine 307 23.1% 2 263 16.6% 13 Maryland 1,184 20.0% 19 1,227 16.5% 17 Massachusetts 1,385 20.5% 12 1,397 17.3% 2 Michigan 2,066 21.3% 4 1,621 16.6% 13 Minnesota 1,093 20.2% 15 1,028 16.5% 17 Mississippi 551 18.4% 43 529 15.9% 34 Missouri 1,209 19.7% 23 1,158 16.2% 27 Montana 217 21.3% 4 203 15.3% 39 Nebraska 352 19.0% 38 331 14.7% 48 Nevada 498 17.8% 46 636 16.3% 24 New Hampshire 301 22.4% 3 262 16.6% 13 New Jersey 1,789 20.4% 13 1,733 17.3% 2 New Mexico 391 18.9% 39 387 15.0% 43 New York 3,949 20.2% 15 3,904 17.6% 1 North Carolina 1,839 18.7% 40 1,949 15.9% 34 North Dakota 130 19.3% 31 120 14.1% 50 Ohio 2,392 20.7% 9 2,127 17.1% 6 Oklahoma 703 18.6% 42 671 15.8% 36 Oregon 804 20.4% 13 811 17.3% 2 Pennsylvania 2,669 20.8% 8 2,510 16.5% 17 Rhode Island 220 20.7% 9 210 16.2% 27 South Carolina 910 19.3% 31 909 16.2% 27 South Dakota 165 19.4% 27 156 14.8% 47 Tennessee 1,265 19.4% 27 1,352 17.0% 7 Texas 4,381 17.0% 50 5,011 16.0% 32 Utah 428 14.3% 51 621 15.0% 43 Vermont 144 23.2% 1 114 15.8% 36 Virginia 1,582 19.1% 34 1,764 16.4% 22 Washington 1,388 19.8% 21 1,540 17.3% 2 West Virginia 396 21.3% 4 369 16.9% 8 Wisconsin 1,186 20.6% 11 1,033 16.2% 27 Wyoming 116 20.1% 17 119 15.1% 42 United States 60,506 19.2% 61,753 16.4% Note: The highest data value within each ranking is indicated by a rank of 1. 30 Population & Characteristics: Population Projections Population, Age 50-64, 2050 Percent Change in Population, Percent Change in Population, Value Percent of Total Age 50-64 2012-2032 Age 50-64, 2012-2050 (Thousands) Population Rank Value Rank Value Rank Alabama 1,062 16.8% 28 -4% 28 +14% 33 Alaska 182 18.5% 7 +1% 20 +27% 12 Arizona 1,429 12.9% 50 +6% 11 +20% 23 Arkansas 677 16.6% 32 +2% 17 +22% 18 California 8,148 15.3% 46 +11% 7 +18% 25 Colorado 1,303 16.2% 38 +14% 4 +28% 11 Connecticut 828 19.3% 4 -13% 45 +11% 41 Delaware 206 16.4% 36 -1% 24 +16% 29 District of Columbia 97 11.4% 51 +2% 17 -12% 51 Florida 4,788 16.4% 36 +6% 11 +31% 7 Georgia 2,756 16.5% 34 +23% 3 +49% 2 Hawaii 282 15.8% 40 +2% 17 +13% 37 Idaho 394 16.5% 34 +8% 9 +35% 5 Illinois 2,989 16.8% 28 +4% 14 +18% 25 Indiana 1,337 16.8% 28 -9% 41 +5% 45 Iowa 604 15.5% 44 -16% 49 -1% 49 Kansas 572 15.6% 41 -12% 44 +4% 47 Kentucky 902 16.6% 32 -8% 39 +4% 47 Louisiana 963 18.1% 10 -10% 42 +12% 39 Maine 359 19.6% 3 -14% 48 +17% 28 Maryland 1,486 17.5% 20 +4% 14 +26% 14 Massachusetts 1,683 18.3% 9 +1% 20 +22% 18 Michigan 1,953 18.0% 12 -22% 51 -5% 50 Minnesota 1,145 16.1% 39 -6% 34 +5% 45 Mississippi 665 17.6% 18 -4% 28 +21% 22 Missouri 1,405 17.2% 22 -4% 28 +16% 29 Montana 291 19.3% 4 -6% 34 +34% 6 Nebraska 403 15.3% 46 -6% 34 +14% 33 Nevada 726 15.6% 41 +27% 2 +46% 3 New Hampshire 354 20.1% 1 -13% 45 +18% 25 New Jersey 2,032 17.9% 14 -3% 27 +14% 33 New Mexico 452 15.5% 44 -1% 24 +16% 29 New York 4,458 18.1% 10 -1% 24 +13% 37 North Carolina 2,274 15.6% 41 +6% 11 +24% 16 North Dakota 167 17.7% 16 -8% 39 +29% 9 Ohio 2,540 18.0% 12 -11% 43 +6% 44 Oklahoma 805 16.8% 28 -5% 31 +14% 33 Oregon 937 17.1% 23 +1% 20 +16% 29 Pennsylvania 3,261 18.8% 6 -6% 34 +22% 18 Rhode Island 265 17.6% 18 -5% 31 +20% 23 South Carolina 1,114 17.0% 26 0% 23 +22% 18 South Dakota 207 17.1% 23 -5% 31 +26% 14 Tennessee 1,632 17.1% 23 +7% 10 +29% 9 Texas 5,428 15.0% 48 +14% 4 +24% 16 Utah 724 14.4% 49 +45% 1 +69% 1 Vermont 161 20.0% 2 -21% 50 +12% 39 Virginia 2,159 17.0% 26 +12% 6 +36% 4 Washington 1,819 17.8% 15 +11% 7 +31% 7 West Virginia 440 18.5% 7 -7% 38 +11% 41 Wisconsin 1,269 17.5% 20 -13% 45 +7% 43 Wyoming 147 17.7% 16 +3% 16 +27% 12 United States 72,281 16.6% +2% +19% Note: The highest data value within each ranking is indicated by a rank of 1. 31 Population & Characteristics: Population Projections Population, Age 65+, 2012 Population, Age 65+, 2032 Value Percent of Total Value Percent of Total (Thousands) Population Rank (Thousands) Population Rank Alabama 701 14.7% 14 1,095 20.1% 25 Alaska 63 8.7% 51 156 16.4% 49 Arizona 968 13.9% 30 1,800 19.4% 31 Arkansas 446 15.0% 10 687 19.7% 28 California 4,556 11.9% 45 8,662 19.0% 38 Colorado 604 11.5% 47 1,268 18.4% 43 Connecticut 522 14.8% 12 884 22.6% 6 Delaware 139 15.2% 7 233 21.1% 11 District of Columbia 75 11.9% 45 116 15.2% 50 Florida 3,445 18.0% 1 5,674 22.9% 5 Georgia 1,147 10.9% 48 2,352 17.0% 48 Hawaii 206 15.8% 6 331 20.7% 19 Idaho 207 12.7% 44 370 18.1% 45 Illinois 1,696 12.8% 40 2,890 18.7% 40 Indiana 887 13.7% 31 1,443 20.8% 14 Iowa 463 15.2% 7 710 20.8% 14 Kansas 391 13.7% 31 645 19.9% 26 Kentucky 619 14.2% 23 1,002 20.8% 14 Louisiana 600 13.6% 34 964 20.2% 24 Maine 223 16.8% 2 371 23.4% 3 Maryland 766 12.9% 38 1,440 19.4% 31 Massachusetts 959 14.2% 23 1,690 20.9% 13 Michigan 1,436 14.8% 12 2,289 23.4% 3 Minnesota 720 13.3% 37 1,322 21.2% 10 Mississippi 406 13.6% 34 641 19.3% 35 Missouri 883 14.4% 20 1,453 20.3% 23 Montana 154 15.2% 7 263 19.8% 27 Nebraska 253 13.7% 31 417 18.6% 41 Nevada 359 12.8% 40 746 19.1% 37 New Hampshire 197 14.6% 17 372 23.5% 2 New Jersey 1,258 14.3% 22 2,157 21.5% 9 New Mexico 289 14.0% 29 498 19.4% 31 New York 2,782 14.2% 23 4,525 20.4% 22 North Carolina 1,321 13.4% 36 2,331 19.0% 38 North Dakota 98 14.6% 17 156 18.3% 44 Ohio 1,703 14.7% 14 2,685 21.6% 8 Oklahoma 535 14.2% 23 836 19.7% 28 Oregon 569 14.4% 20 970 20.7% 19 Pennsylvania 2,036 15.9% 4 3,156 20.8% 14 Rhode Island 160 15.0% 10 270 20.8% 14 South Carolina 693 14.7% 14 1,155 20.5% 21 South Dakota 124 14.6% 17 204 19.3% 35 Tennessee 924 14.2% 23 1,559 19.6% 30 Texas 2,823 10.9% 48 5,490 17.5% 46 Utah 276 9.2% 50 552 13.3% 51 Vermont 99 15.9% 4 172 23.8% 1 Virginia 1,065 12.9% 38 2,004 18.6% 41 Washington 900 12.8% 40 1,731 19.4% 31 West Virginia 307 16.5% 3 457 21.0% 12 Wisconsin 813 14.2% 23 1,402 21.9% 7 Wyoming 73 12.8% 40 135 17.2% 47 United States 42,941 13.6% 74,728 19.8% Note: The highest data value within each ranking is indicated by a rank of 1. 32 Population & Characteristics: Population Projections Population, Age 65+, 2050 Percent Change in Population, Percent Change in Population, Value Percent of Total Age 65+, 2012-2032 Age 65+, 2012-2050 (Thousands) Population Rank Value Rank Value Rank Alabama 1,240 19.6% 37 +56% 45 +77% 44 Alaska 196 19.9% 33 +147% 1 +210% 1 Arizona 2,161 19.5% 38 +86% 12 +123% 13 Arkansas 810 19.9% 33 +54% 49 +82% 35 California 10,866 20.4% 21 +90% 8 +138% 9 Colorado 1,649 20.5% 20 +110% 2 +173% 5 Connecticut 937 21.8% 5 +69% 25 +79% 40 Delaware 270 21.4% 10 +68% 27 +94% 25 District of Columbia 125 14.8% 51 +56% 45 +68% 48 Florida 6,805 23.3% 1 +65% 31 +98% 23 Georgia 3,163 18.9% 47 +105% 4 +176% 4 Hawaii 394 22.1% 3 +60% 40 +91% 27 Idaho 466 19.5% 38 +79% 15 +125% 12 Illinois 3,458 19.4% 43 +70% 22 +104% 19 Indiana 1,586 20.0% 31 +63% 36 +79% 40 Iowa 740 19.0% 46 +53% 50 +60% 50 Kansas 708 19.3% 44 +65% 31 +81% 37 Kentucky 1,099 20.2% 28 +62% 38 +78% 42 Louisiana 1,080 20.3% 25 +61% 39 +80% 38 Maine 397 21.7% 8 +66% 30 +78% 42 Maryland 1,735 20.4% 21 +88% 10 +127% 10 Massachusetts 1,979 21.5% 9 +76% 16 +106% 16 Michigan 2,265 20.9% 16 +59% 41 +58% 51 Minnesota 1,511 21.3% 12 +84% 13 +110% 15 Mississippi 737 19.5% 38 +58% 43 +82% 35 Missouri 1,661 20.3% 25 +65% 31 +88% 31 Montana 307 20.3% 25 +70% 22 +99% 22 Nebraska 479 18.2% 49 +65% 31 +89% 30 Nevada 1,017 21.9% 4 +107% 3 +183% 3 New Hampshire 401 22.7% 2 +89% 9 +104% 19 New Jersey 2,437 21.4% 10 +72% 20 +94% 25 New Mexico 584 20.0% 31 +73% 19 +102% 21 New York 5,155 21.0% 14 +63% 36 +85% 33 North Carolina 2,811 19.3% 44 +76% 16 +113% 14 North Dakota 179 18.9% 47 +59% 41 +83% 34 Ohio 2,900 20.6% 18 +58% 43 +70% 47 Oklahoma 965 20.2% 28 +56% 45 +80% 38 Oregon 1,166 21.3% 12 +70% 22 +105% 18 Pennsylvania 3,528 20.4% 21 +55% 48 +73% 46 Rhode Island 306 20.4% 21 +68% 27 +91% 27 South Carolina 1,354 20.6% 18 +67% 29 +95% 24 South Dakota 237 19.5% 38 +64% 35 +91% 27 Tennessee 1,903 19.9% 33 +69% 25 +106% 16 Texas 7,074 19.5% 38 +94% 6 +151% 6 Utah 855 17.1% 50 +100% 5 +210% 1 Vermont 175 21.8% 5 +74% 18 +77% 44 Virginia 2,543 20.1% 30 +88% 10 +139% 8 Washington 2,223 21.8% 5 +92% 7 +147% 7 West Virginia 497 20.8% 17 +49% 51 +62% 49 Wisconsin 1,521 21.0% 14 +72% 20 +87% 32 Wyoming 166 19.9% 33 +84% 13 +126% 11 United States 88,820 20.4% +74% +107% Note: The highest data value within each ranking is indicated by a rank of 1. 33 Population & Characteristics: Population Projections Population, Age 65-74, 2012 Population, Age 65-74, 2032 Value Percent of Total Value Percent of Total ( Thousands) Population Rank (Thousands) Population Rank Alabama 385 8.0% 12 549 10.1% 22 Alaska 41 5.6% 50 83 8.7% 48 Arizona 528 7.6% 24 865 9.3% 43 Arkansas 245 8.2% 8 342 9.8% 29 California 2,471 6.5% 47 4,514 9.9% 26 Colorado 348 6.6% 46 661 9.6% 36 Connecticut 277 7.8% 18 463 11.8% 2 Delaware 77 8.4% 5 117 10.6% 14 District of Columbia 42 6.8% 45 63 8.3% 50 Florida 1,761 9.2% 1 2,721 11.0% 10 Georgia 671 6.4% 48 1,260 9.1% 44 Hawaii 103 7.9% 15 151 9.5% 37 Idaho 116 7.1% 39 182 8.9% 47 Illinois 915 6.9% 44 1,530 9.9% 26 Indiana 481 7.4% 34 735 10.6% 14 Iowa 234 7.7% 21 354 10.4% 18 Kansas 204 7.1% 39 319 9.8% 29 Kentucky 347 7.9% 15 508 10.6% 14 Louisiana 331 7.5% 28 484 10.1% 22 Maine 121 9.1% 2 183 11.6% 5 Maryland 428 7.2% 37 760 10.2% 20 Massachusetts 508 7.5% 28 900 11.1% 8 Michigan 785 8.1% 9 1,156 11.8% 2 Minnesota 386 7.1% 39 691 11.1% 8 Mississippi 223 7.5% 28 322 9.7% 33 Missouri 477 7.8% 18 738 10.3% 19 Montana 85 8.3% 6 126 9.5% 37 Nebraska 130 7.0% 43 210 9.4% 40 Nevada 214 7.6% 24 366 9.4% 40 New Hampshire 109 8.1% 9 194 12.3% 1 New Jersey 672 7.7% 21 1,142 11.4% 6 New Mexico 158 7.6% 24 241 9.4% 40 New York 1,491 7.6% 24 2,408 10.9% 11 North Carolina 743 7.5% 28 1,185 9.7% 33 North Dakota 48 7.1% 39 78 9.1% 44 Ohio 907 7.9% 15 1,362 10.9% 11 Oklahoma 291 7.7% 21 411 9.7% 33 Oregon 318 8.0% 12 468 10.0% 25 Pennsylvania 1,036 8.1% 9 1,613 10.6% 14 Rhode Island 83 7.8% 18 140 10.8% 13 South Carolina 393 8.3% 6 565 10.1% 22 South Dakota 63 7.5% 28 100 9.5% 37 Tennessee 520 8.0% 12 788 9.9% 26 Texas 1,577 6.1% 49 2,854 9.1% 44 Utah 153 5.1% 51 289 7.0% 51 Vermont 55 8.9% 4 85 11.8% 2 Virginia 603 7.3% 35 1,048 9.8% 29 Washington 511 7.3% 35 878 9.8% 29 West Virginia 167 9.0% 3 223 10.2% 20 Wisconsin 431 7.5% 28 722 11.3% 7 Wyoming 41 7.2% 37 67 8.6% 49 United States 23,305 7.4% 38,215 10.1% Note: The highest data value within each ranking is indicated by a rank of 1. 34 Population & Characteristics: Population Projections Population, Age 65-74, 2050 Percent Change in Population, Percent Change in Population, Value Percent of Total Age 65-74, 2012-2032 Age 65-74, 2012-2050 (Thousands) Population Rank Value Rank Value Rank Alabama 563 8.9% 37 +43% 48 +46% 41 Alaska 96 9.8% 2 +103% 1 +136% 2 Arizona 833 7.5% 50 +64% 19 +58% 27 Arkansas 378 9.3% 18 +39% 50 +54% 31 California 4,756 8.9% 37 +83% 5 +92% 9 Colorado 752 9.4% 13 +90% 2 +116% 4 Connecticut 385 9.0% 33 +67% 16 +39% 46 Delaware 118 9.4% 13 +52% 33 +54% 31 District of Columbia 53 6.3% 51 +49% 39 +26% 50 Florida 2,859 9.8% 2 +54% 30 +62% 25 Georgia 1,461 8.7% 41 +88% 4 +118% 3 Hawaii 174 9.8% 2 +47% 41 +69% 19 Idaho 217 9.1% 26 +57% 26 +87% 11 Illinois 1,596 9.0% 33 +67% 16 +74% 14 Indiana 698 8.8% 40 +53% 31 +45% 42 Iowa 313 8.0% 49 +51% 35 +34% 48 Kansas 305 8.3% 47 +57% 26 +50% 40 Kentucky 492 9.1% 26 +46% 44 +42% 44 Louisiana 509 9.6% 8 +46% 44 +54% 31 Maine 172 9.4% 13 +51% 35 +42% 44 Maryland 772 9.1% 26 +77% 9 +80% 12 Massachusetts 876 9.5% 11 +77% 9 +72% 15 Michigan 934 8.6% 45 +47% 41 +19% 51 Minnesota 659 9.3% 18 +79% 7 +71% 17 Mississippi 344 9.1% 26 +44% 46 +54% 31 Missouri 751 9.2% 20 +55% 29 +57% 29 Montana 145 9.6% 8 +49% 39 +71% 17 Nebraska 215 8.2% 48 +62% 22 +66% 22 Nevada 449 9.7% 6 +71% 13 +110% 5 New Hampshire 166 9.4% 13 +78% 8 +52% 38 New Jersey 1,042 9.2% 20 +70% 14 +55% 30 New Mexico 261 8.9% 37 +52% 33 +65% 23 New York 2,377 9.7% 6 +61% 23 +59% 26 North Carolina 1,226 8.4% 46 +60% 24 +65% 23 North Dakota 85 9.0% 33 +63% 20 +78% 13 Ohio 1,300 9.2% 20 +50% 38 +43% 43 Oklahoma 448 9.4% 13 +41% 49 +54% 31 Oregon 535 9.8% 2 +47% 41 +68% 21 Pennsylvania 1,591 9.2% 20 +56% 28 +54% 31 Rhode Island 130 8.7% 41 +69% 15 +58% 27 South Carolina 607 9.2% 20 +44% 46 +54% 31 South Dakota 109 9.0% 33 +58% 25 +72% 15 Tennessee 877 9.2% 20 +51% 35 +69% 19 Texas 3,159 8.7% 41 +81% 6 +100% 7 Utah 434 8.7% 41 +89% 3 +184% 1 Vermont 73 9.1% 26 +53% 31 +32% 49 Virginia 1,153 9.1% 26 +74% 11 +91% 10 Washington 1,035 10.1% 1 +72% 12 +103% 6 West Virginia 228 9.5% 11 +34% 51 +37% 47 Wisconsin 656 9.1% 26 +67% 16 +52% 38 Wyoming 80 9.6% 8 +63% 20 +94% 8 United States 39,451 9.1% +64% +69% Note: The highest data value within each ranking is indicated by a rank of 1. 35 Population & Characteristics: Population Projections Population, Age 75-84, 2012 Population, Age 75-84, 2032 Value Percent of Total Value Percent of Total (Thousands) Population Rank (Thousands) Population Rank Alabama 221 4.6% 10 380 7.0% 21 Alaska 16 2.3% 51 55 5.8% 48 Arizona 301 4.3% 26 648 7.0% 21 Arkansas 137 4.6% 10 239 6.9% 28 California 1,391 3.6% 45 2,912 6.4% 41 Colorado 177 3.4% 46 439 6.4% 41 Connecticut 159 4.5% 16 292 7.5% 9 Delaware 43 4.7% 7 80 7.3% 12 District of Columbia 21 3.4% 46 38 5.0% 50 Florida 1,103 5.8% 1 2,011 8.1% 4 Georgia 335 3.2% 49 778 5.6% 49 Hawaii 65 4.9% 5 118 7.4% 11 Idaho 62 3.8% 41 133 6.5% 39 Illinois 521 3.9% 38 968 6.2% 45 Indiana 273 4.2% 32 499 7.2% 17 Iowa 146 4.8% 6 250 7.3% 12 Kansas 122 4.3% 26 230 7.1% 20 Kentucky 189 4.3% 26 350 7.3% 12 Louisiana 186 4.2% 32 336 7.0% 21 Maine 69 5.2% 2 132 8.3% 2 Maryland 231 3.9% 38 475 6.4% 41 Massachusetts 294 4.3% 26 562 6.9% 28 Michigan 440 4.5% 16 800 8.2% 3 Minnesota 218 4.0% 37 452 7.3% 12 Mississippi 126 4.2% 32 224 6.7% 35 Missouri 272 4.4% 18 502 7.0% 21 Montana 47 4.6% 10 97 7.3% 12 Nebraska 81 4.4% 18 147 6.6% 37 Nevada 105 3.8% 41 264 6.8% 32 New Hampshire 59 4.4% 18 127 8.0% 5 New Jersey 390 4.4% 18 707 7.0% 21 New Mexico 90 4.3% 26 178 6.9% 28 New York 860 4.4% 18 1,490 6.7% 35 North Carolina 402 4.1% 36 800 6.5% 39 North Dakota 32 4.7% 7 56 6.6% 37 Ohio 536 4.6% 10 936 7.5% 9 Oklahoma 167 4.4% 18 294 6.9% 28 Oregon 167 4.2% 32 356 7.6% 6 Pennsylvania 650 5.1% 4 1,088 7.2% 17 Rhode Island 49 4.6% 10 91 7.0% 21 South Carolina 209 4.4% 18 408 7.2% 17 South Dakota 39 4.6% 10 73 7.0% 21 Tennessee 281 4.3% 26 538 6.8% 32 Texas 859 3.3% 48 1,860 5.9% 47 Utah 85 2.8% 50 190 4.6% 51 Vermont 29 4.7% 7 62 8.6% 1 Virginia 320 3.9% 38 671 6.2% 45 Washington 261 3.7% 44 609 6.8% 32 West Virginia 97 5.2% 2 167 7.6% 6 Wisconsin 253 4.4% 18 485 7.6% 6 Wyoming 22 3.8% 41 50 6.3% 44 United States 13,210 4.2% 25,647 6.8% Note: The highest data value within each ranking is indicated by a rank of 1. 36 Population & Characteristics: Population Projections Population, Age 75-84, 2050 Percent Change in Population, Percent Change in Population, Value Percent of Total Age 75-84, 2012-2032 Age 75-84, 2012-2050 (Thousands) Population Rank Value Rank Value Rank Alabama 394 6.2% 33 +72% 48 +79% 41 Alaska 55 5.5% 49 +232% 1 +231% 1 Arizona 770 6.9% 7 +115% 9 +156% 8 Arkansas 253 6.2% 33 +75% 45 +85% 36 California 3,545 6.7% 12 +109% 15 +155% 9 Colorado 526 6.5% 22 +148% 3 +197% 5 Connecticut 305 7.1% 4 +84% 32 +92% 28 Delaware 87 6.9% 7 +87% 27 +101% 25 District of Columbia 47 5.5% 49 +78% 41 +119% 16 Florida 2,254 7.7% 1 +82% 36 +104% 23 Georgia 1,029 6.2% 33 +132% 5 +207% 3 Hawaii 117 6.6% 18 +82% 36 +82% 38 Idaho 144 6.0% 40 +115% 9 +133% 12 Illinois 1,103 6.2% 33 +86% 29 +112% 21 Indiana 508 6.4% 25 +83% 34 +86% 35 Iowa 237 6.1% 37 +71% 50 +62% 51 Kansas 221 6.0% 40 +89% 26 +82% 38 Kentucky 353 6.5% 22 +86% 29 +87% 34 Louisiana 319 6.0% 40 +81% 39 +72% 45 Maine 124 6.8% 11 +90% 25 +79% 41 Maryland 543 6.4% 25 +106% 17 +135% 11 Massachusetts 644 7.0% 5 +91% 23 +119% 16 Michigan 742 6.9% 7 +82% 36 +68% 48 Minnesota 476 6.7% 12 +107% 16 +118% 19 Mississippi 228 6.0% 40 +78% 41 +81% 40 Missouri 518 6.3% 30 +84% 32 +90% 29 Montana 89 5.9% 44 +106% 17 +89% 31 Nebraska 149 5.7% 47 +83% 34 +85% 36 Nevada 335 7.2% 3 +151% 2 +218% 2 New Hampshire 131 7.4% 2 +114% 11 +120% 14 New Jersey 797 7.0% 5 +81% 39 +104% 23 New Mexico 178 6.1% 37 +98% 20 +98% 27 New York 1,630 6.6% 18 +73% 47 +89% 31 North Carolina 934 6.4% 25 +99% 19 +132% 13 North Dakota 53 5.6% 48 +77% 43 +66% 49 Ohio 912 6.5% 22 +75% 45 +70% 47 Oklahoma 292 6.1% 37 +77% 43 +75% 44 Oregon 366 6.7% 12 +113% 12 +119% 16 Pennsylvania 1,113 6.4% 25 +67% 51 +71% 46 Rhode Island 99 6.6% 18 +86% 29 +101% 25 South Carolina 431 6.6% 18 +95% 21 +106% 22 South Dakota 70 5.8% 45 +87% 27 +79% 41 Tennessee 605 6.3% 30 +91% 23 +115% 20 Texas 2,296 6.3% 30 +117% 8 +167% 6 Utah 260 5.2% 51 +122% 7 +205% 4 Vermont 55 6.9% 7 +111% 13 +89% 31 Virginia 813 6.4% 25 +110% 14 +154% 10 Washington 687 6.7% 12 +133% 4 +164% 7 West Virginia 161 6.7% 12 +72% 48 +66% 49 Wisconsin 481 6.7% 12 +92% 22 +90% 29 Wyoming 49 5.8% 45 +125% 6 +120% 14 United States 28,527 6.6% +94% +116% Note: The highest data value within each ranking is indicated by a rank of 1. 37 Population & Characteristics: Population Projections Population, Age 85+, 2012 Population, Age 85+, 2032 Value Percent of Total Value Percent of Total (Thousands) Population Rank (Thousands) Population Rank Alabama 96 2.0% 28 166 3.1% 10 Alaska 6 0.8% 51 18 1.9% 49 Arizona 140 2.0% 28 287 3.1% 10 Arkansas 64 2.2% 16 106 3.0% 20 California 694 1.8% 38 1,236 2.7% 38 Colorado 79 1.5% 46 168 2.4% 46 Connecticut 86 2.4% 8 128 3.3% 6 Delaware 19 2.1% 23 36 3.3% 6 District of Columbia 11 1.7% 44 15 1.9% 49 Florida 581 3.0% 1 942 3.8% 2 Georgia 142 1.4% 49 313 2.3% 47 Hawaii 39 3.0% 1 62 3.9% 1 Idaho 29 1.8% 38 55 2.7% 38 Illinois 260 2.0% 28 392 2.5% 43 Indiana 133 2.1% 23 209 3.0% 20 Iowa 82 2.7% 3 105 3.1% 10 Kansas 66 2.3% 10 96 3.0% 20 Kentucky 83 1.9% 33 144 3.0% 20 Louisiana 83 1.9% 33 143 3.0% 20 Maine 33 2.4% 8 56 3.5% 3 Maryland 106 1.8% 38 205 2.8% 34 Massachusetts 157 2.3% 10 228 2.8% 34 Michigan 211 2.2% 16 333 3.4% 5 Minnesota 116 2.1% 23 179 2.9% 30 Mississippi 57 1.9% 33 95 2.9% 30 Missouri 133 2.2% 16 213 3.0% 20 Montana 23 2.2% 16 39 3.0% 20 Nebraska 43 2.3% 10 59 2.6% 42 Nevada 41 1.5% 46 116 3.0% 20 New Hampshire 28 2.1% 23 50 3.2% 8 New Jersey 195 2.2% 16 308 3.1% 10 New Mexico 41 2.0% 28 79 3.1% 10 New York 431 2.2% 16 627 2.8% 34 North Carolina 176 1.8% 38 347 2.8% 34 North Dakota 18 2.7% 3 21 2.5% 43 Ohio 260 2.3% 10 388 3.1% 10 Oklahoma 77 2.0% 28 131 3.1% 10 Oregon 84 2.1% 23 145 3.1% 10 Pennsylvania 349 2.7% 3 455 3.0% 20 Rhode Island 29 2.7% 3 39 3.0% 20 South Carolina 90 1.9% 33 182 3.2% 8 South Dakota 22 2.6% 7 30 2.9% 30 Tennessee 122 1.9% 33 233 2.9% 30 Texas 387 1.5% 46 776 2.5% 43 Utah 38 1.3% 50 73 1.8% 51 Vermont 14 2.3% 10 25 3.5% 3 Virginia 142 1.7% 44 285 2.7% 38 Washington 128 1.8% 38 244 2.7% 38 West Virginia 44 2.3% 10 68 3.1% 10 Wisconsin 129 2.2% 16 195 3.1% 10 Wyoming 10 1.8% 38 18 2.3% 47 United States 6,426 2.0% 10,867 2.9% Note: The highest data value within each ranking is indicated by a rank of 1. 38 Population & Characteristics: Population Projections Population, Age 85+, 2050 Percent Change in Population, Percent Change in Population, Value Percent of Total Age 85+, 2012-2032 Age 85+, 2012-2050 (Thousands) Population Rank Value Rank Value Rank Alabama 283 4.5% 38 +74% 21 +196% 29 Alaska 45 4.6% 34 +207% 1 +650% 1 Arizona 559 5.0% 13 +105% 5 +299% 8 Arkansas 178 4.4% 41 +65% 29 +178% 39 California 2,564 4.8% 22 +78% 18 +270% 11 Colorado 371 4.6% 34 +112% 4 +369% 4 Connecticut 248 5.8% 2 +49% 40 +188% 36 Delaware 65 5.2% 11 +91% 13 +243% 19 District of Columbia 25 2.9% 51 +37% 47 +132% 49 Florida 1,692 5.8% 2 +62% 30 +191% 34 Georgia 674 4.0% 49 +121% 3 +375% 3 Hawaii 103 5.8% 2 +59% 32 +163% 46 Idaho 105 4.4% 41 +90% 15 +264% 15 Illinois 759 4.3% 47 +51% 39 +192% 32 Indiana 379 4.8% 22 +57% 35 +185% 37 Iowa 190 4.9% 18 +28% 50 +131% 50 Kansas 182 5.0% 13 +46% 42 +176% 40 Kentucky 253 4.7% 30 +74% 21 +204% 27 Louisiana 252 4.7% 30 +74% 21 +205% 26 Maine 101 5.5% 6 +71% 26 +211% 24 Maryland 419 4.9% 18 +92% 12 +294% 9 Massachusetts 459 5.0% 13 +46% 42 +193% 31 Michigan 588 5.4% 7 +58% 33 +179% 38 Minnesota 376 5.3% 8 +55% 36 +224% 21 Mississippi 165 4.4% 41 +67% 28 +189% 35 Missouri 392 4.8% 22 +60% 31 +194% 30 Montana 73 4.8% 22 +73% 24 +222% 22 Nebraska 114 4.3% 47 +38% 46 +167% 42 Nevada 234 5.0% 13 +184% 2 +474% 2 New Hampshire 104 5.9% 1 +77% 19 +267% 13 New Jersey 597 5.3% 8 +58% 33 +206% 25 New Mexico 145 5.0% 13 +94% 10 +255% 16 New York 1,148 4.7% 30 +46% 42 +167% 42 North Carolina 651 4.5% 38 +97% 9 +269% 12 North Dakota 42 4.4% 41 +17% 51 +127% 51 Ohio 688 4.9% 18 +49% 40 +165% 45 Oklahoma 226 4.7% 30 +70% 27 +192% 32 Oregon 264 4.8% 22 +73% 24 +214% 23 Pennsylvania 824 4.8% 22 +30% 49 +136% 48 Rhode Island 77 5.1% 12 +37% 47 +170% 41 South Carolina 316 4.8% 22 +101% 6 +250% 17 South Dakota 58 4.8% 22 +39% 45 +166% 44 Tennessee 421 4.4% 41 +91% 13 +245% 18 Texas 1,619 4.5% 38 +100% 8 +318% 6 Utah 160 3.2% 50 +94% 10 +323% 5 Vermont 47 5.8% 2 +77% 19 +230% 20 Virginia 578 4.6% 34 +101% 6 +307% 7 Washington 501 4.9% 18 +90% 15 +290% 10 West Virginia 109 4.6% 34 +55% 36 +150% 47 Wisconsin 384 5.3% 8 +52% 38 +199% 28 Wyoming 37 4.4% 41 +82% 17 +266% 14 United States 20,842 4.8% +69% +224% Note: The highest data value within each ranking is indicated by a rank of 1. 39 Population & Characteristics: Race & Ethnicity People of Color, Asian/Pacific Islander, Black, Age 65+, 2010 Hispanic, Age 65+, 2010 Age 65+, 2010 Age 65+, 2010 Value Rank Value Rank Value Rank Value Rank Alabama 19.6% 18 0.5% 40 17.6% 7 0.6% 46 Alaska 25.5% 10 6.3% 4 1.9% 35 2.1% 24 Arizona 17.4% 20 1.8% 17 1.9% 35 11.0% 5 Arkansas 11.3% 28 0.3% 47 9.3% 16 0.8% 42 California 38.1% 4 13.6% 2 5.2% 25 17.7% 3 Colorado 15.5% 22 1.8% 17 2.6% 31 9.9% 6 Connecticut 12.6% 25 1.6% 21 6.2% 22 4.3% 11 Delaware 17.1% 21 1.8% 17 12.4% 10 1.9% 25 District of Columbia 69.4% 2 2.0% 14 61.9% 1 4.0% 13 Florida 22.9% 14 1.3% 22 7.7% 19 13.5% 4 Georgia 25.0% 11 1.9% 15 20.5% 5 1.9% 25 Hawaii 75.8% 1 63.6% 1 0.6% 43 3.4% 15 Idaho 5.9% 40 0.9% 29 0.1% 48 3.2% 16 Illinois 20.2% 17 3.3% 10 11.2% 12 5.2% 10 Indiana 8.5% 35 0.5% 40 5.8% 24 1.5% 30 Iowa 2.5% 49 0.4% 45 0.9% 41 0.7% 43 Kansas 8.8% 33 1.0% 27 3.9% 28 2.6% 19 Kentucky 6.5% 38 0.5% 40 4.7% 26 0.6% 46 Louisiana 26.4% 8 0.9% 29 22.3% 3 2.3% 22 Maine 1.6% 51 0.2% 49 0.2% 47 0.5% 51 Maryland 28.8% 6 4.2% 8 21.4% 4 2.3% 22 Massachusetts 10.4% 30 2.8% 11 3.9% 28 3.0% 18 Michigan 13.5% 24 1.2% 24 9.7% 14 1.5% 30 Minnesota 5.0% 43 1.7% 20 1.5% 38 0.9% 40 Mississippi 26.0% 9 0.4% 45 24.4% 2 0.6% 46 Missouri 10.2% 31 0.8% 33 7.4% 20 1.1% 36 Montana 5.0% 43 0.5% 40 0.1% 48 0.9% 40 Nebraska 5.1% 42 0.5% 40 2.1% 33 1.9% 25 Nevada 23.8% 12 7.4% 3 6.0% 23 8.8% 8 New Hampshire 3.0% 48 0.6% 38 0.3% 45 1.2% 35 New Jersey 23.2% 13 4.8% 7 9.7% 14 8.1% 9 New Mexico 39.6% 3 0.9% 29 1.5% 38 31.4% 1 New York 27.0% 7 5.0% 6 12.1% 11 9.6% 7 North Carolina 19.3% 19 0.9% 29 15.8% 8 1.3% 33 North Dakota 3.2% 47 0.0% 50 0.0% 50 0.7% 43 Ohio 10.9% 29 0.8% 33 8.5% 17 1.0% 37 Oklahoma 14.8% 23 1.1% 25 4.3% 27 1.7% 29 Oregon 7.2% 37 2.2% 13 0.9% 41 2.4% 21 Pennsylvania 10.0% 32 1.3% 22 6.7% 21 1.5% 30 Rhode Island 8.6% 34 1.1% 25 2.5% 32 3.8% 14 South Carolina 22.2% 15 1.0% 27 19.7% 6 1.0% 37 South Dakota 4.9% 45 0.0% 50 0.0% 50 0.7% 43 Tennessee 12.4% 26 0.7% 35 10.1% 13 1.0% 37 Texas 32.5% 5 2.6% 12 8.5% 17 20.6% 2 Utah 7.5% 36 1.9% 15 0.5% 44 4.2% 12 Vermont 2.0% 50 0.7% 35 0.3% 45 0.6% 46 Virginia 21.2% 16 3.5% 9 15.0% 9 1.9% 25 Washington 11.7% 27 5.4% 5 1.8% 37 2.6% 19 West Virginia 3.7% 46 0.3% 47 2.1% 33 0.6% 46 Wisconsin 5.5% 41 0.7% 35 2.7% 30 1.3% 33 Wyoming 6.3% 39 0.6% 38 1.2% 40 3.2% 16 United States 20.1% 3.6% 8.5% 6.9% Note: The highest data value within each ranking is indicated by a rank of 1. 40 Population & Characteristics: Living Arrangements Men per 100 Women People Age 75+ Living Alone, People Age 60+ with Grandchildren Age 85+, 2010 2010 in Household, 2010 Value Rank Percent Rank Percent Rank Alabama 43 45 34% 28 5.5% 14 Alaska 54 9 30% 43 6.8% 6 Arizona 58 2 30% 43 5.2% 18 Arkansas 47 23 35% 17 4.3% 28 California 54 9 30% 43 9.1% 2 Colorado 50 14 35% 17 4.8% 23 Connecticut 47 23 35% 17 5.2% 18 Delaware 48 19 32% 39 4.4% 27 District of Columbia 43 45 45% 1 5.3% 17 Florida 57 5 30% 43 5.2% 18 Georgia 41 51 32% 39 6.7% 7 Hawaii 60 1 22% 51 11.4% 1 Idaho 56 6 32% 39 4.2% 31 Illinois 45 39 35% 17 5.4% 16 Indiana 45 39 35% 17 3.8% 38 Iowa 46 31 38% 5 2.1% 48 Kansas 48 19 35% 17 3.6% 40 Kentucky 44 43 37% 9 3.9% 32 Louisiana 47 23 34% 28 6.2% 11 Maine 47 23 33% 35 2.4% 45 Maryland 46 31 33% 35 6.6% 9 Massachusetts 45 39 35% 17 4.8% 23 Michigan 47 23 36% 11 3.9% 32 Minnesota 47 23 38% 5 2.4% 45 Mississippi 42 50 32% 39 6.3% 10 Missouri 46 31 36% 11 3.9% 32 Montana 54 9 38% 5 2.8% 42 Nebraska 48 19 36% 11 2.6% 44 Nevada 58 2 30% 43 7.2% 4 New Hampshire 48 19 34% 28 3.3% 41 New Jersey 46 31 34% 28 6.7% 7 New Mexico 55 7 29% 49 5.5% 14 New York 46 31 35% 17 6.2% 11 North Carolina 43 45 34% 28 4.6% 26 North Dakota 49 15 37% 9 1.4% 51 Ohio 46 31 36% 11 3.9% 32 Oklahoma 49 15 35% 17 3.9% 32 Oregon 52 12 35% 17 3.9% 32 Pennsylvania 45 39 36% 11 3.8% 38 Rhode Island 44 43 39% 3 4.7% 25 South Carolina 43 45 34% 28 4.9% 22 South Dakota 49 15 40% 2 1.6% 50 Tennessee 43 45 33% 35 5.0% 21 Texas 49 15 30% 43 7.4% 3 Utah 58 2 29% 49 6.9% 5 Vermont 47 23 36% 11 2.0% 49 Virginia 46 31 33% 35 5.9% 13 Washington 52 12 34% 28 4.3% 28 West Virginia 47 23 38% 5 4.3% 28 Wisconsin 46 31 39% 3 2.4% 45 Wyoming 55 7 35% 17 2.8% 42 United States 48 34% 5.5% Note: The highest data value within each ranking is indicated by a rank of 1. 41 Population & Characteristics: Living Arrangements People Age 60+ Responsible for Percent of Age 65+ Households with Raising Grandchildren, 2010 Someone Under Age 18, 2010 Value Rank Value Rank Alabama 2.5% 3 6.6% 17 Alaska 2.1% 8 11.0% 3 Arizona 1.8% 17 6.8% 16 Arkansas 2.1% 8 4.9% 33 California 1.9% 13 11.8% 2 Colorado 1.6% 24 5.4% 29 Connecticut 1.2% 36 6.4% 19 Delaware 1.7% 22 5.8% 25 District of Columbia 1.9% 13 7.6% 15 Florida 1.4% 26 6.2% 22 Georgia 2.3% 4 8.8% 7 Hawaii 1.8% 17 16.4% 1 Idaho 1.8% 17 5.3% 30 Illinois 1.3% 30 6.4% 19 Indiana 1.4% 26 4.1% 41 Iowa 1.0% 41 2.1% 51 Kansas 1.3% 30 4.2% 40 Kentucky 1.9% 13 4.9% 33 Louisiana 3.0% 1 8.4% 9 Maine 0.7% 46 3.7% 43 Maryland 1.6% 24 9.1% 6 Massachusetts 0.8% 44 6.5% 18 Michigan 1.2% 36 5.3% 30 Minnesota 0.8% 44 2.9% 47 Mississippi 3.0% 1 8.3% 11 Missouri 1.4% 26 4.5% 38 Montana 1.2% 36 3.5% 44 Nebraska 1.3% 30 4.4% 39 Nevada 2.2% 5 9.6% 4 New Hampshire 0.6% 49 4.0% 42 New Jersey 1.2% 36 8.4% 9 New Mexico 2.1% 8 8.0% 12 New York 1.3% 30 8.7% 8 North Carolina 1.8% 17 5.5% 26 North Dakota 0.6% 49 2.8% 49 Ohio 1.3% 30 4.8% 35 Oklahoma 1.7% 22 4.8% 35 Oregon 1.4% 26 5.5% 26 Pennsylvania 1.0% 41 4.8% 35 Rhode Island 1.3% 30 6.0% 24 South Carolina 2.1% 8 6.2% 22 South Dakota 0.7% 46 2.2% 50 Tennessee 2.0% 12 6.3% 21 Texas 2.2% 5 9.4% 5 Utah 2.2% 5 7.8% 13 Vermont 0.6% 49 3.3% 45 Virginia 1.9% 13 7.7% 14 Washington 1.1% 40 5.5% 26 West Virginia 1.8% 17 5.1% 32 Wisconsin 0.7% 46 2.9% 47 Wyoming 0.9% 43 3.0% 46 United States 1.6% 7.0% Note: The highest data value within each ranking is indicated by a rank of 1. 42 Population & Characteristics: Income & Poverty Median Household Income Percent of Age 65+ At/Below Percent of Age 65+ At/Below Age 65+, 2010 Poverty Level, 2010 250% of Poverty Level, 2010 Value Rank Percent Rank Percent Rank Alabama $30,763 42 10.7% 9 48% 6 Alaska $43,987 3 5.7% 51 31% 50 Arizona $37,134 14 7.7% 31 39% 37 Arkansas $29,452 48 10.2% 12 49% 5 California $40,255 8 9.7% 17 40% 35 Colorado $37,684 13 8.1% 26 37% 40 Connecticut $39,235 10 6.6% 48 34% 46 Delaware $40,301 7 7.7% 31 35% 44 District of Columbia $41,128 5 13.1% 1 35% 44 Florida $35,024 17 9.9% 13 43% 21 Georgia $32,183 34 10.7% 9 45% 12 Hawaii $51,293 1 6.8% 43 28% 51 Idaho $33,725 25 7.9% 28 42% 23 Illinois $34,673 19 8.4% 23 41% 30 Indiana $32,172 35 6.8% 43 43% 21 Iowa $32,487 31 6.7% 47 42% 23 Kansas $34,653 20 7.7% 31 40% 35 Kentucky $27,920 49 11.2% 6 51% 3 Louisiana $29,788 47 11.5% 5 50% 4 Maine $30,644 44 9.5% 19 47% 8 Maryland $44,712 2 7.7% 31 32% 49 Massachusetts $35,683 16 8.7% 22 39% 37 Michigan $33,381 28 8.0% 27 42% 23 Minnesota $34,397 22 8.3% 24 41% 30 Mississippi $27,529 50 11.9% 4 54% 1 Missouri $31,324 41 9.1% 21 45% 12 Montana $32,423 32 7.0% 41 41% 30 Nebraska $32,745 30 7.5% 37 42% 23 Nevada $38,951 12 7.6% 36 38% 39 New Hampshire $37,119 15 6.1% 49 36% 41 New Jersey $41,452 4 7.2% 39 34% 46 New Mexico $33,447 27 12.0% 3 47% 8 New York $34,518 21 10.9% 8 42% 23 North Carolina $31,694 37 9.9% 13 45% 12 North Dakota $30,669 43 12.1% 2 45% 12 Ohio $31,798 36 7.7% 31 44% 17 Oklahoma $31,486 39 9.3% 20 46% 10 Oregon $34,901 18 7.9% 28 42% 23 Pennsylvania $31,364 40 7.9% 28 44% 17 Rhode Island $33,192 29 8.2% 25 42% 23 South Carolina $31,691 38 9.8% 16 46% 10 South Dakota $29,950 46 11.1% 7 45% 12 Tennessee $30,160 45 9.7% 17 48% 6 Texas $34,178 23 10.7% 9 44% 17 Utah $40,784 6 6.0% 50 36% 41 Vermont $33,474 26 6.8% 43 41% 30 Virginia $39,274 9 7.4% 38 36% 41 Washington $39,207 11 6.9% 42 34% 46 West Virginia $26,796 51 9.9% 13 54% 1 Wisconsin $32,315 33 7.1% 40 44% 17 Wyoming $33,777 24 6.8% 43 41% 30 United States $34,381 9.0% 42% Note: The highest data value within each ranking is indicated by a rank of 1. 43 Population & Characteristics: Income & Poverty Percent of Women Age 75+ Percent of Women Age 75+ At/ Percent of Age 65+ with Bachelor At/Below Poverty Level, 2010 Below 250% of Poverty Level, 2010 Level Education or Higher, 2010 Percent Rank Percent Rank Percent Rank Alabama 15.4% 6 60% 8 17% 38 Alaska 7.2% 51 43% 49 24% 13 Arizona 9.3% 45 49% 40 25% 10 Arkansas 16.1% 4 63% 4 15% 46 California 12.4% 23 50% 39 27% 5 Colorado 11.1% 30 51% 38 30% 2 Connecticut 8.3% 50 47% 44 26% 6 Delaware 10.6% 34 47% 44 22% 20 District of Columbia 15.3% 7 38% 50 35% 1 Florida 12.6% 21 53% 34 23% 17 Georgia 15.1% 9 56% 26 20% 28 Hawaii 11.6% 27 36% 51 24% 13 Idaho 12.0% 25 54% 31 20% 28 Illinois 11.3% 28 55% 28 20% 28 Indiana 9.5% 44 58% 16 15% 46 Iowa 9.9% 42 58% 16 15% 46 Kansas 10.3% 37 53% 34 21% 21 Kentucky 15.9% 5 63% 4 14% 50 Louisiana 15.2% 8 61% 6 17% 38 Maine 11.2% 29 60% 8 21% 21 Maryland 12.0% 25 44% 48 28% 4 Massachusetts 12.2% 24 53% 34 26% 6 Michigan 10.8% 33 57% 23 18% 35 Minnesota 13.4% 16 59% 13 21% 21 Mississippi 16.6% 3 64% 1 17% 38 Missouri 13.2% 18 59% 13 17% 38 Montana 13.4% 16 58% 16 21% 21 Nebraska 12.7% 20 57% 23 18% 35 Nevada 10.1% 41 49% 40 20% 28 New Hampshire 10.3% 37 52% 37 25% 10 New Jersey 9.1% 47 45% 47 23% 17 New Mexico 15.1% 9 58% 16 25% 10 New York 14.0% 12 54% 31 23% 17 North Carolina 14.1% 11 57% 23 20% 28 North Dakota 20.6% 1 64% 1 15% 46 Ohio 10.4% 36 59% 13 17% 38 Oklahoma 12.9% 19 58% 16 18% 35 Oregon 9.6% 43 54% 31 24% 13 Pennsylvania 11.0% 32 58% 16 17% 38 Rhode Island 10.2% 40 56% 26 21% 21 South Carolina 13.6% 15 58% 16 21% 21 South Dakota 19.0% 2 61% 6 17% 38 Tennessee 13.9% 13 60% 8 16% 45 Texas 13.7% 14 55% 28 21% 21 Utah 9.3% 45 49% 40 26% 6 Vermont 8.5% 49 55% 28 29% 3 Virginia 10.5% 35 47% 44 24% 13 Washington 9.0% 48 48% 43 26% 6 West Virginia 12.5% 22 64% 1 12% 51 Wisconsin 11.1% 30 60% 8 19% 34 Wyoming 10.3% 37 60% 8 20% 28 United States 12.2% 54% 21% Note: The highest data value within each ranking is indicated by a rank of 1. 44 Population & Characteristics: Disability Rates People Age 65+ with Self-Care Difficulty, 2010 People Age 65+ with Cognitive Difficulty, 2010 Value Percent of Age Value Percent of Age (Thousands) 65+ Rank (Thousands) 65+ Rank Alabama 72 11.3% 2 83 13.0% 2 Alaska 4 8.3% 21 4 8.7% 28 Arizona 58 6.6% 44 68 7.8% 42 Arkansas 37 9.1% 13 45 11.1% 7 California 449 10.7% 4 444 10.6% 13 Colorado 38 7.1% 36 42 7.9% 40 Connecticut 36 7.5% 34 39 8.1% 37 Delaware 7 5.8% 49 10 8.0% 38 District of Columbia 6 8.7% 17 7 9.8% 18 Florida 258 8.0% 24 292 9.1% 24 Georgia 98 9.7% 9 111 11.1% 7 Hawaii 14 7.3% 35 19 9.9% 17 Idaho 15 7.6% 33 18 9.5% 21 Illinois 128 8.3% 21 123 8.0% 38 Indiana 64 7.9% 26 70 8.7% 28 Iowa 25 5.9% 47 28 6.6% 48 Kansas 28 7.8% 29 34 9.4% 23 Kentucky 57 10.2% 8 62 11.1% 7 Louisiana 58 10.8% 3 65 12.1% 3 Maine 14 6.7% 43 20 9.8% 18 Maryland 54 7.8% 29 58 8.4% 33 Massachusetts 67 7.7% 32 71 8.2% 35 Michigan 113 8.5% 19 128 9.7% 20 Minnesota 45 6.9% 37 43 6.6% 48 Mississippi 43 11.7% 1 51 13.9% 1 Missouri 68 8.4% 20 77 9.5% 21 Montana 9 6.6% 44 11 7.7% 44 Nebraska 16 6.8% 41 17 7.3% 46 Nevada 25 7.8% 29 25 7.8% 42 New Hampshire 10 5.9% 47 10 6.1% 51 New Jersey 95 8.3% 21 95 8.3% 34 New Mexico 26 9.6% 10 29 10.9% 11 New York 222 8.8% 16 226 9.0% 25 North Carolina 111 9.2% 12 125 10.4% 14 North Dakota 5 4.9% 50 6 6.5% 50 Ohio 123 7.9% 26 137 8.8% 27 Oklahoma 45 9.1% 13 51 10.3% 15 Oregon 49 9.4% 11 60 11.4% 6 Pennsylvania 149 7.9% 26 162 8.6% 31 Rhode Island 10 6.9% 37 11 7.9% 40 South Carolina 55 8.9% 15 68 11.0% 10 South Dakota 8 6.8% 41 8 7.4% 45 Tennessee 89 10.7% 4 99 11.9% 4 Texas 271 10.7% 4 275 10.8% 12 Utah 17 6.9% 37 20 8.2% 35 Vermont 6 6.9% 37 8 8.9% 26 Virginia 77 8.0% 24 83 8.7% 28 Washington 70 8.7% 17 81 10.0% 16 West Virginia 31 10.5% 7 34 11.6% 5 Wisconsin 50 6.6% 44 50 6.7% 47 Wyoming 3 4.9% 50 6 8.6% 31 United States 3,428 8.8% 3,712 9.5% Note: The highest data value within each ranking is indicated by a rank of 1. 45 Population & Characteristics: Disability Rates People Age 65+ with Any Disability, 2010 People Age 18-64 with Self-Care Difficulty, 2010 Value Percent of Value Percent of Age (Thousands) Age 65+ Rank (Thousands) 18-64 Rank Alabama 281 44% 2 76 2.6% 4 Alaska 20 39% 12 7 1.6% 30 Arizona 287 33% 42 64 1.7% 24 Arkansas 173 43% 3 43 2.5% 5 California 1,539 37% 21 355 1.5% 33 Colorado 185 35% 31 43 1.4% 39 Connecticut 159 33% 42 27 1.2% 47 Delaware 39 31% 51 9 1.7% 24 District of Columbia 23 34% 35 4 1.0% 51 Florida 1,096 34% 35 207 1.8% 21 Georgia 397 40% 11 112 1.9% 19 Hawaii 63 33% 42 11 1.4% 39 Idaho 74 38% 14 17 1.8% 21 Illinois 544 35% 31 121 1.5% 33 Indiana 295 37% 21 79 2.0% 14 Iowa 138 32% 48 28 1.5% 33 Kansas 136 38% 14 34 2.0% 14 Kentucky 233 42% 7 76 2.8% 3 Louisiana 232 43% 3 67 2.4% 7 Maine 78 38% 14 16 1.9% 19 Maryland 231 34% 35 52 1.4% 39 Massachusetts 285 33% 42 59 1.4% 39 Michigan 496 37% 21 139 2.3% 9 Minnesota 209 32% 48 46 1.4% 39 Mississippi 168 45% 1 53 3.0% 2 Missouri 311 39% 12 88 2.4% 7 Montana 52 37% 21 9 1.4% 39 Nebraska 85 36% 27 19 1.7% 24 Nevada 110 34% 35 29 1.7% 24 New Hampshire 54 32% 48 13 1.6% 30 New Jersey 375 33% 42 74 1.3% 46 New Mexico 112 41% 9 28 2.3% 9 New York 858 34% 35 180 1.5% 33 North Carolina 460 38% 14 124 2.1% 13 North Dakota 32 35% 31 5 1.1% 50 Ohio 569 36% 27 140 2.0% 14 Oklahoma 212 43% 3 52 2.3% 9 Oregon 198 38% 14 49 2.0% 14 Pennsylvania 677 36% 27 136 1.7% 24 Rhode Island 53 37% 21 11 1.7% 24 South Carolina 237 38% 14 65 2.3% 9 South Dakota 40 36% 27 7 1.4% 39 Tennessee 348 42% 7 97 2.5% 5 Texas 1,029 41% 9 309 2.0% 14 Utah 85 34% 35 19 1.2% 47 Vermont 30 34% 35 7 1.8% 21 Virginia 336 35% 31 77 1.5% 33 Washington 307 38% 14 68 1.6% 30 West Virginia 126 43% 3 36 3.1% 1 Wisconsin 246 33% 42 54 1.5% 33 Wyoming 25 37% 21 4 1.2% 47 United States 14,352 37% 3,444 1.8% Note: The highest data value within each ranking is indicated by a rank of 1. 46 Population & Characteristics: Disability Rates People Age 18-64 with Cognitive Difficulty, 2010 People Age 18-64 with Any Disability, 2010 Value Percent of Value Percent of (Thousands) Age 18-64 Rank (Thousands) Age 18-64 Rank Alabama 174 5.9% 4 423 14.4% 5 Alaska 18 3.9% 32 48 10.8% 22 Arizona 152 4.0% 30 364 9.6% 31 Arkansas 99 5.6% 9 255 14.6% 4 California 762 3.3% 44 1,818 7.8% 48 Colorado 114 3.6% 39 273 8.5% 40 Connecticut 77 3.5% 40 179 8.1% 44 Delaware 25 4.6% 20 60 10.9% 20 District of Columbia 19 4.6% 20 37 8.7% 38 Florida 469 4.1% 28 1,115 9.8% 30 Georgia 242 4.0% 30 615 10.2% 26 Hawaii 26 3.2% 47 66 8.1% 44 Idaho 45 4.8% 17 103 11.1% 19 Illinois 257 3.2% 47 640 8.0% 46 Indiana 182 4.6% 20 435 10.9% 20 Iowa 71 3.8% 35 172 9.3% 33 Kansas 73 4.2% 25 178 10.3% 25 Kentucky 179 6.7% 2 423 15.9% 2 Louisiana 161 5.8% 5 378 13.6% 7 Maine 48 5.8% 5 104 12.4% 9 Maryland 116 3.2% 47 298 8.2% 42 Massachusetts 163 3.9% 32 354 8.4% 41 Michigan 314 5.1% 13 715 11.7% 13 Minnesota 126 3.8% 35 266 8.0% 46 Mississippi 111 6.2% 3 267 15.0% 3 Missouri 186 5.1% 13 440 12.0% 11 Montana 25 4.1% 28 64 10.5% 23 Nebraska 39 3.5% 40 104 9.4% 32 Nevada 56 3.3% 44 152 9.1% 34 New Hampshire 35 4.2% 25 77 9.1% 34 New Jersey 163 3.0% 50 398 7.3% 51 New Mexico 60 4.8% 17 140 11.3% 16 New York 402 3.3% 44 1,012 8.2% 42 North Carolina 272 4.6% 20 673 11.4% 14 North Dakota 12 2.8% 51 32 7.6% 49 Ohio 350 4.9% 16 804 11.4% 14 Oklahoma 129 5.7% 8 323 14.3% 6 Oregon 129 5.3% 12 287 11.9% 12 Pennsylvania 370 4.7% 19 824 10.5% 23 Rhode Island 37 5.6% 9 75 11.2% 17 South Carolina 146 5.1% 13 352 12.4% 9 South Dakota 18 3.7% 37 43 8.9% 36 Tennessee 230 5.8% 5 530 13.5% 8 Texas 602 3.9% 32 1,549 10.1% 28 Utah 56 3.4% 43 124 7.6% 49 Vermont 22 5.5% 11 45 11.2% 17 Virginia 174 3.5% 40 447 8.9% 36 Washington 182 4.3% 24 425 10.0% 29 West Virginia 81 7.1% 1 197 17.2% 1 Wisconsin 132 3.7% 37 306 8.7% 38 Wyoming 15 4.2% 25 36 10.2% 26 United States 7,943 4.2% 19,048 10.0% Note: The highest data value within each ranking is indicated by a rank of 1. 47 Population & Characteristics: Family Caregivers Family Caregivers, 2009 Economic Value of Family Caregiving, 2009 Per 1,000 Value Per 1,000 Value Population Rank (millions) Population Rank Alabama 818,000 174 3 $7,300 $1,560 18 Alaska 88,000 126 41 $1,100 $1,570 16 Arizona 855,000 130 35 $9,400 $1,430 35 Arkansas 478,000 165 7 $4,500 $1,560 18 California 4,020,000 109 50 $47,000 $1,270 44 Colorado 576,000 115 47 $6,600 $1,310 41 Connecticut 486,000 138 24 $5,800 $1,650 8 Delaware 138,000 156 9 $1,560 $1,760 3 District of Columbia 68,000 113 49 $760 $1,270 44 Florida 2,780,000 150 10 $29,000 $1,560 18 Georgia 1,360,000 139 23 $13,100 $1,330 40 Hawaii 169,000 130 35 $1,990 $1,540 22 Idaho 210,000 136 30 $2,000 $1,300 42 Illinois 1,660,000 129 38 $18,800 $1,460 31 Indiana 916,000 143 18 $9,400 $1,460 31 Iowa 369,000 123 44 $4,100 $1,370 38 Kansas 414,000 147 12 $4,100 $1,460 31 Kentucky 735,000 170 4 $7,100 $1,640 9 Louisiana 627,000 140 22 $5,700 $1,270 44 Maine 191,000 145 14 $2,300 $1,730 5 Maryland 769,000 135 31 $8,100 $1,420 37 Massachusetts 858,000 130 35 $10,900 $1,660 7 Michigan 1,440,000 145 14 $15,500 $1,560 18 Minnesota 679,000 129 38 $8,200 $1,570 16 Mississippi 565,000 191 1 $5,200 $1,780 2 Missouri 865,000 144 16 $8,900 $1,480 29 Montana 131,000 134 32 $1,390 $1,430 35 Nebraska 219,000 122 45 $2,200 $1,250 49 Nevada 364,000 138 24 $4,000 $1,510 27 New Hampshire 183,000 138 24 $2,200 $1,680 6 New Jersey 1,190,000 137 28 $13,200 $1,520 25 New Mexico 287,000 143 18 $3,100 $1,530 24 New York 2,800,000 143 18 $32,000 $1,630 10 North Carolina 1,180,000 126 41 $11,700 $1,250 49 North Dakota 75,000 115 47 $830 $1,290 43 Ohio 1,660,000 144 16 $17,500 $1,520 25 Oklahoma 596,000 162 8 $6,000 $1,610 12 Oregon 463,000 121 46 $5,500 $1,440 34 Pennsylvania 1,850,000 147 12 $19,900 $1,580 15 Rhode Island 148,000 141 21 $1,880 $1,790 1 South Carolina 770,000 169 5 $7,400 $1,620 11 South Dakota 101,000 124 43 $1,030 $1,270 44 Tennessee 1,130,000 180 2 $11,000 $1,750 4 Texas 3,420,000 138 24 $34,000 $1,370 38 Utah 382,000 137 28 $4,200 $1,490 28 Vermont 83,000 134 32 $990 $1,590 13 Virginia 1,180,000 150 10 $11,700 $1,480 29 Washington 854,000 128 40 $10,600 $1,590 13 West Virginia 303,000 166 6 $2,800 $1,540 22 Wisconsin 524,000 93 51 $5,800 $1,020 51 Wyoming 72,000 133 34 $680 $1,260 48 United States 42,100,000 137 $450,000 $1,460 Note: The highest data value within each ranking is indicated by a rank of 1. 48 Population & Characteristics: Family Caregivers Ratio of Economic Value of Family Caregiving to Medicaid LTSS Economic Value per Hour, 2009 Spending, 2009 Value Rank Value Rank Alabama $9.37 51 5.2 12 Alaska $13.10 3 2.9 43 Arizona $11.50 21 6.3 7 Arkansas $9.87 46 4.2 23 California $12.17 12 4.1 25 Colorado $11.93 13 4.8 17 Connecticut $12.50 7 1.8 49 Delaware $11.77 16 4.7 19 District of Columbia $11.70 17 1.4 51 Florida $10.88 31 6.8 4 Georgia $10.03 43 6.6 5 Hawaii $12.33 11 7.9 3 Idaho $10.03 43 4.9 16 Illinois $11.83 15 6.1 9 Indiana $10.70 32 4.1 25 Iowa $11.66 19 3.2 37 Kansas $10.41 37 4.0 28 Kentucky $10.03 43 5.1 13 Louisiana $9.53 50 2.9 43 Maine $12.50 7 3.2 37 Maryland $11.03 29 4.3 22 Massachusetts $13.33 1 2.9 43 Michigan $11.23 27 6.5 6 Minnesota $12.70 5 2.4 46 Mississippi $9.70 48 4.4 21 Missouri $10.70 32 4.7 19 Montana $11.16 28 4.1 25 Nebraska $10.70 32 3.4 34 Nevada $11.48 23 11.9 1 New Hampshire $12.67 6 3.9 29 New Jersey $11.59 20 3.5 31 New Mexico $11.25 26 3.3 35 New York $11.85 14 1.5 50 North Carolina $10.37 38 3.5 31 North Dakota $11.68 18 2.3 47 Ohio $11.03 29 3.5 31 Oklahoma $10.44 36 5.0 15 Oregon $12.43 9 4.2 23 Pennsylvania $11.27 25 3.1 40 Rhode Island $13.27 2 3.3 35 South Carolina $10.04 42 6.3 7 South Dakota $10.70 32 3.7 30 Tennessee $10.20 41 5.1 13 Texas $10.35 40 5.6 11 Utah $11.37 24 10.7 2 Vermont $12.37 10 3.1 40 Virginia $10.37 38 6.0 10 Washington $12.94 4 4.8 17 West Virginia $9.67 49 3.1 40 Wisconsin $11.49 22 1.9 48 Wyoming $9.87 46 3.2 37 United States $11.16 3.8 Note: The highest data value within each ranking is indicated by a rank of 1. 49 Population & Characteristics: Long-Term Care Insurance Private Long-Term Care Insurance Policies in Effect, 2010 Per 1,000 Value Age 40+ Rank Alabama 74,291 33 42 Alaska 8,793 29 48 Arizona 103,642 36 36 Arkansas 41,093 30 47 California 708,605 44 24 Colorado 122,775 55 12 Connecticut 93,955 52 16 Delaware 17,227 40 29 District of Columbia 30,069 122 2 Florida 330,017 34 39 Georgia 145,914 35 37 Hawaii 76,518 116 3 Idaho 23,514 35 37 Illinois 286,437 49 20 Indiana 101,381 34 39 Iowa 124,729 86 7 Kansas 96,305 75 8 Kentucky 66,822 32 44 Louisiana 57,721 28 49 Maine 219,330 308 1 Maryland 164,752 60 11 Massachusetts 159,155 50 18 Michigan 180,912 38 33 Minnesota 180,578 73 9 Mississippi 40,847 31 46 Missouri 155,771 55 12 Montana 26,686 54 14 Nebraska 83,702 101 6 Nevada 34,417 28 49 New Hampshire 32,516 48 21 New Jersey 184,611 43 26 New Mexico 32,664 34 39 New York 348,203 38 33 North Carolina 183,514 41 28 North Dakota 32,337 103 5 Ohio 216,142 39 31 Oklahoma 56,960 33 42 Oregon 86,657 47 22 Pennsylvania 255,389 40 29 Rhode Island 20,432 39 31 South Carolina 92,292 42 27 South Dakota 42,904 113 4 Tennessee 131,025 44 24 Texas 381,754 37 35 Utah 30,969 32 44 Vermont 16,510 51 17 Virginia 243,465 65 10 Washington 155,059 50 18 West Virginia 25,965 27 51 Wisconsin 148,636 54 14 Wyoming 11,636 45 23 United States 6,485,598 45 Note: The highest data value within each ranking is indicated by a rank of 1. 50 Public LTSS Expenditures: Medicaid Expenditures Federal Medical Assistance Total Medicaid Expenditures, 2009 Percentage (FMAP), 2009 Value (Millions) Rank Value Rank Alabama $4,417 26 68.01% 10 Alaska $1,070 47 51.43% 36 Arizona $8,561 12 65.75% 14 Arkansas $3,500 31 72.78% 3 California $40,818 2 50.00% 41 Colorado $3,571 30 50.00% 41 Connecticut $5,974 22 50.00% 41 Delaware $1,213 45 50.21% 37 District of Columbia $1,626 40 70.00% 8 Florida $15,547 5 54.98% 32 Georgia $7,461 14 65.10% 17 Hawaii $1,339 42 54.24% 34 Idaho $1,295 44 69.40% 9 Illinois $13,572 7 50.17% 38 Indiana $6,263 21 65.93% 13 Iowa $2,983 33 63.51% 21 Kansas $2,456 35 60.38% 28 Kentucky $5,371 24 70.96% 6 Louisiana $6,581 20 67.61% 11 Maine $2,589 34 64.99% 18 Maryland $6,702 19 50.00% 41 Massachusetts $12,196 8 50.00% 41 Michigan $10,635 10 63.19% 23 Minnesota $7,425 15 50.00% 41 Mississippi $3,813 28 75.67% 1 Missouri $7,676 13 64.51% 19 Montana $876 48 67.42% 12 Nebraska $1,633 39 60.56% 27 Nevada $1,383 41 50.16% 39 New Hampshire $1,328 43 50.00% 41 New Jersey $9,928 11 50.00% 41 New Mexico $3,257 32 71.35% 5 New York $49,719 1 50.00% 41 North Carolina $11,490 9 65.13% 16 North Dakota $590 50 63.01% 24 Ohio $14,080 6 63.42% 22 Oklahoma $3,936 27 64.43% 20 Oregon $3,594 29 62.74% 25 Pennsylvania $17,129 4 54.81% 33 Rhode Island $1,891 37 52.63% 35 South Carolina $5,097 25 70.32% 7 South Dakota $715 49 62.72% 26 Tennessee $7,393 16 65.57% 15 Texas $24,121 3 58.73% 30 Utah $1,643 38 71.68% 4 Vermont $1,146 46 58.73% 30 Virginia $5,806 23 50.00% 41 Washington $6,828 18 50.12% 40 West Virginia $2,446 36 74.04% 2 Wisconsin $7,123 17 60.21% 29 Wyoming $526 51 50.00% 41 United States $368,330 Note: The highest data value within each ranking is indicated by a rank of 1. 51 Public LTSS Expenditures: Medicaid Expenditures Medicaid HCBS Spending as a % of Medicaid HCBS Spending as LTSS Spending for Older People and a % of LTSS Spending for All Adults w/ Physical Disabilities, 2009* Populations, 2009* Value Rank Value Rank Alabama 15% 46 30% 46 Alaska 56% 5 63% 6 Arizona 44% 9 67% 4 Arkansas 29% 24 30% 46 California 55% 6 57% 9 Colorado 44% 9 58% 8 Connecticut 24% 32 44% 21 Delaware 13% 49 35% 39 District of Columbia 46% 8 50% 14 Florida 21% 37 34% 40 Georgia 26% 27 37% 36 Hawaii 19% 40 42% 24 Idaho 43% 12 46% 17 Illinois 23% 34 30% 46 Indiana 16% 44 31% 44 Iowa 29% 24 39% 33 Kansas 39% 16 55% 11 Kentucky 19% 40 31% 44 Louisiana 32% 22 36% 38 Maine 25% 29 52% 12 Maryland 15% 46 37% 36 Massachusetts 35% 17 47% 15 Michigan 22% 36 33% 41 Minnesota 60% 3 68% 3 Mississippi 16% 44 14% 51 Missouri 34% 19 41% 29 Montana 34% 19 47% 15 Nebraska 25% 29 38% 34 Nevada 34% 19 42% 24 New Hampshire 18% 42 41% 29 New Jersey 21% 37 26% 50 New Mexico 65% 1 75% 1 New York 41% 14 46% 17 North Carolina 43% 12 43% 22 North Dakota 10% 51 29% 49 Ohio 24% 32 33% 41 Oklahoma 32% 22 42% 24 Oregon 59% 4 74% 2 Pennsylvania 18% 42 32% 43 Rhode Island 13% 49 46% 17 South Carolina 28% 26 38% 34 South Dakota 14% 48 40% 31 Tennessee 26% 27 42% 24 Texas 50% 7 46% 17 Utah 20% 39 43% 22 Vermont 41% 14 65% 5 Virginia 35% 17 42% 24 Washington 62% 2 62% 7 West Virginia 25% 29 40% 31 Wisconsin 44% 9 56% 10 Wyoming 23% 34 51% 13 United States 36% 44% Note: The highest data value within each ranking is indicated by a rank of 1. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 B and 2009 is used for GA and WI. 52 Public LTSS Expenditures: LTSS & Home Health Medicaid LTSS Expenditures for Older People and Adults w/ Physical Disabilities, 2009* Medicaid Nursing Facility Expenditures, 2009* Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $1,103 $232 27 $938 $197 15 Alaska $268 $384 6 $119 $170 24 Arizona $794 $125 49 $447 $70 49 Arkansas $807 $279 17 $573 $198 14 California $9,856 $267 18 $4,430 $120 39 Colorado $973 $196 39 $549 $110 42 Connecticut $1,638 $460 3 $1,240 $348 2 Delaware $212 $238 24 $186 $208 13 District of Columbia $362 $612 2 $197 $333 3 Florida $3,074 $165 44 $2,423 $130 36 Georgia $1,552 $161 46 $1,153 $120 39 Hawaii $273 $203 37 $222 $165 26 Idaho $278 $179 41 $157 $101 43 Illinois $2,103 $164 45 $1,616 $126 38 Indiana $1,428 $221 29 $1,195 $185 19 Iowa $660 $218 31 $467 $154 31 Kansas $617 $218 31 $373 $132 35 Kentucky $1,027 $238 24 $828 $192 16 Louisiana $1,103 $246 20 $746 $166 25 Maine $335 $252 19 $252 $190 17 Maryland $1,248 $218 31 $1,062 $185 19 Massachusetts $2,681 $411 4 $1,746 $268 6 Michigan $1,972 $199 38 $1,547 $156 29 Minnesota $2,166 $410 5 $871 $165 26 Mississippi $864 $292 13 $727 $246 9 Missouri $1,311 $220 30 $869 $146 32 Montana $240 $243 21 $158 $161 28 Nebraska $423 $233 26 $318 $175 22 Nevada $246 $92 50 $162 $60 50 New Hampshire $382 $290 14 $315 $239 10 New Jersey $2,509 $287 16 $1,984 $227 11 New Mexico $491 $241 22 $174 $85 47 New York $13,053 $676 1 $7,675 $398 1 North Carolina $2,256 $239 23 $1,292 $137 34 North Dakota $192 $289 15 $172 $259 7 Ohio $3,382 $293 12 $2,565 $222 12 Oklahoma $783 $211 34 $530 $142 33 Oregon $744 $195 40 $304 $80 48 Pennsylvania $4,394 $347 7 $3,606 $285 4 Rhode Island $343 $326 9 $298 $283 5 South Carolina $712 $155 47 $513 $112 41 South Dakota $165 $205 36 $142 $176 21 Tennessee $1,312 $208 35 $975 $155 30 Texas $4,269 $172 42 $2,152 $87 45 Utah $186 $68 51 $150 $55 51 Vermont $197 $316 10 $117 $187 18 Virginia $1,185 $149 48 $769 $97 44 Washington $1,533 $230 28 $581 $87 45 West Virginia $616 $334 8 $459 $249 8 Wisconsin $1,767 $312 11 $986 $174 23 Wyoming $95 $170 43 $73 $130 36 United States $80,181 $261 $51,403 $168 Note: The highest data value within each ranking is indicated by a rank of 1. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 and 2009 is B used for GA and WI. 53 Public LTSS Expenditures: LTSS & Home Health Medicaid HCBS Expenditures for Older People and Medicaid Aged/Disabled Waiver Services Adults w/ Physical Disabilities, 2009* Expenditures, 2009* Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $165 $35 44 $104 $22 31 Alaska $150 $214 4 $67 $95 4 Arizona $347 $55 30 NA NA NA Arkansas $234 $81 19 $101 $35 23 California $5,426 $147 6 $149 $4 48 Colorado $424 $85 15 $182 $37 20 Connecticut $398 $112 12 $151 $42 15 Delaware $27 $30 48 $18 $20 32 District of Columbia $165 $279 1 $70 $118 2 Florida $650 $35 44 $381 $20 32 Georgia $399 $42 39 $310 $32 27 Hawaii $52 $38 41 $51 $38 19 Idaho $120 $77 21 $89 $57 9 Illinois $486 $38 41 $443 $35 23 Indiana $233 $36 43 $95 $15 41 Iowa $194 $64 25 $99 $33 26 Kansas $243 $86 14 $223 $79 6 Kentucky $199 $46 34 $83 $19 36 Louisiana $358 $80 20 $71 $16 39 Maine $82 $62 26 $27 $20 32 Maryland $187 $33 46 $113 $20 32 Massachusetts $935 $143 7 $77 $12 43 Michigan $426 $43 36 $118 $12 43 Minnesota $1,295 $245 3 $683 $129 1 Mississippi $136 $46 34 $131 $44 14 Missouri $442 $74 22 $113 $19 36 Montana $81 $83 18 $33 $34 25 Nebraska $105 $58 29 $66 $37 20 Nevada $84 $31 47 $12 $5 46 New Hampshire $68 $51 33 $53 $41 16 New Jersey $524 $60 28 $152 $17 38 New Mexico $317 $156 5 $81 $40 17 New York $5,377 $279 1 $40 $2 49 North Carolina $964 $102 13 $277 $29 28 North Dakota $20 $29 49 $3 $5 46 Ohio $818 $71 23 $607 $53 10 Oklahoma $254 $68 24 $222 $60 8 Oregon $439 $115 11 $370 $97 3 Pennsylvania $789 $62 26 $569 $45 12 Rhode Island $45 $43 36 $43 $40 17 South Carolina $199 $43 36 $165 $36 22 South Dakota $23 $29 49 $13 $16 39 Tennessee $337 $53 31 $84 $13 42 Texas $2,117 $85 15 $559 $23 30 Utah $36 $13 51 $24 $9 45 Vermont $81 $129 10 NA NA NA Virginia $416 $52 32 $398 $50 11 Washington $952 $143 7 $496 $74 7 West Virginia $157 $85 15 $84 $45 12 Wisconsin $781 $138 9 $506 $89 5 Wyoming $22 $40 40 $15 $26 29 United States $28,778 $94 $8,821 $29 Note: The highest data value within each ranking is indicated by a rank of 1. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 B and 2009 is used for GA and WI. 54 Public LTSS Expenditures: LTSS & Home Health Medicaid Personal Care Services Expenditures, 2009* Medicaid Home Health Services Expenditures, 2009* Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama NA NA NA $61 $13 15 Alaska $82 $118 4 $1 $1 44 Arizona $8 $1 32 $1 $0** 48 Arkansas $79 $27 18 $53 $18 10 California $4,983 $135 3 $179 $5 31 Colorado NA NA NA $176 $35 4 Connecticut NA NA NA $247 $69 2 Delaware NA NA NA $8 $9 24 District of Columbia $89 $150 2 $7 $11 19 Florida $57 $3 28 $169 $9 24 Georgia $1 $0** 35 $88 $9 24 Hawaii NA NA NA $1 $0** 48 Idaho $23 $15 23 $9 $6 29 Illinois NA NA NA $43 $3 36 Indiana NA NA NA $138 $21 7 Iowa NA NA NA $94 $31 5 Kansas $3 $1 32 $13 $5 31 Kentucky NA NA NA $116 $27 6 Louisiana $246 $55 10 $36 $8 27 Maine $51 $39 13 $4 $3 36 Maryland $35 $6 26 $39 $7 28 Massachusetts $632 $97 6 $101 $16 12 Michigan $268 $27 18 $26 $3 36 Minnesota $505 $96 7 $107 $20 8 Mississippi NA NA NA $5 $2 42 Missouri $318 $53 11 $5 $1 44 Montana $36 $36 15 $12 $12 18 Nebraska $16 $9 24 $23 $13 15 Nevada $68 $25 20 $3 $1 44 New Hampshire $6 $5 27 $8 $6 29 New Jersey $344 $39 13 $27 $3 36 New Mexico $226 $111 5 $1 $0** 48 New York $3,332 $173 1 $1,848 $96 1 North Carolina $526 $56 9 $161 $17 11 North Dakota $14 $21 21 $1 $2 42 Ohio NA NA NA $188 $16 12 Oklahoma $12 $3 28 $19 $5 31 Oregon $28 $7 25 $1 $0** 48 Pennsylvania NA NA NA $130 $10 23 Rhode Island NA NA NA $3 $3 36 South Carolina $10 $2 30 $12 $3 36 South Dakota $2 $2 30 $9 $11 19 Tennessee NA NA NA $242 $38 3 Texas $1,256 $51 12 $272 $11 19 Utah $2 $1 32 $11 $4 34 Vermont $19 $31 17 $7 $11 19 Virginia $0** $0** 35 $7 $1 44 Washington $418 $63 8 $29 $4 34 West Virginia $38 $21 21 $35 $19 9 Wisconsin $198 $35 16 $76 $13 15 Wyoming NA NA NA $8 $14 14 United States $13,931 $45 $4,861 $16 Note: The highest data value within each ranking is indicated by a rank of 1. Personal care services are not included in the state plan in some states. States not reporting any PCS expenditures or participants are indicated by NA. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 and 2009 B is used for GA and WI. **The value is less than $0.5 but rounds to zero. 55 Public LTSS Expenditures: LTSS & Home Health Medicaid LTSS Expenditures for Medicaid, Other HCBS Expenditures, 2009* All Populations, 2009* Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama NA NA NA $1,479 $311 38 Alaska NA NA NA $403 $576 6 Arizona $338 $53 2 $1,528 $241 47 Arkansas $1 $0** 22 $1,225 $423 20 California $116 $3 9 $12,801 $346 34 Colorado $67 $13 4 $1,374 $276 41 Connecticut NA NA NA $3,437 $965 2 Delaware NA NA NA $341 $382 24 District of Columbia NA NA NA $570 $962 3 Florida $43 $2 11 $4,379 $235 48 Georgia NA NA NA $1,998 $208 49 Hawaii NA NA NA $399 $296 39 Idaho NA NA NA $422 $272 43 Illinois NA NA NA $3,498 $273 42 Indiana NA NA NA $2,402 $372 27 Iowa $1 $0** 22 $1,337 $441 18 Kansas $5 $2 11 $1,056 $373 26 Kentucky NA NA NA $1,476 $342 36 Louisiana $4 $1 15 $2,110 $470 15 Maine NA NA NA $874 $658 4 Maryland NA NA NA $2,133 $372 27 Massachusetts $124 $19 3 $3,749 $575 7 Michigan $13 $1 15 $2,557 $258 46 Minnesota NA NA NA $3,430 $649 5 Mississippi NA NA NA $1,245 $421 21 Missouri $5 $1 15 $2,135 $358 29 Montana $0** $0** 22 $353 $358 29 Nebraska NA NA NA $718 $396 22 Nevada NA NA NA $378 $141 51 New Hampshire NA NA NA $607 $461 17 New Jersey $1 $0** 22 $4,457 $509 13 New Mexico $10 $5 8 $797 $391 23 New York $157 $8 6 $22,236 $1,152 1 North Carolina NA NA NA $3,576 $378 25 North Dakota $1 $1 15 $370 $557 8 Ohio $22 $2 11 $5,691 $494 14 Oklahoma $1 $0** 22 $1,298 $349 33 Oregon $40 $11 5 $1,289 $338 37 Pennsylvania $90 $7 7 $6,855 $541 10 Rhode Island NA NA NA $583 $553 9 South Carolina $12 $3 9 $1,281 $279 40 South Dakota NA NA NA $286 $354 31 Tennessee $11 $2 11 $2,160 $343 35 Texas $30 $1 15 $6,465 $261 45 Utah NA NA NA $411 $151 50 Vermont $54 $87 1 $336 $537 11 Virginia $11 $1 15 $2,092 $264 44 Washington $9 $1 15 $2,333 $350 32 West Virginia NA NA NA $986 $534 12 Wisconsin NA NA NA $2,654 $468 16 Wyoming NA NA NA $245 $438 19 United States $1,165 $4 $126,816 $413 Note: The highest data value within each ranking is indicated by a rank of 1. “Other HCBS” includes PACE, self-directed services authorized under Section 1915(j), and several other programs. States not reporting any expenditures of these types are indicated by NA. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 B 56 **The2009 isisused for GA and WI. and value less than $0.5 but rounds to zero. Public LTSS Expenditures: LTSS & Home Health Medicaid Institutional LTSS Expenditures for Medicaid HCBS Expenditures for All Populations, 2009* All Populations, 2009* Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $1,040 $219 22 $439 $92 44 Alaska $150 $215 24 $253 $361 5 Arizona $505 $80 51 $1,023 $161 24 Arkansas $860 $297 14 $365 $126 36 California $5,507 $149 41 $7,293 $197 17 Colorado $576 $116 46 $798 $160 27 Connecticut $1,921 $539 2 $1,516 $426 4 Delaware $221 $248 18 $120 $135 34 District of Columbia $283 $478 3 $287 $484 2 Florida $2,879 $154 39 $1,500 $80 47 Georgia $1,264 $131 45 $734 $76 48 Hawaii $231 $171 37 $168 $125 37 Idaho $227 $146 42 $195 $125 37 Illinois $2,439 $191 32 $1,059 $83 46 Indiana $1,664 $258 17 $739 $114 40 Iowa $811 $267 16 $526 $173 20 Kansas $477 $169 38 $579 $204 16 Kentucky $1,017 $235 20 $460 $107 42 Louisiana $1,343 $299 13 $767 $171 21 Maine $422 $317 10 $453 $340 7 Maryland $1,349 $235 20 $784 $137 33 Massachusetts $1,984 $304 11 $1,766 $271 9 Michigan $1,714 $173 35 $844 $85 45 Minnesota $1,099 $208 28 $2,331 $441 3 Mississippi $1,066 $360 7 $179 $60 50 Missouri $1,265 $212 26 $870 $146 29 Montana $186 $189 33 $166 $169 22 Nebraska $445 $245 19 $273 $151 28 Nevada $221 $82 50 $157 $59 51 New Hampshire $357 $271 15 $250 $190 18 New Jersey $3,311 $378 5 $1,146 $131 35 New Mexico $201 $99 47 $596 $293 8 New York $11,977 $620 1 $10,258 $531 1 North Carolina $2,046 $216 23 $1,530 $162 23 North Dakota $263 $396 4 $107 $161 24 Ohio $3,839 $333 8 $1,852 $161 24 Oklahoma $759 $204 30 $539 $145 30 Oregon $329 $86 48 $960 $252 11 Pennsylvania $4,630 $365 6 $2,225 $176 19 Rhode Island $317 $301 12 $266 $252 11 South Carolina $789 $172 36 $492 $107 42 South Dakota $170 $211 27 $116 $143 32 Tennessee $1,244 $197 31 $916 $145 30 Texas $3,490 $141 43 $2,975 $120 39 Utah $234 $86 48 $178 $65 49 Vermont $118 $189 33 $218 $349 6 Virginia $1,209 $153 40 $883 $111 41 Washington $884 $133 44 $1,449 $217 14 West Virginia $592 $320 9 $395 $214 15 Wisconsin $1,177 $208 28 $1,478 $261 10 Wyoming $121 $215 24 $124 $222 13 United States $71,220 $232 $55,596 $181 Note: The highest data value within each ranking is indicated by a rank of 1. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 and 2009 B is used for GA and WI. 57 Public LTSS Expenditures: LTSS & Home Health Medicaid HCBS Waiver Services Expenditures for Medicaid, Other HCBS Expenditures (including All Populations, 2009* PCS and Home Health) for All Populations, 2009* Value Per Person Value Per Person (Millions) in State Rank (Millions) in State Rank Alabama $378 $79 40 $61 $13 37 Alaska $170 $243 7 $83 $119 7 Arizona NA NA NA $1,023 $161 3 Arkansas $232 $80 38 $133 $46 19 California $2,016 $55 47 $5,277 $143 5 Colorado $556 $112 28 $242 $49 16 Connecticut $1,270 $356 1 $247 $69 11 Delaware $112 $125 24 $8 $9 41 District of Columbia $191 $323 3 $95 $161 3 Florida $1,231 $66 43 $269 $14 35 Georgia $645 $67 42 $89 $9 41 Hawaii $167 $124 25 $1 $0** 51 Idaho $163 $105 31 $32 $20 31 Illinois $1,016 $79 40 $43 $3 47 Indiana $601 $93 34 $138 $21 29 Iowa $431 $142 17 $95 $31 24 Kansas $558 $197 11 $21 $7 44 Kentucky $344 $80 38 $116 $27 26 Louisiana $481 $107 30 $286 $64 13 Maine $397 $299 4 $56 $42 21 Maryland $711 $124 25 $74 $13 37 Massachusetts $908 $139 19 $858 $132 6 Michigan $536 $54 48 $307 $31 24 Minnesota $1,719 $325 2 $612 $116 8 Mississippi $174 $59 45 $5 $2 49 Missouri $541 $91 35 $329 $55 15 Montana $118 $120 27 $48 $49 16 Nebraska $234 $129 23 $39 $21 29 Nevada $85 $32 49 $72 $27 26 New Hampshire $236 $179 12 $14 $11 40 New Jersey $774 $88 37 $372 $43 20 New Mexico $359 $176 13 $236 $116 8 New York $4,921 $255 5 $5,337 $276 2 North Carolina $844 $89 36 $687 $73 10 North Dakota $91 $137 20 $16 $24 28 Ohio $1,642 $142 17 $210 $18 32 Oklahoma $508 $137 20 $31 $8 43 Oregon $891 $234 8 $69 $18 32 Pennsylvania $2,006 $158 15 $219 $17 34 Rhode Island $263 $250 6 $3 $3 47 South Carolina $458 $100 33 $34 $7 44 South Dakota $105 $130 22 $10 $13 37 Tennessee $663 $105 31 $253 $40 22 Texas $1,417 $57 46 $1,558 $63 14 Utah $166 $61 44 $12 $4 46 Vermont NA NA NA $218 $349 1 Virginia $865 $109 29 $18 $2 49 Washington $992 $149 16 $456 $68 12 West Virginia $321 $174 14 $73 $40 22 Wisconsin $1,203 $212 9 $274 $48 18 Wyoming $117 $209 10 $8 $14 35 United States $34,826 $114 $20,770 $68 Note: The highest data value within each ranking is indicated by a rank of 1. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 B and 2009 is used for GA and WI. 58 **The value is less than $0.5 but rounds to zero. Public LTSS Expenditures: LTSS & Home Health State-funded HCBS Expenditures for Older People and Adults w/ Physical Disabilities, 2009* Value Per Person (Millions) in State Rank Alabama NA NA NA Alaska $4 $5.58 14 Arizona $16 $2.53 27 Arkansas $8 $2.66 24 California $182 $4.93 17 Colorado $22 $4.42 19 Connecticut $68 $19.09 2 Delaware $2 $1.77 32 District of Columbia NA NA NA Florida $57 $3.05 23 Georgia $18 $1.86 31 Hawaii $6 $4.12 22 Idaho NA NA NA Illinois $228 $17.85 3 Indiana $32 $4.94 16 Iowa $7 $2.20 29 Kansas $8 $2.65 25 Kentucky $34 $7.78 9 Louisiana NA NA NA Maine $16 $12.19 5 Maryland $13 $2.20 29 Massachusetts $136 $20.94 1 Michigan NA NA NA Minnesota $30 $5.76 13 Mississippi NA NA NA Missouri $9 $1.43 35 Montana NA NA NA Nebraska $2 $1.12 37 Nevada $28 $10.43 6 New Hampshire $12 $9.25 7 New Jersey $43 $4.93 17 New Mexico NA NA NA New York $115 $5.96 12 North Carolina $39 $4.14 21 North Dakota $1 $1.20 36 Ohio $12 $1.00 38 Oklahoma $3 $0.69 39 Oregon $6 $1.59 33 Pennsylvania $220 $17.34 4 Rhode Island $5 $4.41 20 South Carolina NA NA NA South Dakota NA NA NA Tennessee $9 $1.49 34 Texas $13 $0.52 40 Utah $25 $9.09 8 Vermont $4 $6.96 10 Virginia $18 $2.27 28 Washington $18 $2.63 26 West Virginia $13 $6.91 11 Wisconsin NA NA NA Wyoming $3 $5.45 15 United States $1,481 $4.83 Note: The highest data value within each ranking is indicated by a rank of 1. * ecause of inconsistencies in the numbers for some services, 2008 data are used for HI, NM, and RI, and an average of 2008 and B 2009 is used for GA and WI. 59 Public LTSS Expenditures: Users by Type of Service Medicaid HCBS Users (Older People and Adults Medicaid Nursing Facility Users, 2008 with Physical Disabilities), 2008 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama 25,671 5.4 26 16,211 3.4 40 Alaska 939 1.4 50 6,863 10.0 12 Arizona NA NA NA NA NA NA Arkansas 27,184 9.5 3 29,859 10.4 10 California 137,361 3.8 39 524,639 14.3 2 Colorado 16,320 3.3 44 28,454 5.8 30 Connecticut 39,696 11.2 1 27,543 7.8 21 Delaware 3,713 4.2 35 2,576 2.9 42 District of Columbia 3,359 5.8 20 8,248 14.2 3 Florida 77,853 4.2 35 46,742 2.5 44 Georgia 38,806 4.1 38 21,115 2.2 47 Hawaii 4,863 3.7 40 4,347 3.3 41 Idaho 5,337 3.5 42 16,459 10.7 9 Illinois 71,848 5.6 23 186,145 14.6 1 Indiana 44,479 6.9 10 15,602 2.4 45 Iowa 19,597 6.5 12 28,333 9.4 14 Kansas 15,549 5.5 25 20,801 7.4 23 Kentucky 27,701 6.5 12 28,363 6.6 27 Louisiana 28,846 6.5 12 27,838 6.3 29 Maine 10,285 7.7 7 13,464 10.1 11 Maryland 24,714 4.3 34 12,123 2.1 48 Massachusetts 53,232 8.2 6 44,381 6.9 25 Michigan 46,964 4.7 31 74,047 7.4 23 Minnesota 29,124 5.6 23 74,107 14.1 4 Mississippi 21,734 7.4 8 20,249 6.9 25 Missouri 38,466 6.5 12 75,096 12.7 5 Montana 5,163 5.3 27 5,690 5.8 30 Nebraska 10,815 6.0 19 15,419 8.6 18 Nevada 4,842 1.8 49 9,572 3.6 39 New Hampshire 6,840 5.2 28 6,015 4.6 36 New Jersey 44,595 5.1 30 46,663 5.4 32 New Mexico 6,021 3.0 46 16,336 8.1 19 New York 212,714 11.1 2 212,020 11.0 8 North Carolina 41,234 4.4 32 104,983 11.3 7 North Dakota 5,505 8.4 5 3,079 4.7 35 Ohio 83,530 7.3 9 76,001 6.6 27 Oklahoma 21,376 5.8 20 34,015 9.3 15 Oregon 10,189 2.7 47 33,804 9.0 17 Pennsylvania 77,931 6.2 16 52,489 4.2 38 Rhode Island 9,815 9.3 4 5,013 4.8 34 South Carolina 16,288 3.6 41 22,885 5.1 33 South Dakota 5,533 6.9 10 7,333 9.2 16 Tennessee 32,471 5.2 28 14,069 2.3 46 Texas 102,111 4.2 35 289,935 11.9 6 Utah 5,498 2.1 48 5,592 2.1 48 Vermont 3,793 6.1 18 NA NA NA Virginia 26,804 3.4 43 20,316 2.6 43 Washington 21,209 3.2 45 62,105 9.5 13 West Virginia 11,474 6.2 16 13,765 7.5 22 Wisconsin 32,585 5.8 20 45,354 8.0 20 Wyoming 2,427 4.4 32 2,464 4.5 37 United States 1,614,404 5.3 2,499,867 8.2 Note: The highest data value within each ranking is indicated by a rank of 1. 60 Public LTSS Expenditures: Users by Type of Service Medicaid HCBS Aged/Disabled Waiver Medicaid HCBS Personal Care Services Users, 2008 Services Users, 2008 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama 9,468 2.0 28 NA NA NA Alaska 3,049 4.4 10 3,520 5.1 7 Arizona NA NA NA NA NA NA Arkansas 10,173 3.5 14 13,923 4.8 8 California 16,119 0.4 49 422,823 11.6 1 Colorado 17,490 3.6 13 NA NA NA Connecticut 12,386 3.5 14 NA NA NA Delaware 1,307 1.5 36 NA NA NA District of Columbia 1,714 3.0 21 2,298 4.0 12 Florida 29,316 1.6 32 403 0.0* 30 Georgia 15,082 1.6 32 NA NA NA Hawaii 2,719 2.0 28 NA NA NA Idaho 8,185 5.3 5 3,799 2.5 19 Illinois 58,001 4.6 8 NA NA NA Indiana 7,311 1.1 41 NA NA NA Iowa 15,103 5.0 6 NA NA NA Kansas 16,567 5.9 4 89 0.0* 30 Kentucky 10,217 2.4 24 NA NA NA Louisiana 4,615 1.0 42 11,532 2.6 17 Maine 1,635 1.2 40 8,963 6.7 3 Maryland 3,998 0.7 45 4,416 0.8 28 Massachusetts 9,828 1.5 36 16,900 2.6 17 Michigan 9,498 1.0 42 58,653 5.9 5 Minnesota 40,724 7.8 1 20,759 4.0 12 Mississippi 12,361 4.2 11 NA NA NA Missouri 19,620 3.3 18 49,333 8.3 2 Montana 2,205 2.3 25 3,093 3.2 15 Nebraska 5,909 3.3 18 1,832 1.0 25 Nevada 2,654 1.0 42 6,205 2.3 22 New Hampshire 3,454 2.6 23 21 0.0* 30 New Jersey 11,345 1.3 38 20,623 2.4 21 New Mexico 3,575 1.8 30 12,365 6.1 4 New York 24,140 1.3 38 78,494 4.1 10 North Carolina 14,579 1.6 32 50,017 5.4 6 North Dakota 361 0.5 47 1,853 2.8 16 Ohio 44,693 3.9 12 NA NA NA Oklahoma 25,687 7.0 3 3,327 0.9 26 Oregon 27,403 7.3 2 3,389 0.9 26 Pennsylvania 26,714 2.1 26 NA NA NA Rhode Island 3,577 3.4 17 NA NA NA South Carolina 14,922 3.3 18 NA NA NA South Dakota 1,472 1.8 30 996 1.2 24 Tennessee 3,204 0.5 47 NA NA NA Texas 39,536 1.6 32 51,567 2.1 23 Utah 1,492 0.6 46 1,964 0.7 29 Vermont NA NA NA 2,653 4.3 9 Virginia 16,583 2.1 26 NA NA NA Washington 31,748 4.8 7 27,075 4.1 10 West Virginia 5,592 3.0 21 6,026 3.3 14 Wisconsin 25,287 4.5 9 14,032 2.5 19 Wyoming 1,909 3.5 14 NA NA NA United States 674,528 2.2 902,943 3.0 Note: The highest data value within each ranking is indicated by a rank of 1. Personal care services are not included in the state plan in some states. States not reporting any PCS expenditures or participants are indicated by NA. *The value is less than 0.05 but rounds to zero. 61 Public LTSS Expenditures: Users by Type of Service Medicaid Institutional Services Medicaid HCBS Home Health Services Users, 2008 (NF and ICF-MR) Users, 2008 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama 6,743 1.4 28 25,912 5.5 26 Alaska 294 0.4 47 944 1.4 50 Arizona NA NA NA NA NA NA Arkansas 5,763 2.0 21 29,416 10.2 3 California 85,697 2.3 18 145,978 4.0 39 Colorado 10,964 2.2 19 16,476 3.4 44 Connecticut 15,157 4.3 8 40,929 11.5 1 Delaware 1,269 1.4 28 3,851 4.4 35 District of Columbia 4,236 7.3 3 4,017 6.9 14 Florida 17,023 0.9 39 80,860 4.4 35 Georgia 6,033 0.6 43 40,469 4.3 38 Hawaii 1,628 1.2 34 4,950 3.7 42 Idaho 4,475 2.9 12 5,908 3.9 41 Illinois 128,144 10.1 1 81,126 6.4 19 Indiana 8,291 1.3 32 48,785 7.6 11 Iowa 13,230 4.4 7 21,881 7.3 12 Kansas 4,145 1.5 27 16,176 5.8 25 Kentucky 18,146 4.2 11 28,378 6.6 16 Louisiana 11,691 2.6 16 34,294 7.7 10 Maine 2,866 2.2 19 10,504 7.9 8 Maryland 3,709 0.7 42 25,061 4.4 35 Massachusetts 17,653 2.7 13 54,271 8.4 6 Michigan 5,896 0.6 43 47,098 4.7 32 Minnesota 12,624 2.4 17 32,035 6.1 22 Mississippi 7,888 2.7 13 24,877 8.4 6 Missouri 6,143 1.0 37 39,427 6.7 15 Montana 392 0.4 47 5,228 5.4 28 Nebraska 7,678 4.3 8 11,454 6.4 19 Nevada 713 0.3 49 4,971 1.9 49 New Hampshire 2,540 1.9 23 6,874 5.2 30 New Jersey 14,695 1.7 25 48,038 5.5 26 New Mexico 396 0.2 50 6,291 3.1 46 New York 109,386 5.7 6 221,828 11.5 1 North Carolina 40,387 4.3 8 45,419 4.9 31 North Dakota 865 1.3 32 6,160 9.4 4 Ohio 31,308 2.7 13 91,274 7.9 8 Oklahoma 5,001 1.4 28 23,127 6.3 21 Oregon 3,012 0.8 40 10,229 2.7 47 Pennsylvania 25,775 2.0 21 81,945 6.5 17 Rhode Island 1,436 1.4 28 9,862 9.3 5 South Carolina 7,963 1.8 24 17,917 4.0 39 South Dakota 4,865 6.1 4 5,715 7.2 13 Tennessee 10,865 1.7 25 33,688 5.4 28 Texas 198,832 8.2 2 114,213 4.7 32 Utah 2,136 0.8 40 6,326 2.4 48 Vermont 3,723 6.0 5 3,802 6.1 22 Virginia 3,733 0.5 45 28,603 3.7 42 Washington 3,282 0.5 45 21,271 3.2 45 West Virginia 2,147 1.2 34 12,046 6.5 17 Wisconsin 6,035 1.1 36 34,028 6.0 24 Wyoming 555 1.0 37 2,522 4.6 34 United States 922,396 3.0 1,717,794 5.6 Note: The highest data value within each ranking is indicated by a rank of 1. 62 Public LTSS Expenditures: Users by Type of Service HCBS Waiver Services Users, HCBS Users, All Populations, 2008 All Populations, 2008 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama 21,888 4.6 42 15,145 3.2 34 Alaska 8,358 12.2 13 4,544 6.6 10 Arizona 34,968 5.6 39 NA NA NA Arkansas 33,404 11.6 17 13,718 4.8 23 California 599,526 16.4 2 91,006 2.5 45 Colorado 40,455 8.3 29 29,491 6.0 13 Connecticut 31,145 8.8 26 15,988 4.5 27 Delaware 4,129 4.7 41 2,860 3.2 34 District of Columbia 9,352 16.1 4 2,818 4.9 22 Florida 82,578 4.5 43 65,152 3.5 33 Georgia 32,680 3.4 49 26,647 2.8 41 Hawaii 7,183 5.4 40 5,555 4.2 30 Idaho 18,844 12.3 12 10,570 6.9 9 Illinois 208,346 16.3 3 80,202 6.3 11 Indiana 26,323 4.1 46 18,032 2.8 41 Iowa 40,185 13.3 7 26,955 8.9 4 Kansas 33,423 11.9 15 29,189 10.4 2 Kentucky 31,617 7.4 34 13,471 3.1 37 Louisiana 36,172 8.2 32 12,949 2.9 38 Maine 17,368 13.1 8 5,539 4.2 30 Maryland 24,552 4.3 44 16,427 2.9 38 Massachusetts 57,662 8.9 25 23,109 3.6 32 Michigan 82,580 8.3 29 18,031 1.8 47 Minnesota 90,225 17.2 1 56,842 10.8 1 Mississippi 22,924 7.8 33 15,036 5.1 19 Missouri 84,110 14.2 6 28,634 4.8 23 Montana 8,105 8.3 29 4,620 4.7 25 Nebraska 19,546 10.9 18 10,036 5.6 16 Nevada 11,258 4.2 45 4,340 1.6 49 New Hampshire 9,088 6.9 35 6,527 5.0 21 New Jersey 60,322 6.9 35 25,004 2.9 38 New Mexico 21,575 10.7 21 8,814 4.4 29 New York 276,868 14.4 5 88,988 4.6 26 North Carolina 115,793 12.4 11 25,389 2.7 43 North Dakota 6,614 10.1 22 3,896 5.9 14 Ohio 96,932 8.4 27 65,624 5.7 15 Oklahoma 39,720 10.8 20 31,392 8.6 5 Oregon 44,688 11.9 15 38,287 10.2 3 Pennsylvania 82,724 6.6 38 56,949 4.5 27 Rhode Island 8,893 8.4 27 7,457 7.1 8 South Carolina 31,099 6.9 35 23,136 5.1 19 South Dakota 10,211 12.8 10 4,350 5.4 17 Tennessee 21,183 3.4 49 10,318 1.7 48 Texas 314,728 12.9 9 64,329 2.6 44 Utah 10,215 3.8 47 6,115 2.3 46 Vermont NA NA NA NA NA NA Virginia 28,493 3.6 48 24,760 3.2 34 Washington 71,808 10.9 18 41,451 6.3 11 West Virginia 17,659 9.6 23 9,486 5.2 18 Wisconsin 67,941 12.0 14 47,874 8.5 6 Wyoming 4,915 9.0 24 4,360 8.0 7 United States 3,066,750 10.1 1,241,411 4.1 Note: The highest data value within each ranking is indicated by a rank of 1. 63 Public LTSS Expenditures: Users by Type of Service Other HCBS Services (including PCS and Adults with Disabilities Home Health) Users, All Populations, 2008 Self-Directing Services, 2011 Per 1,000 Per 1,000 Value Population Rank Value Population Rank Alabama 6,743 1.4 42 89 0.02 49 Alaska 3,814 5.5 16 3,688 5.36 4 Arizona 34,968 5.6 15 2,140 0.34 39 Arkansas 19,686 6.8 11 4,928 1.71 11 California 508,520 13.9 1 480,000 13.11 1 Colorado 10,964 2.2 34 19,550 4.00 6 Connecticut 15,157 4.3 24 2,429 0.69 31 Delaware 1,269 1.4 42 35 0.04 48 District of Columbia 6,534 11.3 2 1 0.00* 51 Florida 17,426 0.9 49 1,984 0.11 46 Georgia 6,033 0.6 50 2,849 0.30 41 Hawaii 1,628 1.2 47 2,271 1.70 12 Idaho 8,274 5.4 17 1,178 0.77 29 Illinois 128,144 10.1 5 8,327 0.65 33 Indiana 8,291 1.3 46 905 0.14 45 Iowa 13,230 4.4 22 3,095 1.03 24 Kansas 4,234 1.5 40 3,416 1.22 21 Kentucky 18,146 4.2 25 4,332 1.01 25 Louisiana 23,223 5.2 20 2,235 0.50 35 Maine 11,829 8.9 9 930 0.70 30 Maryland 8,125 1.4 42 7,175 1.26 20 Massachusetts 34,553 5.3 18 19,460 3.01 8 Michigan 64,549 6.5 12 9,355 0.94 27 Minnesota 33,383 6.4 13 5,736 1.09 22 Mississippi 7,888 2.7 30 3,750 1.27 19 Missouri 55,476 9.4 8 15,270 2.58 9 Montana 3,485 3.6 28 4,832 4.95 5 Nebraska 9,510 5.3 18 2,346 1.31 17 Nevada 6,918 2.6 32 1,238 0.47 36 New Hampshire 2,561 1.9 36 1,770 1.35 16 New Jersey 35,318 4.1 26 2,587 0.30 41 New Mexico 12,761 6.3 14 4,400 2.19 10 New York 187,880 9.8 6 10,252 0.53 34 North Carolina 90,404 9.7 7 70 0.01 50 North Dakota 2,718 4.1 26 432 0.66 32 Ohio 31,308 2.7 30 1,082 0.09 47 Oklahoma 8,328 2.3 33 953 0.26 43 Oregon 6,401 1.7 38 23,512 6.24 3 Pennsylvania 25,775 2.0 35 19,157 1.52 15 Rhode Island 1,436 1.4 42 1,642 1.56 14 South Carolina 7,963 1.8 37 1,786 0.39 37 South Dakota 5,861 7.3 10 1,036 1.30 18 Tennessee 10,865 1.7 38 1,186 0.19 44 Texas 250,399 10.3 3 7,964 0.33 40 Utah 4,100 1.5 40 2,875 1.08 23 Vermont 6,376 10.2 4 4,310 6.91 2 Virginia 3,733 0.5 51 7,809 1.00 26 Washington 30,357 4.6 21 22,585 3.44 7 West Virginia 8,173 4.4 22 690 0.37 38 Wisconsin 20,067 3.6 28 9,563 1.70 12 Wyoming 555 1.0 48 506 0.93 28 United States 1,825,339 6.0 739,711 2.43 Note: The highest data value within each ranking is indicated by a rank of 1. *The value is less than less than 0.005 but rounds to zero. 64 Public LTSS Expenditures: Medicaid LTSS Balance Medicaid Aged/Disabled Waiver Medicaid HCBS Beneficiaries as a % Medicaid HCBS Beneficiaries as a Participants per 100 Beneficiaries in of LTSS Users, for Older People and % of LTSS Users, for All Populations, Nursing Facilities, 2008 Adults with PD, 2008 2008 Value (Thousands) Rank Value Rank Value Rank Alabama 37 29 39% 42 46% 45 Alaska 325 1 88% 1 90% 1 Arizona NA NA NA NA NA NA Arkansas 37 29 52% 25 53% 32 California 12 46 79% 2 80% 3 Colorado 107 7 64% 14 71% 11 Connecticut 31 36 41% 39 43% 47 Delaware 35 33 41% 39 52% 34 District of Columbia 51 21 71% 11 70% 12 Florida 38 28 38% 43 51% 38 Georgia 39 26 35% 45 45% 46 Hawaii 56 17 47% 35 59% 27 Idaho 153 3 76% 4 76% 6 Illinois 81 10 72% 8 72% 9 Indiana 16 42 26% 49 35% 49 Iowa 77 13 59% 17 65% 18 Kansas 107 7 57% 21 67% 15 Kentucky 37 29 51% 27 53% 32 Louisiana 16 42 49% 32 51% 38 Maine 16 42 57% 21 62% 24 Maryland 16 42 33% 47 49% 42 Massachusetts 18 41 45% 37 52% 34 Michigan 20 40 61% 15 64% 19 Minnesota 140 5 72% 8 74% 7 Mississippi 57 16 48% 33 48% 43 Missouri 51 21 66% 12 68% 14 Montana 43 25 52% 25 61% 26 Nebraska 55 18 59% 17 63% 21 Nevada 55 18 66% 12 69% 13 New Hampshire 50 23 47% 35 57% 29 New Jersey 25 39 51% 27 56% 30 New Mexico 59 15 73% 7 77% 4 New York 11 47 50% 29 56% 30 North Carolina 35 33 72% 8 72% 9 North Dakota 7 49 36% 44 52% 34 Ohio 54 20 48% 33 52% 34 Oklahoma 120 6 61% 15 63% 21 Oregon 269 2 77% 3 81% 2 Pennsylvania 34 35 40% 41 50% 40 Rhode Island 36 32 34% 46 47% 44 South Carolina 92 9 58% 19 63% 21 South Dakota 27 37 57% 21 64% 19 Tennessee 10 48 30% 48 39% 48 Texas 39 26 74% 6 73% 8 Utah 27 37 50% 29 62% 24 Vermont NA NA NA NA NA NA Virginia 62 14 43% 38 50% 40 Washington 150 4 75% 5 77% 4 West Virginia 49 24 55% 24 59% 27 Wisconsin 78 12 58% 19 67% 15 Wyoming 79 11 50% 29 66% 17 United States 42 61% 64% Note: The highest data value within each ranking is indicated by a rank of 1. 65 Public LTSS Expenditures: per Person Served Medicaid Nursing Facility Medicaid HCBS Expenditures for Medicaid Aged/Disabled Waiver Services Expenditures per Older People and Adults w/ PD per Services Expenditures per Person Person Served, 2008 Person Served, 2008 Served, 2008 Value Rank Value Rank Value Rank Alabama $32,322 16 $9,704 22 $9,704 28 Alaska $79,078 1 $18,711 2 $16,543 5 Arizona $24,154 43 NA NA NA NA Arkansas $16,318 51 $5,136 43 $6,697 39 California $28,341 31 $10,184 19 $8,906 32 Colorado $30,886 20 $7,895 33 $7,895 35 Connecticut $33,346 13 $10,626 17 $10,626 23 Delaware $48,369 3 $12,893 10 $12,893 13 District of Columbia $47,938 4 $8,456 32 $14,564 10 Florida $30,019 24 $10,380 18 $10,305 24 Georgia $27,253 36 $8,935 28 $8,935 31 Hawaii $43,501 5 $15,853 4 $15,853 6 Idaho $32,519 14 $8,784 29 $9,106 30 Illinois $21,865 48 $8,503 30 $8,503 33 Indiana $23,625 46 $8,460 31 $8,460 34 Iowa $24,294 42 $5,772 41 $5,772 43 Kansas $23,026 47 $11,874 14 $11,938 21 Kentucky $28,157 34 $3,393 48 $3,393 48 Louisiana $24,887 40 $3,518 46 $12,308 18 Maine $23,988 44 $7,499 36 $14,163 11 Maryland $41,167 6 $13,510 7 $22,455 1 Massachusetts $35,462 10 $13,295 8 $4,156 46 Michigan $32,319 17 $5,296 42 $9,504 29 Minnesota $28,341 31 $13,279 9 $14,998 9 Mississippi $32,490 15 $7,572 35 $7,572 38 Missouri $21,832 49 $5,868 40 $5,148 45 Montana $29,937 25 $10,988 16 $13,350 12 Nebraska $27,296 35 $9,388 23 $9,987 27 Nevada $33,912 12 $9,325 24 $4,083 47 New Hampshire $30,823 21 $12,827 11 $12,781 14 New Jersey $40,908 7 $12,226 13 $12,384 17 New Mexico $28,767 27 $3,457 47 $15,416 8 New York $34,175 11 $23,177 1 $1,484 49 North Carolina $26,210 37 $8,975 27 $18,037 3 North Dakota $30,907 19 $1,067 49 $6,543 40 Ohio $30,535 22 $12,612 12 $12,612 15 Oklahoma $24,444 41 $7,085 37 $7,605 37 Oregon $31,766 18 $9,312 25 $10,283 25 Pennsylvania $37,867 8 $18,218 3 $18,218 2 Rhode Island $52,105 2 $10,025 21 $10,025 26 South Carolina $28,361 30 $7,734 34 $7,734 36 South Dakota $24,983 38 $3,894 45 $5,332 44 Tennessee $28,367 29 $5,928 39 $5,928 42 Texas $18,963 50 $10,065 20 $12,506 16 Utah $28,933 26 $5,091 44 $10,697 22 Vermont $30,496 23 NA NA NA NA Virginia $28,215 33 $15,566 5 $15,566 7 Washington $24,899 39 $11,692 15 $12,080 19 West Virginia $37,860 9 $9,054 26 $12,051 20 Wisconsin $23,958 45 $15,056 6 $17,661 4 Wyoming $28,427 28 $5,970 38 $5,970 41 United States $29,533 $10,957 $10,710 Note: The highest data value within each ranking is indicated by a rank of 1. 66 Public LTSS Expenditures: per Person Served Medicaid PCS Expenditures per Medicaid Home Health Services Person Served, 2008 Expenditures per Person Served, 2008 Value Rank Value Rank Alabama NA NA $3,708 18 Alaska $20,589 2 $3,256 20 Arizona NA NA NA NA Arkansas $3,996 27 $1,799 34 California $10,232 13 $1,823 33 Colorado NA NA $8,086 5 Connecticut NA NA $9,799 4 Delaware NA NA $3,995 16 District of Columbia $3,900 28 $4,163 15 Florida $15,830 7 $4,189 14 Georgia NA NA $835 47 Hawaii NA NA $1,946 32 Idaho $8,089 17 $1,673 35 Illinois NA NA $962 45 Indiana NA NA $12,762 3 Iowa NA NA $8,075 6 Kansas $14,011 8 $2,916 25 Kentucky NA NA $2,750 26 Louisiana $16,833 5 $3,124 22 Maine $6,284 22 $2,688 27 Maryland $5,412 25 $627 49 Massachusetts $18,610 4 $4,853 11 Michigan $4,614 26 $685 48 Minnesota $9,906 14 $1,993 31 Mississippi NA NA $923 46 Missouri $6,154 24 $969 44 Montana $9,304 15 $1,101 41 Nebraska $7,453 19 $4,966 10 Nevada $11,567 10 $4,694 13 New Hampshire $20,496 3 $1,173 40 New Jersey $12,140 9 $3,337 19 New Mexico $16,471 6 $1,077 42 New York $29,848 1 $16,846 2 North Carolina $6,333 21 $3,251 21 North Dakota $6,675 20 $6,648 8 Ohio NA NA $4,787 12 Oklahoma $3,077 29 $2,147 29 Oregon $1,463 31 $350 50 Pennsylvania NA NA $7,268 7 Rhode Island NA NA $2,115 30 South Carolina NA NA $3,721 17 South Dakota $1,770 30 $979 43 Tennessee NA NA $17,045 1 Texas $8,193 16 $2,349 28 Utah $832 32 $5,322 9 Vermont $7,676 18 $1,639 36 Virginia NA NA $1,565 38 Washington $11,236 11 $1,305 39 West Virginia $6,273 23 $1,570 37 Wisconsin $10,362 12 $2,922 24 Wyoming NA NA $3,072 23 United States $11,142 $5,495 Note: The highest data value within each ranking is indicated by a rank of 1. Personal care services are not included in the state plan in some states. States not reporting any PCS expenditures or participants are indicated by NA. 67 Public LTSS Expenditures: per Person Served Medicaid ICF-MR Services Medicaid MR/DD Waiver Services Expenditures per Person Served, 2008 Expenditures per Person Served, 2008 Value Rank Value Rank Alabama $144,633 14 $43,421 24 Alaska $170,340 10 $59,949 8 Arizona NA NA NA NA Arkansas $61,467 50 $32,074 35 California $83,545 40 $23,564 45 Colorado $144,069 15 $39,340 28 Connecticut $190,441 6 $19,488 48 Delaware $215,541 3 $96,836 1 District of Columbia $112,654 23 $30,409 38 Florida $109,714 26 $30,323 39 Georgia $71,121 44 $13,599 49 Hawaii $102,725 30 $32,833 34 Idaho $114,706 22 $27,518 43 Illinois $61,960 49 $30,176 40 Indiana $67,259 48 $44,455 20 Iowa $125,416 20 $26,531 44 Kansas $100,801 31 $36,224 30 Kentucky $88,394 37 $67,486 6 Louisiana $87,358 39 $45,281 19 Maine $137,218 19 $77,736 3 Maryland $158,901 12 $46,780 18 Massachusetts $206,175 4 $48,810 14 Michigan $163,811 11 $48,251 17 Minnesota $68,762 46 $63,802 7 Mississippi $89,852 34 $20,774 47 Missouri $111,027 25 $44,194 21 Montana $182,088 9 $33,671 33 Nebraska $106,731 28 $35,988 31 Nevada $145,041 13 $39,587 27 New Hampshire $88,394 37 $48,447 15 New Jersey $184,533 8 $31,281 36 New Mexico $78,659 41 $48,447 15 New York $384,582 1 $77,992 2 North Carolina $111,333 24 $43,520 23 North Dakota $107,602 27 $21,949 46 Ohio $96,287 32 $40,889 25 Oklahoma $68,021 47 $52,103 12 Oregon $281,470 2 $40,590 26 Pennsylvania $140,236 18 $50,294 13 Rhode Island $189,654 7 $69,470 5 South Carolina $89,608 35 $36,602 29 South Dakota $119,182 21 $30,089 41 Tennessee $196,136 5 $70,968 4 Texas $78,237 42 $35,502 32 Utah $70,476 45 $31,161 37 Vermont $143,510 16 NA NA Virginia $143,378 17 $54,967 11 Washington $73,741 43 $43,715 22 West Virginia $105,026 29 $57,480 9 Wisconsin $88,970 36 $28,717 42 Wyoming $94,774 33 $56,804 10 United States $123,053 $42,896 Note: The highest data value within each ranking is indicated by a rank of 1. 68 LTSS Costs: Public & Private Payment Rates Medicaid Payment per Day for Medicare Payment per Day for Medicare Reimbursement per Nursing Facility Care, 2011 Nursing Facility Care, 2010 Home Health Visit, 2010 Value Rank Value Rank Value Rank Alabama NA NA $341 48 $153 35 Alaska NA NA $648 1 $217 2 Arizona $177 21 $423 19 $188 7 Arkansas NA NA $334 50 $127 49 California $171 24 $506 2 $188 7 Colorado $191 17 $437 10 $158 29 Connecticut $221 4 $432 12 $132 47 Delaware $209 8 $421 20 $172 16 District of Columbia $261 1 $428 16 $185 10 Florida $206 11 $404 28 $133 46 Georgia $143 37 $354 41 $166 23 Hawaii $233 2 $440 9 $240 1 Idaho $194 15 $395 30 $153 35 Illinois $120 42 $391 31 $193 6 Indiana $156 29 $364 37 $154 33 Iowa $144 35 $429 15 $138 43 Kansas $150 32 $420 22 $147 38 Kentucky NA NA $349 43 $157 30 Louisiana NA NA $322 51 $143 40 Maine $178 20 $424 18 $167 21 Maryland $223 3 $408 27 $199 5 Massachusetts $197 13 $443 7 $141 41 Michigan $208 10 $382 33 $186 9 Minnesota $165 26 $432 12 $174 15 Mississippi NA NA $353 42 $156 32 Missouri $133 38 $347 45 $168 18 Montana $174 23 $402 29 $170 17 Nebraska $144 35 $415 24 $165 25 Nevada $184 19 $456 5 $179 13 New Hampshire $195 14 $434 11 $163 27 New Jersey $209 8 $464 3 $180 12 New Mexico NA NA $377 36 $154 33 New York $220 6 $417 23 $131 48 North Carolina NA NA $356 39 $178 14 North Dakota $206 11 $383 32 $140 42 Ohio $177 21 $378 34 $146 39 Oklahoma $127 40 $344 46 $127 49 Oregon $221 4 $454 6 $216 3 Pennsylvania $212 7 $378 34 $165 25 Rhode Island $194 15 $427 17 $168 18 South Carolina $154 30 $348 44 $182 11 South Dakota $130 39 $430 14 $166 23 Tennessee $145 34 $342 47 $157 30 Texas $126 41 $356 39 $138 43 Utah $163 28 $414 25 $119 51 Vermont $189 18 $442 8 $135 45 Virginia $153 31 $358 38 $167 21 Washington $168 25 $459 4 $215 4 West Virginia NA NA $339 49 $168 18 Wisconsin $150 32 $412 26 $163 27 Wyoming $164 27 $421 20 $150 37 United States $178 $398 $154 Note: The highest data value within each ranking is indicated by a rank of 1. 69 LTSS Costs: Public & Private Payment Rates Semi-Private Pay Rate per Day in Private Pay Rate per Month in Nursing Facility, 2011 Assisted Living, 2011 Value Rank Value Rank Alabama $170 39 $2,899 40 Alaska $609 1 $5,500 1 Arizona $175 36 $3,000 35 Arkansas $143 47 $2,700 46 California $213 20 $3,500 17 Colorado $202 23 $3,288 25 Connecticut $357 2 $4,488 6 Delaware $230 14 $4,626 4 District of Columbia $282 7 $4,350 7 Florida $210 21 $2,663 47 Georgia $160 42 $2,400 51 Hawaii $297 5 $3,825 11 Idaho $200 24 $3,113 29 Illinois $150 44 $3,490 20 Indiana $183 32 $3,447 21 Iowa $145 45 $3,182 28 Kansas $144 46 $3,518 16 Kentucky $185 30 $2,948 39 Louisiana $137 48 $3,065 34 Maine $260 9 $4,625 5 Maryland $227 15 $3,300 24 Massachusetts $320 3 $4,950 2 Michigan $220 17 $3,000 35 Minnesota $185 30 $3,100 30 Mississippi $189 28 $2,949 38 Missouri $134 49 $2,420 50 Montana $183 32 $3,100 30 Nebraska $175 36 $2,803 41 Nevada $210 21 $2,750 43 New Hampshire $263 8 $3,906 10 New Jersey $289 6 $4,938 3 New Mexico $183 32 $3,491 19 New York $315 4 $3,660 13 North Carolina $183 32 $2,800 42 North Dakota $188 29 $2,500 49 Ohio $190 27 $3,325 23 Oklahoma $130 50 $2,748 45 Oregon $220 17 $3,500 17 Pennsylvania $245 12 $3,000 35 Rhode Island $258 10 $4,213 8 South Carolina $175 36 $3,070 33 South Dakota $167 41 $2,750 43 Tennessee $170 39 $3,080 32 Texas $127 51 $3,210 27 Utah $157 43 $2,648 48 Vermont $249 11 $3,600 14 Virginia $191 26 $3,705 12 Washington $224 16 $4,000 9 West Virginia $233 13 $3,275 26 Wisconsin $218 19 $3,550 15 Wyoming $192 25 $3,407 22 United States $193 $3,261 Note: The highest data value within each ranking is indicated by a rank of 1. 70 LTSS Costs: Public & Private Payment Rates Private Pay Daily Rate for Private Pay Hourly Rate for Adult Day Care, 2011 Home Health Aide, 2011 Value Rank Value Rank Alabama $35 50 $16 47 Alaska $90 6 $27 1 Arizona $80 8 $19 31 Arkansas $63 25 $16 47 California $77 9 $21 11 Colorado $60 27 $21 11 Connecticut $75 11 $22 8 Delaware $75 11 $21 11 District of Columbia $104 2 $21 11 Florida $60 27 $18 37 Georgia $59 33 $18 37 Hawaii $64 23 $25 3 Idaho $96 4 $18 37 Illinois $65 21 $20 22 Indiana $68 16 $18 37 Iowa $52 41 $20 22 Kansas $63 25 $18 37 Kentucky $59 33 $18 37 Louisiana $59 33 $16 47 Maine $92 5 $21 11 Maryland $75 11 $20 22 Massachusetts $60 27 $25 3 Michigan $76 10 $19 31 Minnesota $66 19 $26 2 Mississippi $64 23 $16 47 Missouri $70 14 $19 31 Montana $70 14 $21 11 Nebraska $50 42 $20 22 Nevada $65 21 $21 11 New Hampshire $60 27 $24 5 New Jersey $87 7 $21 11 New Mexico $68 16 $20 22 New York $48 47 $21 11 North Carolina $48 47 $19 31 North Dakota $67 18 $23 6 Ohio $50 42 $18 37 Oklahoma $60 27 $19 31 Oregon $97 3 $22 8 Pennsylvania $54 39 $20 22 Rhode Island $66 19 $23 6 South Carolina $49 46 $17 45 South Dakota $50 42 $20 22 Tennessee $50 42 $17 45 Texas $30 51 $18 37 Utah $40 49 $20 22 Vermont $120 1 $21 11 Virginia $55 37 $19 31 Washington $60 27 $22 8 West Virginia $55 37 $16 47 Wisconsin $59 33 $21 11 Wyoming $54 39 $20 22 United States $60 $19 Note: The highest data value within each ranking is indicated by a rank of 1. 71 LTSS Resources: HCBS Resources Assisted Living and Residential Care Facilities, 2010 Assisted Living and Residential Care Units, 2010 Per 1,000 Per 1,000 Value Age 65+ Rank Value Age 65+ Rank Alabama 472 0.72 33 9,860 15 44 Alaska 229 4.15 5 1,912 35 14 Arizona 1,925 2.17 11 28,536 32 18 Arkansas 175 0.42 44 7,713 18 39 California 7,471 1.75 14 211,402 50 6 Colorado 540 0.98 26 16,664 30 19 Connecticut 158 0.31 49 NA NA NA Delaware 133 1.03 23 2,365 18 39 District of Columbia 22 0.32 48 509 7 50 Florida 3,330 1.02 25 83,761 26 30 Georgia 2,224 2.14 12 30,567 29 22 Hawaii 659 3.33 7 4,891 25 31 Idaho 2,515 12.87 1 11,701 60 3 Illinois 549 0.34 47 29,214 18 39 Indiana 527 0.62 37 32,875 39 10 Iowa 475 1.05 21 21,360 47 7 Kansas 280 0.74 32 8,363 22 36 Kentucky 459 0.79 30 15,411 27 27 Louisiana 138 0.25 50 5,860 10 49 Maine 686 3.25 8 8,958 42 9 Maryland 1,803 2.54 9 20,226 28 25 Massachusetts 437 0.48 40 25,681 28 25 Michigan 3,181 2.33 10 39,849 29 22 Minnesota 5,768 8.42 2 53,712 78 1 Mississippi 176 0.46 43 5,079 13 47 Missouri 603 0.72 33 21,333 25 31 Montana 256 1.74 16 5,246 36 11 Nebraska 387 1.56 17 11,356 46 8 Nevada 392 1.20 20 4,408 14 46 New Hampshire 149 0.83 29 4,899 27 27 New Jersey 302 0.25 50 20,420 17 43 New Mexico 254 0.93 27 7,800 29 22 New York 1,000 0.38 45 40,670 15 44 North Carolina 1,277 1.03 23 42,458 34 15 North Dakota 181 1.85 13 3,562 36 11 Ohio 1,378 0.85 28 49,405 30 19 Oklahoma 248 0.49 39 12,540 25 31 Oregon 3,792 7.08 3 33,171 62 2 Pennsylvania 2,054 1.05 21 70,300 36 11 Rhode Island 73 0.48 40 3,829 25 31 South Carolina 480 0.76 31 16,930 27 27 South Dakota 205 1.75 14 3,989 34 15 Tennessee 317 0.37 46 15,375 18 39 Texas 1,601 0.61 38 50,782 19 38 Utah 167 0.67 35 5,926 24 35 Vermont 119 1.30 18 2,749 30 19 Virginia 618 0.63 36 33,067 34 15 Washington 3,445 4.14 6 44,687 54 5 West Virginia 379 1.27 19 3,565 12 48 Wisconsin 4,895 6.28 4 44,537 57 4 Wyoming 34 0.48 40 1,440 21 37 United States 58,938 1.46 1,233,690 31 Note: The highest data value within each ranking is indicated by a rank of 1. 72 LTSS Resources: HCBS Resources Personal and Home Care Aides, 2010 Personal and Home Care Aides, Per 1,000 Median Hourly Wage, 2010 Value Age 65+ Rank Value Rank Alabama 3,800 6 47 $8.35 48 Alaska 2,310 42 4 $14.38 1 Arizona 11,460 13 29 $10.05 20 Arkansas 8,940 21 13 $8.30 49 California 44,400 10 34 $10.23 17 Colorado 10,130 18 20 $9.63 26 Connecticut 9,450 19 16 $10.37 13 Delaware 470 4 48 $9.82 21 District of Columbia 1,020 15 25 $12.53 2 Florida 14,030 4 48 $8.96 35 Georgia 8,810 8 38 $8.63 43 Hawaii 4,730 24 11 $8.77 39 Idaho 3,840 20 15 $9.22 31 Illinois 16,060 10 34 $9.69 24 Indiana 12,070 14 27 $9.40 30 Iowa 4,070 9 37 $9.80 23 Kansas 12,080 32 7 $8.87 37 Kentucky 4,090 7 42 $8.67 41 Louisiana 16,600 30 8 $8.41 46 Maine 5,520 26 9 $9.82 21 Maryland 5,480 8 38 $10.37 13 Massachusetts 16,030 18 20 $11.90 3 Michigan 11,360 8 38 $9.55 28 Minnesota 41,600 61 2 $10.92 5 Mississippi NA NA NA $8.37 47 Missouri 17,250 21 13 $8.75 40 Montana 2,480 17 23 $9.65 25 Nebraska 1,830 7 42 $10.28 16 Nevada 4,400 13 29 $10.41 11 New Hampshire 3,460 19 16 $10.49 10 New Jersey 9,600 8 38 $11.24 4 New Mexico 16,340 60 3 $8.84 38 New York 101,530 39 5 $10.29 15 North Carolina 11,880 10 34 $9.03 33 North Dakota NA NA NA $10.08 18 Ohio 12,140 7 42 $9.48 29 Oklahoma 7,870 15 25 $8.52 45 Oregon 9,590 18 20 $10.52 9 Pennsylvania 25,330 13 29 $10.08 18 Rhode Island 1,120 7 42 $10.79 7 South Carolina 6,910 11 33 $8.91 36 South Dakota 1,590 14 27 $9.22 31 Tennessee 10,610 12 32 $8.65 42 Texas 101,960 39 5 $8.16 50 Utah 1,770 7 42 $9.03 33 Vermont 6,130 67 1 $10.40 12 Virginia 16,000 16 24 $8.62 44 Washington 15,760 19 16 $10.85 6 West Virginia 6,600 22 12 $8.14 51 Wisconsin 19,630 25 10 $9.62 27 Wyoming 1,300 19 16 $10.56 8 United States 686,030 17 $9.44 Note: The highest data value within each ranking is indicated by a rank of 1. 73 LTSS Resources: HCBS Resources Home Health Aides, 2010 Home Health Aides, Median Per 1,000 Hourly Wage, 2010 Value Age 65+ Rank Value Rank Alabama 9,850 15 37 $8.80 47 Alaska 1,570 28 10 $14.56 1 Arizona 21,280 24 16 $10.36 20 Arkansas 8,120 19 27 $8.30 51 California 59,750 14 43 $10.13 27 Colorado 13,360 24 16 $10.38 19 Connecticut 11,410 22 19 $13.33 2 Delaware 2,000 15 37 $11.34 6 District of Columbia 3,520 51 4 $10.64 15 Florida 31,340 10 47 $10.00 30 Georgia 11,990 12 45 $8.94 42 Hawaii 1,330 7 49 $10.84 13 Idaho 3,770 19 27 $8.88 45 Illinois 36,120 22 19 $10.13 27 Indiana 17,030 20 24 $9.90 33 Iowa 11,440 25 13 $10.18 24 Kansas 7,910 21 22 $9.92 32 Kentucky 4,270 7 49 $10.14 26 Louisiana 12,240 22 19 $8.81 46 Maine 4,810 23 18 $10.52 18 Maryland 10,450 15 37 $11.24 7 Massachusetts 17,080 19 27 $12.54 3 Michigan 34,980 26 12 $9.48 38 Minnesota 36,920 54 1 $10.97 11 Mississippi 6,520 17 31 $8.53 49 Missouri 13,440 16 34 $9.15 41 Montana 3,740 25 13 $10.06 29 Nebraska 2,340 9 48 $10.30 23 Nevada 4,830 15 37 $10.58 17 New Hampshire 2,290 13 44 $10.84 13 New Jersey 29,550 25 13 $10.61 16 New Mexico 8,100 30 9 $8.90 44 New York 137,830 52 3 $10.36 20 North Carolina 67,190 54 1 $9.25 40 North Dakota 1,950 20 24 $11.05 10 Ohio 67,140 41 5 $9.36 39 Oklahoma 8,810 17 31 $9.69 36 Oregon 8,640 16 34 $9.85 34 Pennsylvania 65,660 33 7 $9.96 31 Rhode Island 5,540 36 6 $12.16 4 South Carolina 11,730 18 30 $9.80 35 South Dakota 560 5 51 $11.21 8 Tennessee 13,230 15 37 $9.67 37 Texas 86,350 33 7 $8.64 48 Utah 4,910 20 24 $10.17 25 Vermont 1,090 12 45 $12.13 5 Virginia 16,410 17 31 $8.94 42 Washington 13,010 16 34 $10.88 12 West Virginia 6,340 21 22 $8.45 50 Wisconsin 22,080 28 10 $10.35 22 Wyoming 1,030 15 37 $11.16 9 United States 982,840 24 $9.89 Note: The highest data value within each ranking is indicated by a rank of 1. 74 LTSS Resources: HCBS Resources People Receiving ACL Congregate Meals, 2009 People Receiving ACL Home Delivered Meals, 2009 Per 1,000 Per 1,000 Value Age 65+ Rank Value Age 65+ Rank Alabama 25,081 39 32 13,539 21 30 Alaska 7,970 149 4 2,638 49 6 Arizona 12,316 14 48 11,484 13 46 Arkansas 26,563 64 21 15,284 37 13 California 163,104 39 32 54,209 13 46 Colorado 20,442 38 34 8,030 15 40 Connecticut 15,881 32 39 6,542 13 46 Delaware 19,128 151 3 3,324 26 23 District of Columbia 5,159 76 15 3,926 58 3 Florida 35,287 11 51 30,455 10 50 Georgia 14,562 14 48 14,402 14 44 Hawaii 4,139 22 44 3,287 17 36 Idaho 14,450 76 15 3,795 20 32 Illinois 73,858 46 28 40,893 26 23 Indiana 21,281 26 41 12,119 15 40 Iowa 43,377 96 9 13,433 30 19 Kansas 25,785 69 18 11,934 32 18 Kentucky 18,934 33 38 8,734 15 40 Louisiana 18,823 34 36 20,851 38 12 Maine 8,668 42 29 4,929 24 28 Maryland 28,248 41 30 5,525 8 51 Massachusetts 26,086 29 40 45,642 51 5 Michigan 64,208 48 27 49,744 37 13 Minnesota 56,989 84 11 13,798 20 32 Mississippi 5,300 14 48 15,098 40 10 Missouri 78,108 94 10 36,949 45 9 Montana 24,835 172 2 7,100 49 6 Nebraska 18,060 74 17 7,966 33 17 Nevada 15,813 50 25 5,832 18 35 New Hampshire 14,441 82 13 10,980 63 2 New Jersey 41,035 35 35 32,579 28 20 New Mexico 32,806 123 6 10,371 39 11 New York 147,255 57 23 58,362 23 29 North Carolina 28,369 23 43 19,631 16 38 North Dakota 13,910 144 5 5,364 56 4 Ohio 54,401 34 36 33,901 21 30 Oklahoma 26,158 52 24 12,510 25 27 Oregon 42,398 81 14 14,152 27 22 Pennsylvania 79,154 41 30 32,795 17 36 Rhode Island 7,347 49 26 2,255 15 40 South Carolina 10,871 18 45 12,389 20 32 South Dakota 11,808 102 8 3,188 28 20 Tennessee 13,507 16 46 10,341 12 49 Texas 66,617 26 41 64,857 26 23 Utah 15,747 65 20 8,421 35 15 Vermont 10,325 115 7 4,390 49 6 Virginia 14,073 15 47 13,103 14 44 Washington 51,328 64 21 12,792 16 38 West Virginia 24,736 84 11 10,006 34 16 Wisconsin 53,176 69 18 20,284 26 23 Wyoming 19,753 289 1 5,171 76 1 United States 1,671,670 42 869,304 22 Note: The highest data value within each ranking is indicated by a rank of 1. 75 LTSS Resources: HCBS Resources Total ACL Congregate and Home Delivered Number of Health Maintenance Tasks Meal Expenditures, 2009 Able to be Delegated to LTSS Workers Per 1,000 (out of 16 tasks), 2011 Value (Millions) Age 65+ Rank Value Rank Alabama $23 $36 25 4 29 Alaska $9 $167 1 8 21 Arizona $13 $15 51 NA NA Arkansas $20 $48 19 15 6 California $150 $36 25 2 32 Colorado $14 $27 38 16 1 Connecticut $16 $32 30 1 36 Delaware $4 $34 28 3 30 District of Columbia $5 $74 6 8 21 Florida $53 $16 50 0 41 Georgia $30 $30 32 NA NA Hawaii $6 $30 32 14 8 Idaho $7 $38 22 13 13 Illinois $58 $36 25 2 32 Indiana $22 $27 38 NA NA Iowa $18 $41 20 16 1 Kansas $18 $49 17 6 26 Kentucky $15 $27 38 6 26 Louisiana $27 $49 17 11 16 Maine $6 $30 32 9 20 Maryland $16 $24 43 14 8 Massachusetts $54 $60 12 2 32 Michigan $51 $38 22 0 41 Minnesota $20 $29 35 13 13 Mississippi $8 $22 44 3 30 Missouri $44 $53 13 16 1 Montana $10 $70 10 0 41 Nebraska $15 $61 11 16 1 Nevada $6 $21 46 15 6 New Hampshire $14 $77 4 8 21 New Jersey $44 $38 22 7 24 New Mexico $19 $73 7 NA NA New York $189 $73 7 11 16 North Carolina $24 $20 48 6 26 North Dakota $9 $89 3 13 13 Ohio $51 $32 30 7 24 Oklahoma $21 $41 20 0 41 Oregon $14 $27 38 16 1 Pennsylvania $65 $33 29 NA NA Rhode Island $4 $27 38 0 41 South Carolina $17 $28 36 1 36 South Dakota $8 $73 7 11 16 Tennessee $18 $21 46 1 36 Texas $70 $28 36 14 8 Utah $12 $50 15 1 36 Vermont $7 $77 4 1 36 Virginia $21 $22 44 2 32 Washington $15 $18 49 14 8 West Virginia $15 $50 15 0 41 Wisconsin $39 $51 14 14 8 Wyoming $9 $131 2 10 19 United States $1,423 $36 Note: The highest data value within each ranking is indicated by a rank of 1. 76 LTSS Resources: Nursing Facility Resources & Utilization Total Nursing Facilities, 2010 Nursing Facility Beds, 2010 Per 1,000 Per 1,000 Value Age 65+ Rank Value Age 65+ Rank Alabama 233 0.35 33 26,880 41 28 Alaska 15 0.27 44 682 12 51 Arizona 140 0.16 50 16,245 18 49 Arkansas 246 0.58 11 25,690 61 7 California 1,257 0.29 39 122,233 29 43 Colorado 216 0.39 29 20,506 37 33 Connecticut 242 0.48 21 29,207 58 12 Delaware 48 0.37 31 5,062 39 31 District of Columbia 19 0.28 43 2,768 40 29 Florida 685 0.21 49 82,558 25 46 Georgia 360 0.35 33 39,880 38 32 Hawaii 49 0.25 47 4,171 21 48 Idaho 80 0.41 27 6,177 32 41 Illinois 802 0.50 19 97,312 60 8 Indiana 522 0.62 8 50,246 60 8 Iowa 460 1.01 1 32,365 71 1 Kansas 351 0.93 4 23,425 62 6 Kentucky 289 0.50 19 26,181 45 21 Louisiana 288 0.51 18 35,645 64 4 Maine 109 0.52 16 7,130 34 38 Maryland 231 0.33 36 28,546 40 29 Massachusetts 436 0.48 21 48,780 54 15 Michigan 434 0.32 37 47,412 35 37 Minnesota 390 0.57 12 32,292 47 19 Mississippi 206 0.54 15 18,771 49 17 Missouri 526 0.63 7 53,600 64 4 Montana 89 0.60 9 7,010 48 18 Nebraska 233 0.94 3 16,275 66 3 Nevada 51 0.16 50 5,892 18 49 New Hampshire 80 0.45 24 7,742 43 25 New Jersey 365 0.31 38 51,514 43 25 New Mexico 74 0.27 44 7,112 26 45 New York 646 0.25 47 119,184 45 21 North Carolina 431 0.35 33 44,230 36 34 North Dakota 88 0.90 5 6,536 67 2 Ohio 980 0.60 9 93,445 57 14 Oklahoma 330 0.65 6 30,083 59 10 Oregon 138 0.26 46 12,293 23 47 Pennsylvania 724 0.37 31 89,317 45 21 Rhode Island 86 0.57 12 8,814 58 12 South Carolina 186 0.29 39 18,966 30 42 South Dakota 111 0.95 2 6,936 59 10 Tennessee 330 0.39 29 37,928 44 24 Texas 1,255 0.48 21 133,349 51 16 Utah 102 0.41 27 8,335 33 39 Vermont 40 0.44 25 3,276 36 34 Virginia 289 0.29 39 32,251 33 39 Washington 238 0.29 39 22,244 27 44 West Virginia 129 0.43 26 10,828 36 34 Wisconsin 403 0.52 16 36,422 47 19 Wyoming 39 0.56 14 2,975 42 27 United States 16,071 0.40 1,696,721 42 Note: The highest data value within each ranking is indicated by a rank of 1. 77 LTSS Resources: Nursing Facility Resources & Utilization Nursing Facility Residents, 2010 Per 1,000 Nursing Facility Occupancy Rate, 2010 Value (Millions) Age 65+ Rank Value Rank Alabama 23,080 35 26 86% 24 Alaska 640 12 51 94% 1 Arizona 11,758 13 50 72% 43 Arkansas 18,770 45 14 73% 42 California 103,434 24 41 85% 26 Colorado 16,421 30 35 80% 37 Connecticut 26,186 52 6 90% 9 Delaware 4,242 33 30 84% 30 District of Columbia 2,577 37 25 93% 3 Florida 72,304 22 42 88% 16 Georgia 34,520 33 30 87% 22 Hawaii 3,854 19 47 92% 4 Idaho 4,377 22 42 71% 46 Illinois 75,844 47 10 78% 41 Indiana 39,967 47 10 80% 37 Iowa 25,783 57 2 80% 37 Kansas 19,294 51 7 82% 32 Kentucky 23,574 41 18 90% 9 Louisiana 25,778 46 12 72% 43 Maine 6,414 30 35 90% 9 Maryland 24,820 35 26 87% 22 Massachusetts 43,066 48 9 88% 16 Michigan 40,082 29 38 85% 26 Minnesota 29,173 43 15 90% 9 Mississippi 16,526 43 15 88% 16 Missouri 38,504 46 12 72% 43 Montana 4,928 33 30 70% 47 Nebraska 13,037 53 4 80% 37 Nevada 4,744 15 48 81% 36 New Hampshire 6,920 39 20 89% 13 New Jersey 45,837 39 20 89% 13 New Mexico 5,853 21 45 82% 32 New York 109,909 42 17 92% 4 North Carolina 37,736 30 35 85% 26 North Dakota 5,722 58 1 88% 16 Ohio 79,658 49 8 85% 26 Oklahoma 19,878 39 20 66% 49 Oregon 7,567 14 49 62% 51 Pennsylvania 81,190 41 18 91% 6 Rhode Island 7,998 53 4 91% 6 South Carolina 17,261 27 40 91% 6 South Dakota 6,544 56 3 94% 1 Tennessee 32,487 38 24 86% 24 Texas 92,859 35 26 70% 47 Utah 5,391 21 45 65% 50 Vermont 2,899 32 33 88% 16 Virginia 28,572 29 38 89% 13 Washington 18,339 22 42 82% 32 West Virginia 9,569 32 33 88% 16 Wisconsin 30,565 39 20 84% 30 Wyoming 2,435 35 26 82% 32 United States 1,408,886 35 83% Note: The highest data value within each ranking is indicated by a rank of 1. 78 LTSS Resources: Nursing Facility Resources & Utilization Total Direct Care Nursing Hours RN Nursing Hours per Nursing Facility Staffing per Resident Day, 2010 Resident Day, 2010 Turnover, 2010 Value Rank Value Rank Value Rank Alabama 4.2 6 0.56 44 48% 13 Alaska 5.4 1 1.51 1 NA NA Arizona 3.9 17 0.71 23 44% 17 Arkansas 4.1 9 0.41 49 45% 16 California 4.0 14 0.64 34 27% 45 Colorado 3.8 30 0.80 17 48% 13 Connecticut 3.9 17 0.77 19 22% 48 Delaware 4.1 9 0.89 5 37% 28 District of Columbia 4.4 3 0.71 23 24% 47 Florida 4.6 2 0.60 40 28% 44 Georgia 3.6 44 0.44 47 42% 22 Hawaii 4.0 14 0.94 3 15% 50 Idaho 4.2 6 0.85 10 53% 8 Illinois 3.4 49 0.64 34 38% 25 Indiana 3.7 36 0.65 30 46% 15 Iowa 3.5 47 0.64 34 30% 40 Kansas 3.8 30 0.65 30 61% 5 Kentucky 3.9 17 0.63 37 55% 6 Louisiana 3.4 49 0.38 50 43% 19 Maine 4.4 3 1.00 2 35% 37 Maryland 3.9 17 0.67 27 38% 25 Massachusetts 4.0 14 0.79 18 26% 46 Michigan 3.9 17 0.70 26 37% 28 Minnesota 3.9 17 0.71 23 37% 28 Mississippi 3.9 17 0.58 43 30% 40 Missouri 3.7 36 0.49 46 67% 4 Montana 4.1 9 0.88 6 51% 11 Nebraska 3.9 17 0.67 27 40% 23 Nevada 3.8 30 0.82 13 44% 17 New Hampshire 3.9 17 0.83 11 33% 38 New Jersey 3.7 36 0.76 20 29% 42 New Mexico 3.4 49 0.65 30 70% 3 New York 3.7 36 0.62 38 20% 49 North Carolina 3.9 17 0.65 30 43% 19 North Dakota 4.1 9 0.72 22 29% 42 Ohio 3.9 17 0.66 29 37% 28 Oklahoma 3.6 44 0.37 51 71% 2 Oregon 4.4 3 0.81 15 36% 33 Pennsylvania 3.8 30 0.74 21 39% 24 Rhode Island 3.7 36 0.86 8 36% 33 South Carolina 3.9 17 0.60 40 36% 33 South Dakota 3.5 47 0.83 11 43% 19 Tennessee 3.7 36 0.53 45 36% 33 Texas 3.6 44 0.42 48 72% 1 Utah 3.8 30 0.88 6 53% 8 Vermont 4.2 6 0.81 15 33% 38 Virginia 3.8 30 0.61 39 38% 25 Washington 4.1 9 0.90 4 52% 10 West Virginia 3.7 36 0.59 42 54% 7 Wisconsin 3.9 17 0.82 13 37% 28 Wyoming 3.7 36 0.86 8 50% 12 United States 3.8 0.64 40% Note: The highest data value within each ranking is indicated by a rank of 1. 79 LTSS Resources: Nursing Facility Resident Characteristics Residents with Dementia, 2010 Nursing Facility Residents with Residents with Medicaid as Value Rank Low Care Needs, 2008 Primary Payer, 2010 Value Rank Value Rank Alabama 52% 9 19% 20 68% 8 Alaska 47% 24 NA NA 73% 3 Arizona 39% 48 15% 29 62% 27 Arkansas 45% 31 24% 5 67% 9 California 39% 48 13% 35 66% 13 Colorado 45% 31 20% 17 59% 39 Connecticut 50% 14 21% 11 67% 9 Delaware 48% 20 17% 26 58% 41 District of Columbia 46% 28 NA NA 80% 1 Florida 47% 24 13% 35 58% 41 Georgia 49% 17 19% 20 72% 5 Hawaii 55% 1 9% 45 67% 9 Idaho 44% 37 12% 39 62% 27 Illinois 42% 45 31% 1 63% 21 Indiana 48% 20 20% 17 62% 27 Iowa 49% 17 26% 4 47% 51 Kansas 46% 28 23% 7 54% 47 Kentucky 50% 14 9% 45 65% 16 Louisiana 42% 45 31% 1 73% 3 Maine 55% 1 2% 49 66% 13 Maryland 42% 45 11% 41 61% 33 Massachusetts 53% 7 15% 29 63% 21 Michigan 55% 1 16% 27 62% 27 Minnesota 44% 37 19% 20 56% 43 Mississippi 50% 14 21% 11 75% 2 Missouri 44% 37 22% 8 61% 33 Montana 43% 43 20% 17 56% 43 Nebraska 44% 37 22% 8 53% 49 Nevada 35% 51 14% 31 56% 43 New Hampshire 55% 1 19% 20 64% 17 New Jersey 44% 37 19% 20 63% 21 New Mexico 46% 28 21% 11 64% 17 New York 49% 17 13% 35 71% 7 North Carolina 45% 31 12% 39 67% 9 North Dakota 54% 6 19% 20 53% 49 Ohio 45% 31 14% 31 63% 21 Oklahoma 43% 43 28% 3 66% 13 Oregon 44% 37 13% 35 61% 33 Pennsylvania 47% 24 10% 43 62% 27 Rhode Island 51% 12 24% 5 64% 17 South Carolina 55% 1 9% 45 62% 27 South Dakota 52% 9 21% 11 55% 46 Tennessee 51% 12 14% 31 63% 21 Texas 48% 20 21% 11 63% 21 Utah 38% 50 16% 27 54% 47 Vermont 52% 9 11% 41 64% 17 Virginia 45% 31 9% 45 61% 33 Washington 45% 31 10% 43 60% 37 West Virginia 53% 7 14% 31 72% 5 Wisconsin 48% 20 21% 11 59% 39 Wyoming 47% 24 22% 8 60% 37 United States 46% 17% 63% Note: The highest data value within each ranking is indicated by a rank of 1. 80 LTSS Resources: Nursing Facility Resident Characteristics Residents with Medicare as Primary Residents with “Other” as Primary Payer, 2010 Payer, 2010 Value Rank Value Rank Alabama 14% 26 19% 36 Alaska 15% 17 12% 49 Arizona 15% 17 23% 19 Arkansas 11% 44 21% 30 California 15% 17 19% 36 Colorado 12% 34 29% 8 Connecticut 14% 26 18% 42 Delaware 17% 7 25% 16 District of Columbia 12% 34 9% 51 Florida 21% 1 21% 30 Georgia 13% 31 15% 46 Hawaii 11% 44 22% 22 Idaho 16% 12 22% 22 Illinois 15% 17 22% 22 Indiana 17% 7 21% 30 Iowa 8% 50 45% 1 Kansas 10% 46 36% 3 Kentucky 15% 17 19% 36 Louisiana 12% 34 15% 46 Maine 16% 12 18% 42 Maryland 17% 7 22% 22 Massachusetts 14% 26 23% 19 Michigan 19% 2 19% 36 Minnesota 10% 46 34% 6 Mississippi 15% 17 10% 50 Missouri 12% 34 27% 9 Montana 12% 34 32% 7 Nebraska 12% 34 36% 3 Nevada 18% 5 26% 13 New Hampshire 15% 17 21% 30 New Jersey 18% 5 19% 36 New Mexico 13% 31 23% 19 New York 12% 34 17% 44 North Carolina 16% 12 17% 44 North Dakota 7% 51 39% 2 Ohio 12% 34 25% 16 Oklahoma 12% 34 22% 22 Oregon 14% 26 25% 16 Pennsylvania 12% 34 26% 13 Rhode Island 9% 49 26% 13 South Carolina 17% 7 20% 34 South Dakota 10% 46 36% 3 Tennessee 16% 12 22% 22 Texas 15% 17 22% 22 Utah 19% 2 27% 9 Vermont 16% 12 19% 36 Virginia 19% 2 20% 34 Washington 17% 7 22% 22 West Virginia 15% 17 14% 48 Wisconsin 14% 26 27% 9 Wyoming 13% 31 27% 9 United States 14% 22% Note: The highest data value within each ranking is indicated by a rank of 1. 81 LTSS Resources: Quality & Oversight of Nursing Facilities % of Long-Stay NH Residents with % of High Risk NH Residents % of Long-Stay Residents with a Physical Restraints, 2008 with Pressure Sores, 2008 Hospital Admission, 2008 Value Rank Value Rank Value Rank Alabama 2% 35 10% 33 23% 11 Alaska NA NA NA NA NA NA Arizona 4% 15 12% 12 11% 45 Arkansas 6% 5 11% 22 28% 3 California 8% 1 13% 6 20% 18 Colorado 4% 15 9% 39 12% 42 Connecticut 3% 24 10% 33 19% 23 Delaware 3% 24 11% 22 20% 18 District of Columbia 2% 35 17% 1 NA NA Florida 5% 9 13% 6 24% 9 Georgia 5% 9 12% 12 21% 16 Hawaii 3% 24 7% 47 NA NA Idaho 4% 15 8% 42 13% 39 Illinois 3% 24 15% 3 25% 6 Indiana 3% 24 12% 12 20% 18 Iowa 2% 35 8% 42 17% 30 Kansas 1% 48 10% 33 22% 12 Kentucky 5% 9 11% 22 24% 9 Louisiana 8% 1 17% 1 32% 2 Maine 2% 35 8% 42 17% 30 Maryland 3% 24 13% 6 21% 16 Massachusetts 4% 15 10% 33 16% 32 Michigan 4% 15 11% 22 19% 23 Minnesota 2% 35 7% 47 8% 48 Mississippi 6% 5 12% 12 33% 1 Missouri 4% 15 11% 22 22% 12 Montana 2% 35 8% 42 13% 39 Nebraska 1% 48 7% 47 18% 28 Nevada 5% 9 12% 12 19% 23 New Hampshire 2% 35 8% 42 14% 35 New Jersey 4% 15 15% 3 27% 4 New Mexico 5% 9 11% 22 14% 35 New York 3% 24 13% 6 20% 18 North Carolina 4% 15 11% 22 19% 23 North Dakota 2% 35 7% 47 13% 39 Ohio 5% 9 11% 22 19% 23 Oklahoma 6% 5 15% 3 26% 5 Oregon 4% 15 12% 12 11% 45 Pennsylvania 3% 24 11% 22 18% 28 Rhode Island 2% 35 11% 22 12% 42 South Carolina 6% 5 12% 12 20% 18 South Dakota 2% 35 10% 33 16% 32 Tennessee 7% 3 12% 12 25% 6 Texas 3% 24 12% 12 25% 6 Utah 7% 3 9% 39 10% 47 Vermont 2% 35 9% 39 12% 42 Virginia 2% 35 13% 6 22% 12 Washington 2% 35 11% 22 14% 35 West Virginia 3% 24 13% 6 22% 12 Wisconsin 1% 48 10% 33 14% 35 Wyoming 3% 24 12% 12 15% 34 United States 4% 12% 21% Note: The highest data value within each ranking is indicated by a rank of 1. 82 LTSS Resources: Quality & Oversight of Nursing Facilities Long-Term Care Facility Beds per FTE % of Nursing Facilities Visited by Ombudsman, 2010 Ombudsman at Least Quarterly, 2010 Value Rank Value Rank Alabama 1,744 32 100% 1 Alaska 1,002 46 53% 41 Arizona 2,374 25 100% 1 Arkansas 2,317 27 100% 1 California 3,758 11 80% 29 Colorado 1,120 44 100% 1 Connecticut 3,614 13 100% 1 Delaware 1,494 35 100% 1 District of Columbia 491 51 63% 35 Florida 3,248 16 100% 1 Georgia 1,755 30 98% 22 Hawaii 5,686 2 98% 22 Idaho 1,142 43 100% 1 Illinois 3,177 17 65% 34 Indiana 4,279 7 10% 50 Iowa 5,265 5 0% 51 Kansas 3,434 15 100% 1 Kentucky 905 48 100% 1 Louisiana 2,309 28 100% 1 Maine 1,921 29 100% 1 Maryland 1,254 41 85% 26 Massachusetts 1,440 36 100% 1 Michigan 4,233 9 59% 38 Minnesota 7,569 1 63% 35 Mississippi 1,370 39 100% 1 Missouri 4,246 8 56% 39 Montana 799 50 100% 1 Nebraska 5,321 4 47% 43 Nevada 1,081 45 100% 1 New Hampshire 2,471 23 26% 49 New Jersey 2,891 20 42% 46 New Mexico 1,317 40 100% 1 New York 3,934 10 79% 30 North Carolina 2,368 26 63% 35 North Dakota 3,555 14 82% 27 Ohio 1,682 33 54% 40 Oklahoma 1,530 34 100% 1 Oregon 5,409 3 81% 28 Pennsylvania 2,516 22 98% 22 Rhode Island 1,420 38 68% 33 South Carolina 1,749 31 74% 32 South Dakota 3,620 12 44% 45 Tennessee 4,355 6 52% 42 Texas 2,964 19 90% 25 Utah 1,421 37 42% 46 Vermont 921 47 100% 1 Virginia 2,413 24 46% 44 Washington 2,597 21 78% 31 West Virginia 1,234 42 99% 21 Wisconsin 2,968 18 32% 48 Wyoming 885 49 100% 1 United States 2,543 76% Note: The highest data value within each ranking is indicated by a rank of 1. 83 Trends: LTSS Utilization Medicaid HCBS Participants, Older People and Adults w/ Physical Disabilities Nursing Facility Residents 2003 2008 % Change Rank 2005 2010 % Change Rank Alabama 8,274 9,468 +14% 31 23,459 23,080 -2% 16 Alaska 4,940 6,569 +33% 22 629 640 +2% 6 Arizona NA NA NA NA 12,893 11,758 -9% 44 Arkansas 24,157 24,096 0% 42 18,265 18,770 +3% 5 California 303,025 438,942 +45% 15 107,787 103,434 -4% 27 Colorado 15,634 17,490 +12% 35 16,669 16,421 -1% 13 Connecticut 10,886 12,386 +14% 31 27,568 26,186 -5% 30 Delaware 1,293 1,307 +1% 41 3,872 4,242 +10% 1 District of Columbia 2,636 4,012 +52% 14 2,801 2,577 -8% 42 Florida 36,222 29,719 -18% 48 72,909 72,304 -1% 13 Georgia 15,418 15,082 -2% 44 37,804 34,520 -9% 44 Hawaii 1,742 2,719 +56% 13 3,691 3,854 +4% 3 Idaho 9,805 11,984 +22% 29 4,654 4,377 -6% 37 Illinois 46,713 58,001 +24% 27 79,622 75,844 -5% 30 Indiana 3,688 7,311 +98% 8 40,841 39,967 -2% 16 Iowa 7,349 15,103 +106% 6 28,367 25,783 -9% 44 Kansas 10,442 16,656 +60% 11 20,685 19,294 -7% 41 Kentucky 15,690 10,217 -35% 49 23,465 23,574 0% 8 Louisiana 2,397 16,147 +574% 1 29,840 25,778 -14% 51 Maine 8,435 10,598 +26% 25 6,746 6,414 -5% 30 Maryland 7,887 8,414 +7% 39 25,269 24,820 -2% 16 Massachusetts 16,569 26,728 +61% 10 45,974 43,066 -6% 37 Michigan 62,495 68,151 +9% 37 42,039 40,082 -5% 30 Minnesota 30,174 61,483 +104% 7 33,651 29,173 -13% 49 Mississippi 10,888 12,361 +14% 31 16,851 16,526 -2% 16 Missouri 68,700 68,953 0% 42 38,443 38,504 0% 8 Montana 4,292 5,298 +23% 28 5,370 4,928 -8% 42 Nebraska 6,211 7,741 +25% 26 13,575 13,037 -4% 27 Nevada 4,277 8,859 +107% 5 4,461 4,744 +6% 2 New Hampshire 2,625 3,475 +32% 23 7,062 6,920 -2% 16 New Jersey 26,618 31,968 +20% 30 45,566 45,837 +1% 7 New Mexico 11,204 15,940 +42% 17 6,163 5,853 -5% 30 New York 105,289 102,634 -3% 45 113,278 109,909 -3% 24 North Carolina 44,628 64,596 +45% 15 38,421 37,736 -2% 16 North Dakota 986 2,214 +125% 4 5,944 5,722 -4% 27 Ohio 31,903 44,693 +40% 19 82,209 79,658 -3% 24 Oklahoma 21,401 29,014 +36% 21 22,777 19,878 -13% 49 Oregon 34,210 30,792 -10% 46 8,347 7,567 -9% 44 Pennsylvania 15,368 26,714 +74% 9 80,886 81,190 0% 8 Rhode Island 2,613 3,577 +37% 20 8,383 7,998 -5% 30 South Carolina 13,633 14,922 +9% 37 16,596 17,261 +4% 3 South Dakota 2,195 2,468 +12% 35 6,752 6,544 -3% 24 Tennessee 515 3,204 +522% 2 33,163 32,487 -2% 16 Texas 107,655 91,103 -15% 47 92,585 92,859 0% 8 Utah 1,407 3,456 +146% 3 5,496 5,391 -2% 16 Vermont 2,802 NA NA NA 3,097 2,899 -6% 37 Virginia 10,449 16,583 +59% 12 28,652 28,572 0% 8 Washington 51,603 58,823 +14% 31 19,588 18,339 -6% 37 West Virginia 10,837 11,618 +7% 39 10,033 9,569 -5% 30 Wisconsin 30,620 39,319 +28% 24 34,523 30,565 -11% 48 Wyoming 1,355 1,909 +41% 18 2,464 2,435 -1% 13 United States 1,270,155 1,577,471 +24% 1,460,185 1,408,886 -4% Note: The highest data value within each ranking is indicated by a rank of 1. 84 Trends: LTSS Financing Medicaid LTSS Spending for Older People and Total Medicaid Spending (Millions) Adults with Physical Disabilities (Millions) 2004 2009 % Change Rank 2004 2009 % Change Rank Alabama $3,670 $4,417 +20% 42 $869 $1,103 +27% 25 Alaska $890 $1,070 +20% 42 $218 $268 +23% 31 Arizona $4,871 $8,561 +76% 1 NA $794 NA NA Arkansas $2,600 $3,500 +35% 17 $684 $807 +18% 38 California $30,246 $40,818 +35% 17 $5,972 $9,856 +65% 2 Colorado $2,685 $3,571 +33% 22 $637 $973 +53% 4 Connecticut $4,004 $5,974 +49% 5 $1,299 $1,638 +26% 26 Delaware $794 $1,213 +53% 3 $182 $212 +17% 39 District of Columbia $1,226 $1,626 +33% 22 $218 $362 +66% 1 Florida $12,726 $15,547 +22% 39 $2,586 $3,074 +19% 35 Georgia $8,859 $7,461 -16% 51 $1,545 $1,552 0% 46 Hawaii $935 $1,339 +43% 9 $231 $273 +19% 35 Idaho $958 $1,295 +35% 17 $205 $278 +36% 10 Illinois $10,417 $13,572 +30% 25 $1,985 $2,103 +6% 42 Indiana $5,052 $6,263 +24% 37 $1,013 $1,428 +41% 8 Iowa $2,283 $2,983 +31% 24 $542 $660 +22% 34 Kansas $1,921 $2,456 +28% 29 $465 $617 +33% 14 Kentucky $4,309 $5,371 +25% 34 $796 $1,027 +29% 16 Louisiana $5,107 $6,581 +29% 27 $671 $1,103 +64% 3 Maine $2,034 $2,589 +27% 31 $321 $335 +4% 44 Maryland $4,730 $6,702 +42% 11 $1,079 $1,248 +16% 40 Massachusetts $8,628 $12,196 +41% 12 $2,075 $2,681 +29% 16 Michigan $8,326 $10,635 +28% 29 $2,002 $1,972 -1% 47 Minnesota $5,404 $7,425 +37% 14 $1,414 $2,166 +53% 4 Mississippi $3,426 $3,813 +11% 49 $635 $864 +36% 10 Missouri $6,155 $7,676 +25% 34 $1,103 $1,311 +19% 35 Montana $653 $876 +34% 20 $185 $240 +29% 16 Nebraska $1,456 $1,633 +12% 48 $442 $423 -4% 49 Nevada $1,034 $1,383 +34% 20 $192 $246 +28% 21 New Hampshire $1,141 $1,328 +16% 46 $293 $382 +31% 15 New Jersey $7,982 $9,928 +24% 37 $1,943 $2,509 +29% 16 New Mexico $2,241 $3,257 +45% 8 $400 $491 +23% 31 New York $41,452 $49,719 +20% 42 $10,215 $13,053 +28% 21 North Carolina $8,380 $11,490 +37% 14 $1,790 $2,256 +26% 26 North Dakota $490 $590 +20% 42 $175 $192 +10% 41 Ohio $11,516 $14,080 +22% 39 $3,299 $3,382 +3% 45 Oklahoma $2,574 $3,936 +53% 3 $584 $783 +34% 13 Oregon $2,626 $3,594 +37% 14 $582 $744 +28% 21 Pennsylvania $14,178 $17,129 +21% 41 $4,458 $4,394 -1% 47 Rhode Island $1,642 $1,891 +15% 47 $326 $343 +5% 43 South Carolina $3,944 $5,097 +29% 27 $574 $712 +24% 30 South Dakota $569 $715 +26% 33 $131 $165 +26% 26 Tennessee $7,055 $7,393 +5% 50 NA $1,312 NA NA Texas $16,232 $24,121 +49% 5 $3,143 $4,269 +36% 10 Utah $1,260 $1,643 +30% 25 $123 $186 +52% 6 Vermont $801 $1,146 +43% 9 $153 $197 +29% 16 Virginia $3,955 $5,806 +47% 7 $808 $1,185 +47% 7 Washington $5,396 $6,828 +27% 31 $1,218 $1,533 +26% 26 West Virginia $1,961 $2,446 +25% 34 $501 $616 +23% 31 Wisconsin $4,540 $7,123 +57% 2 $1,277 $1,767 +38% 9 Wyoming $375 $526 +40% 13 $74 $95 +28% 21 United States $285,710 $368,330 +29% $62,811 $80,181 +28% Note: The highest data value within each ranking is indicated by a rank of 1. 85 Trends: LTSS Financing Medicaid HCBS Spending for Older People and Medicaid Nursing Facility Spending (Millions) Adults with Physical Disabilities (Millions) 2004 2009 % Change Rank 2004 2009 % Change Rank Alabama $767 $938 +22% 12 $102 $165 +61% 28 Alaska $107 $119 +11% 29 $111 $150 +35% 40 Arizona NA $447 NA NA NA $347 NA NA Arkansas $540 $573 +6% 35 $144 $234 +63% 26 California $3,084 $4,430 +44% 1 $2,888 $5,426 +88% 15 Colorado $426 $549 +29% 6 $211 $424 +101% 12 Connecticut $1,016 $1,240 +22% 12 $284 $398 +40% 38 Delaware $159 $186 +17% 19 $23 $27 +16% 46 District of Columbia $188 $197 +5% 36 $30 $165 +451% 1 Florida $2,250 $2,423 +8% 33 $335 $650 +94% 13 Georgia $1,354 $1,153 -15% 50 $191 $399 +109% 10 Hawaii $191 $222 +16% 21 $40 $52 +31% 41 Idaho $127 $157 +24% 8 $78 $120 +54% 29 Illinois $1,576 $1,616 +3% 39 $409 $486 +19% 44 Indiana $918 $1,195 +30% 5 $95 $233 +145% 5 Iowa $426 $467 +10% 31 $116 $194 +67% 22 Kansas $327 $373 +14% 24 $138 $243 +76% 21 Kentucky $629 $828 +32% 4 $167 $199 +19% 44 Louisiana $601 $746 +24% 8 $70 $358 +412% 2 Maine $244 $252 +3% 39 $77 $82 +8% 48 Maryland $864 $1,062 +23% 10 $215 $187 -13% 49 Massachusetts $1,612 $1,746 +8% 33 $464 $935 +102% 11 Michigan $1,704 $1,547 -9% 47 $299 $426 +42% 36 Minnesota $907 $871 -4% 44 $507 $1,295 +155% 4 Mississippi $563 $727 +29% 6 $71 $136 +91% 14 Missouri $795 $869 +9% 32 $308 $442 +43% 33 Montana $140 $158 +13% 26 $45 $81 +80% 18 Nebraska $360 $318 -12% 48 $82 $105 +28% 43 Nevada $141 $162 +15% 23 $50 $84 +66% 23 New Hampshire $255 $315 +23% 10 $38 $68 +80% 18 New Jersey $1,480 $1,984 +34% 3 $463 $524 +13% 47 New Mexico $180 $174 -3% 42 $220 $317 +44% 31 New York $6,487 $7,675 +18% 18 $3,728 $5,377 +44% 31 North Carolina $1,118 $1,292 +16% 21 $672 $964 +43% 33 North Dakota $164 $172 +5% 36 $11 $20 +84% 17 Ohio $2,726 $2,565 -6% 45 $573 $818 +43% 33 Oklahoma $463 $530 +14% 24 $121 $254 +110% 9 Oregon $270 $304 +13% 26 $312 $439 +41% 37 Pennsylvania $4,135 $3,606 -13% 49 $323 $789 +144% 6 Rhode Island $293 $298 +2% 41 $33 $45 +38% 39 South Carolina $462 $513 +11% 29 $112 $199 +77% 20 South Dakota $118 $142 +20% 16 $13 $23 +85% 16 Tennessee $1,006 $975 -3% 42 NA $337 NA NA Texas $1,763 $2,152 +22% 12 $1,380 $2,117 +53% 30 Utah $106 $150 +41% 2 $17 $36 +116% 8 Vermont $104 $117 +12% 28 $49 $81 +65% 24 Virginia $655 $769 +17% 19 $153 $416 +171% 3 Washington $631 $581 -8% 46 $587 $952 +62% 27 West Virginia $379 $459 +21% 15 $122 $157 +29% 42 Wisconsin $949 $986 +4% 38 $329 $781 +137% 7 Wyoming $61 $73 +20% 16 $14 $22 +64% 25 United States $45,842 $51,403 +12% $16,969 $28,778 +70% Note: The highest data value within each ranking is indicated by a rank of 1. 86 Trends: LTSS Financing Medicaid HCBS as a % of LTSS Spending, for Older People and Adults with Physical Disabilities 2004 2009 Change Rank Alabama 12% 15% +3% 39 Alaska 51% 56% +5% 29 Arizona NA 44% NA NA Arkansas 21% 29% +8% 16 California 48% 55% +7% 21 Colorado 33% 44% +11% 10 Connecticut 22% 24% +2% 42 Delaware 13% 13% 0% 46 District of Columbia14% 46% +32% 1 Florida 13% 21% +8% 16 Georgia 12% 26% +13% 7 Hawaii 17% 19% +2% 42 Idaho 38% 43% +5% 29 Illinois 21% 23% +3% 39 Indiana 9% 16% +7% 21 Iowa 21% 29% +8% 16 Kansas 30% 39% +10% 12 Kentucky 21% 19% -2% 47 Louisiana 10% 32% +22% 3 Maine 24% 25% +1% 44 Maryland 20% 15% -5% 49 Massachusetts 22% 35% +13% 7 Michigan 15% 22% +7% 21 Minnesota 36% 60% +24% 2 Mississippi 11% 16% +5% 29 Missouri 28% 34% +6% 25 Montana 24% 34% +10% 12 Nebraska 19% 25% +6% 25 Nevada 26% 34% +8% 16 New Hampshire 13% 18% +5% 29 New Jersey 24% 21% -3% 48 New Mexico 55% 65% +10% 12 New York 36% 41% +5% 29 North Carolina 38% 43% +5% 29 North Dakota 6% 10% +4% 37 Ohio 17% 24% +7% 21 Oklahoma 21% 32% +12% 9 Oregon 54% 59% +5% 29 Pennsylvania 7% 18% +11% 10 Rhode Island 10% 13% +3% 39 South Carolina 20% 28% +8% 16 South Dakota 10% 14% +4% 37 Tennessee NA 26% NA NA Texas 44% 50% +6% 25 Utah 14% 20% +6% 25 Vermont 32% 41% +9% 15 Virginia 19% 35% +16% 5 Washington 48% 62% +14% 6 West Virginia 24% 25% +1% 44 Wisconsin 26% 44% +18% 4 Wyoming 18% 23% +5% 29 United States 27% 36% +9% Note: The highest data value within each ranking is indicated by a rank of 1. 87