The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61313

Martin Kitchener, PhD, MBA¹, Charlene Harrington, PhD¹, and Risa Elias, MPP². (1) Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612, 415-502-7364, martink@itsa.ucsf.edu, (2) Kaiser Family Foundation, 1450 G ST, NW Suite 250, Washington, DC 20005

During the 1990s, in response to growing consumer demand for non-institutional long-term care (LTC) and legal pressures from the Olmstead decision, states steadily expanded combinations of three Medicaid home and community based services (HCBS): home health, personal care, and waivers. As the U.S. economy slips into recession, many states face economic crisis and 43 report budget gaps between declining revenue and increased Medicaid spending. As the states search for new ways to control Medicaid LTC costs which have grown to consume of 24 percent of total program spending, access to both Medicaid HCBS and nursing home care is threatened. This paper presents trend data on participants and expenditures for the three Medicaid HCBS programs from surveys of all states from 1999 through 2001. While data for 2000 show a steady increase in participants and expenditures over 1999, preliminary data for 2001 indicate that the growth rate has slowed dramatically. The survey also reports how states are changing benefit, financial eligibility, and need policies to slow HCBS growth. The trends in Medicaid HCBS expenditures are compared with CMS Form 64 data concerning Medicaid nursing home expenditures over the same period. Learning Objectives. From this session participants will be able to: (1) identify trends in the types and amounts of Medicaid HCBS participants and expenditures, (2) compare these with trends in Medicaid nursing home spending, (3) understand state responses to fiscal crises in terms of Medicaid policy changes, and (4) consider the potential impact on access to Medicaid LTC services.

Learning Objectives:

Learning Objectives. From this session participants will be able to: (
• identify trends in the types and amounts of Medicaid HCBS participants and expenditures, (
• compare these with trends in Medicaid nursing home spending, (
• understand state responses to fiscal crises in terms of Medicaid policy changes, and (
• consider the potential impact on access to Medicaid LTC services.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.