Online Program

Relation between state Medicaid HCBS investment and long-term care services and supports expenditures: 2000-2011

Tuesday, November 3, 2015 : 1:30 p.m. - 1:50 p.m.

Nancy A. Miller, PhD, School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD
Shreyasi Deb, PhD, MBA, Office of Government Relations, American Academy of Orthopaedic Surgeons (AAOS), Washington, DC
Adele Kirk, PhD, Public Policy, University of Maryland, Baltimore County, Baltimore, MD
Obective: There continues to be significant state variation in the share of long-term services and supports (LTSS) expenditures that are home and community-based services (HCBS) for older adults and adults with physical disabilities.  This reflects, in part, concern with the effect of HCBS provision on total LTSS expenditures.  Methods:  We examined the relation between state Medicaid HCBS investment and per capita LTSS, using a cross-sectional time series model with state and year fixed effects.  Findings:  All states but two increased the share of dollars supporting HCBS for older adults and individuals with physical disabilities over the study period.  In 2000, the percentage supporting HCBS ranged from 0.55% in Tennessee to 47.99% in Oregon.  In 2011, it ranged from 13.58 % in North Dakota to 91.83% in New Mexico.  The average investment in HCBS LTSS increased from 17.18% in 2000 to 34.18% in 2011.  In multivariate analyses, the share of LTSS allocated to HCBS was negatively related to per capita LTSS expenditures.  A 1-percentage point increase in the share allocated to HCBS was associated with lower LTSS per capita spending of $366,810 over the study period, all else equal.  Lower per capita spending was also associated with the state having a Democratic governor.  Nursing facility bed supply positively influenced per capita LTSS expenditures.  Implications:  These findings support continued policy efforts to encourage state 'rebalancing' of their LTSS systems to provide care in community-based settings.  Attention to institutional bed capacity and its reduction is important as well.

Learning Areas:

Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe state investment in HCBS for older adults and adults with physical disabilities for the period 2000-2011. Assess the relation between state HCBS investment and state long-term services and supports expenditures for 2000-2011.

Keyword(s): Aging, Long-Term Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My research and teaching focus on Medicaid policy related to long-term services and supports.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.