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Table of Contents

1. Executive Summary.

2. Introduction.

3. List of Tables.

4. Part 1.

5. Part 2.

6. Part 3.

7. References.

8. Download PDF of entire report.

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Home and Community-Based PAS > Reports > Medicaid Home and Community-Based Services: Program Data, 1992-2001

Medicaid Home and Community-Based Services: Program Data, 1992-2001

Prepared By: Martin Kitchener, PhD, Terence Ng, MA, and Charlene Harrington, PhD

Department of Social and Behavioral Sciences
University of California, San Francisco
3333 California Street Suite 455
San Francisco, CA 94118

June 2003

Preparation of this report was supported by a grant from Henry J. Kaiser Family Foundation and the Kaiser Commission on Medicaid and the Uninsured. We wish to thank these bodies and especially Risa Elias for their support. The views expressed in this report are those of the authors and do not necessarily reflect those of the Foundation or the Commission. We also wish to thank Alan Bostrom PhD for programming support and Anna Burdin MA for helping to collect the waiver data.

Executive Summary

As states find themselves caught between the ‘rock’ of budget deficits and the ‘hard place’ of increasing pressures to extend Medicaid home and community-based services (HCBS), there is rising concern about the development of the three main Medicaid (HCBS) programs: (1) 1915(c) waivers, (2) home health (HH), and (3) Personal Care Services (PCS). This study reports two sets of program trend data: (1) waiver participant, expenditure, and service data by state, and by waiver, 1992 through 2001, and (2) participant and expenditure data for HH, PCS, waivers, and total HCBS, by state, 1999 through 2001.

Between 1999 and 2001, national Medicaid HCBS participants grew by 8.6 percent including a 4.1 percent rise in 2001 from 2,034,435 to 2,117,948. Between 1999 and 2001, national Medicaid HCBS expenditures grew by 24.5 percent including a 13.2 percent increase in 2001 from $19.5 billion to $22.1 billion. Within this pattern of growth, there remain significant variations across the states in the development of the three Medicaid HCBS programs (HH, PCS, and waivers) individually, and in the terms of total Medicaid HCBS.

Between 2000 and 2001, total national participants in the PCS program rose by only 0.2 percent and the participation rate per 1,000 persons fell by 0.7 percent from 1.97 to 1.96. Despite this, PCS expenditures per participant increased $8,019 to $9,018 (12.5 percent). While expenditure growth on waiver programs (per capita, per participant, and total) slowed between 1999 and 2000, it increased again in 2001. When compared with 2000, 2001 waiver expenditures on three categories of services increased (residential/foster care, respite, and other), three reduced (case management, nursing, and habilitation/day care), the number of each recipient type increased except AIDS/ARC, and expenditures per recipient type increase for each category except the aged.