During the 1990s, in response to growing consumer demand for community-based alternatives to nursing homes, states steadily expanded combinations of three Medicaid home and community based services (HCBS): home health, personal care, and waivers. As the U.S. economy slipped into recession, many states face economic crisis and 43 reported budget gaps between declining revenue and increased Medicaid spending. As the states search for new ways to control Medicaid LTC costs, seniors’ access to both Medicaid HCBS and nursing home care is threatened. This paper presents the latest available trend data on participants and expenditures for the three Medicaid HCBS programs from surveys of all states from 1999 through 2002, and the findings from a national survey of cost control polices on each program in 2002. Data for 2002 indicate that the growth rates in participants and expenditures are flat and are slowing in some states. The 2002 policy survey data also report 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:

* Learning Objectives. From this session participants will be able to: (identify latest trends in the types and amounts of Medicaid HCBS participants and expenditures for the elderly, (
* 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.