Shifting the balance of Medicaid spending on long-term services and supports (LTSS) from institutional services to home- and community-based services (HCBS) has been a federal and state policy goal for several decades. However, as of fiscal year (FY) 2018, HCBS spending as a percentage of LTSS spending remained under 50 percent in 18 states and the District of Columbia. To understand why some states have made less progress in rebalancing, MACPAC contracted with RTI International and the Center for Healthcare Strategies. This presentation summarized the results of the work, as well as proposed policy considerations.
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Medicaid and CHIP Payment and Access Commission