The Centers for Medicare & Medicaid Services recently released the Medicaid LTSS Annual Expenditures Report for federal fiscal years (FFY) 2017 and 2018. This report discusses the long-term services and supports (LTSS) trends and growth in expenditures for home- and community-based services (HCBS). Among the report’s highlights:

  • HCBS expenditures comprising total Medicaid LTSS expenditures surpassed the benchmark of 50% of LTSS expenditures in FFY 2013. They have remained higher than 50% since then, reaching 55.4% in FFY 2017 and 56.1% in FFY 2018.
  • Section 1915(c) waiver programs represented the majority of HCBS expenditures in FFY 2017 and 2018, accounting for slightly more than 50% of these expenditures in both years. Such programs allow states to provide LTSS in home- and community-based settings as an alternative to institutions for Medicaid-eligible beneficiaries who meet institutional level-of-care criteria. Expenditures for section 1915(c) waiver programs in FY 2017 totaled $46.2 billion, which increased to $49.7 billion in FY 2018.
  • Total Medicaid LTSS spending continues to increase with expenditures increasing from $124 billion in FFY 2017 to $129 billion in FFY 2018.
  • Spending on managed LTSS programs increased more than three-fold in the past 20 years, climbing from $6.7 billion in FFY 2008 to $30.1 billion in FFY 2018.

Report on LTSS HCBS waiver programs

CMS also released the Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, Analysis of CMS 372 Annual Reports for 2015 through 2017. The report focuses on trends in section 1915(c) HCBS waiver program participation and expenditures for 2015 through 2017. Among the report’s highlights:

  • In 2016, 1.68 million individuals participated in section 1915(c) waiver programs, a 3% increase from the 1.63 million that participated in waiver programs in 2015. In 2017, the number of national waiver program participants dipped slightly to 1.66 million for a 1.4% decline.
  • For every 1,000 residents, there were about five 1915(c) waiver program participants in 2015-2017. Average waiver program expenditures per participant were $27,521 in 2015, $27,380 in 2016, and $29,279 in 2017.

Medicaid is the primary payer of LTSS, covering just over half of all spending for such services and supports.