Early access to community-based long-term services and supports through Section 1915(c) waivers — which can cover services provided in assisted living and other settings — may help minimize the use of institutional settings such as nursing homes, according to an analysis on the Tuesday agenda at a Centers for Medicare & Medicaid Services Open Door Forum.

The report authors said they hope the findings will help Medicaid policymakers design programs “divert beneficiaries from long-term institutional care,” which could increase beneficiary satisfaction and lower costs.

In the report, Mathematica Policy Research examined Medicaid Analytic eXtract data from 2009 to 2014 for 16 states. They found that 73% of older adults who started with institutional care had stays of 91 days or more, whereas 4% of older-adult community-based LTSS initiators had long stays.

Use of community-based LTSS before an institutional stay appeared to increase the likelihood that a beneficiary would transition back to the community and use community-based LTSS there, according to the report. Also, among older adults, “previous use of community-based LTSS appears to be associated with a lower likelihood of being readmitted to institutional care,” the authors said.

Another new report, “Medicaid Expenditures for Long-Term Services and Supports in FY 2016,” also was on the Open Door Forum agenda and shows the increasing popularity of home- and community-based services compared with institutional care.

That report, produced for CMS by IBM Watson, found that HCBS “have accounted for almost all Medicaid LTSS growth in recent years, while institutional service expenditures remained close to the FY 2010 amount.” HCBS spending increased 10% in FY 2016, the authors noted, whereas institutional service spending decreased 2%.

HCBS accounted for 45% of programs that primarily supported older adults and people with physical disabilities in FY 2016, according to the report. Ten states spent more than 50% of their LTSS dollars for older adults on HCBS, the authors said.

The United States spent more than $12.5 billion on Section 1915(c) waivers for older adults and people with physical disabilities in FY 2016, according to the report. Minnesota spent more than any other state, $1.1 billion, whereas New Mexico spent the least, $1.7 million, the authors said.