CMS: Older adults dominate HCBS participant numbers but not spending or time

Share this content:
CMS: Older adults dominate HCBS participant numbers but not spending or time
CMS: Older adults dominate HCBS participant numbers but not spending or time

Older adults and/or people with disabilities account for the majority of recipients of home- and community-based services funded through Medicaid Section 1915(c) waivers, although the average dollar amount spent per participant and the duration of service provision for this group are less than they are for some other groups served by the waivers.

That's according to a new report from the Centers for Medicare & Medicaid Services.

States use the waivers for HCBS-related expenses including case management, residential and day habilitation, supported employment, personal care, homemaker services, personal emergency response systems, assistive technology, home delivered meals, non-medical transportation and respite. In addition to older adults and people with physical disabilities, other populations served include people with brain injuries, medically fragile children, people with HIV/AIDS, and people with serious mental illness or serious emotional disturbance.

Waivers targeting older adults and/or people with physical disabilities supported almost 832,000, or 54.2% of participants in 2013, according to the report. The number represents a 3% increase over the previous year. Most of the remaining 2013 participants, 655,000 or 43%, received supports from waivers targeting people with developmental disabilities.

Waivers targeting older adults and/or people with physical disabilities accounted for 28% of all 1915(c) waiver expenditures, or $11.3 billion, according to CMS. Average expenditures per person for this group were about half the average for all waivers. Waivers targeting people with developmental disabilities, for instance, accounted for $28.5 billion, or 70% of all such waiver expenditures, reflecting higher average costs per participant for this population, according to the agency.

Nationally, waiver expenditures for older adults and those with physical disabilities averaged $13,530 in 2013, an increase of 3.2% over the previous year. Nonwaiver expenditures for this population averaged $7,738.

Waivers targeting older adults and/or people with physical disabilities served people an average of 9.6 months, 1.2% increase over the previous year. People with developmental disabilities, by comparison, were served for an average of 10.8 months.

Waivers for older adults and/or people with physical disabilities accounted for 51.5% of participant months, the number of months a person received services (8 million of the total 15.5 million participant months). This percentage was smaller than the percentage of participants served by this population (54.2%, as previously stated).

State data

For waivers targeting older adults and/or people with physical disabilities, Wisconsin was the state with the highest number of participants per 1,000 state residents, at 9.54.The state had 54,598 participants in 2013, an increase of 38.5% over the previous year. Average waiver expenditures in Wisconsin were $27,169, an increase of 10.7% over the previous year.

Illinois was the state with the highest number of participants for waivers targeting older adults and/or people with physical disabilities, however, with 87,005, a 9.8% increase over the previous year. The number represented 6.76 participants per 1,000 state residents. Average waiver expenditures in Illinois were $9,813, an decrease of 7.4% compared with the previous year.

Kansas was the state with the highest average waiver expenditures for older adults or those with physical disabilities, at $29,638, an increase of 128.4% over the previous year. In that state, there were 4.52 participants per 1,000 state residents, or a total of 13,054.

CMS compared data in this report, which presented information from the CMS 372 reports on 1915(c) waivers for waiver years ending in 2012 and 2013, to a separate report focused on 1915(c) waiver expenditures that used different data sources and found some variations in results. For instance, total 1915(c) waiver expenditures in the CMS 372, $40.6 billion, were 0.4% less than the $40.8 billion in federal fiscal year 2013 spending shown in a separate report of 1915(c) waiver expenditures.

Sign up for newsletters

In Focus

May 16

$3 million milestone

Parkville, FL 

Oak Crest recently passed the $3 million mark in the amount of scholarship funds the community has awarded to employees over the past 22 years.