Every year, Medicaid spends more than $200 billion on long-term services and supports (LTSS) for people with physical, intellectual, and developmental disabilities. Historically, over 80% of these funds were spent on institutional care in long-term care facilities. But, over the past thirty-plus years, in response to escalating LTSS expenditures and consumer preferences, both the federal and state governments have pushed to deliver more LTSS in the home and community. Indeed, since 1981 federal waivers offered states the option of providing home and community based services (HCBS) as an alternative to institutional care. As shown in this report, efforts have been successful, with nearly 60% of all LTSS spending now being on HCBS.

Read more