Medicaid Home and Community-Based Services: Characteristics and Spending of High-Cost Users

Download Publication (pdf)

June 2018 | Eligibility, Long-Term Services and Supports

Medicaid enrollees increasingly are receiving long-term services and supports (LTSS) through home and community-based services (HCBS). This fact sheet describes the characteristics and service use of Medicaid enrollees who used HCBS in 44 states in 2012, and analyzes Medicaid spending for these HCBS users. We focused particularly on high-cost users, defined as the 3 percent of HCBS users with the highest spending on HCBS in each state.

We found that most high-cost users, who accounted for nearly one-third of Medicaid spending on HCBS in our analysis, qualified for Medicaid-covered HCBS due to blindness or disability and were age 19 to 64. There were differences between high-cost users and all HCBS users in the most commonly reported conditions in claims data. For example, high-cost users were most frequently diagnosed with intellectual disabilities and related conditions (59.5 percent), but these were not among the five most common reported conditions for all HCBS users. National per capita spending on HCBS for high-cost users exceeded $100,000 in 2012, more than 10 times higher than average spending for all HCBS users. Average spending on high-cost users varied widely by HCBS category and by state.

For the complete results, read the MACPAC-commissioned report by Mathematica Policy Research, HCBS claims analysis chartbook: Final report.

Publication Type: Fact Sheets

Tags: 1915(c) home and community-based services waivers, case management, developmentally disabled, dually eligible beneficiaries, elderly, fee for service, functional status, home and community-based services (HCBS), intellectually disabled, long-term services and supports, nursing facility services, people with disabilities, personal care services, waivers