Medicaid home- and community-based services (HCBS) are designed to allow people with long-term services and supports (LTSS) needs to live in their homes or a home-like setting in the community. In this brief, we focus on HCBS users and expenditures. This analysis found that, nationally, the number of Medicaid beneficiaries using HCBS increased while the number of institutional LTSS users decreased from calendar years (CY) 2019 to 2021. The data show that the share of Medicaid beneficiaries who used HCBS or institutional LTSS varied by state. In most states, the share of HCBS users was larger than the share of institutional LTSS users in CY 2021.
Compared to the overall Medicaid population, HCBS users were older, more likely to be in the blind or disabled eligibility group, more likely to be dually eligible for Medicare and Medicaid, and less likely to identify as Hispanic. Beneficiaries across most LTSS subpopulation groupings were primarily adults, eligible for Medicaid through the blind or disabled pathway, identified as white, and resided in urban settings.