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CMS Releases Report on Medicaid LTSS Expenditures

August 30, 2016

The Center for Medicare and Medicaid Services (CMS) recently released a report on changes to long-term services and supports (LTSS), “Improving the Balance: The Evolution of Medicaid Expenditures for Long-Term Services and Supports (LTSS), FY 1981-2014. The report provides details on CMS’ use of Medicaid to fund LTSS and on the various ways in which LTSS services have changed. LTSS are supports that help people with more chronic conditions live and work in the community, such as long-term health, personal care, or supported employment services.

The report explains that LTSS have undergone profound changes since 1981, changing from services generally provided in institutions to services that are primarily home and community-based. The report describes several major trends over the past 30 years, including the growth of section 1915(c) waivers as a method of service provision rather than providing LTSS in nursing facilities and intermediate care facilities. These changes are the product of the deinstitutionalization movement for persons with developmental disabilities. The use of HCBS now exceeds 50 percent of expenditures for people with developmental disabilities, but not for other groups.