Improving the Balance: The Evolution of Long Term Services and Supports, FY 1981-2014
This historical expenditures report and corresponding state-by-state data tables document three decades Medicaid Long Term Services and Supports (LTSS) systems transformation from primarily institutional services to the present, where home and community-based services (HCBS) are a majority of LTSS spending. These reports include Medicaid expenditures for all LTSS, including institutional services and HCBS, by service category and state. The data comes primarily from the Centers for Medicare & Medicaid Services (CMS)-64 reports.
- Improving the Balance: the Evolution of LTSS Expenditures (PDF, 13.63 MB)
- Data Tables
- Medicaid LTSS Expenditures, fiscal year (FY) 1981 – 2014 (ZIP, 3.02 MB)
Long Term Services and Supports Annual Expenditures
The most recent Medicaid LTSS expenditure reports document the decades-long growth in HCBS, which now are a majority of LTSS expenditures. These reports include Medicaid expenditures for all LTSS, including institutional services and HCBS, by service category and state. The data comes primarily from CMS-64 reports.
Recent reports:
- LTSS Expenditure Report 2016 (PDF, 6.71 MB)
- LTSS Expenditure Report 2015 (PDF, 4.95 MB)
- LTSS Expenditure Report 2014 (PDF, 5.55 MB)
- LTSS Expenditure Report 2013 (PDF, 4.71 MB)
- Webinar (PDF, 2.02 MB) "Home and Community-based Services were a Majority of LTSS Spending”
- Infographic (PDF, 242.67 KB) “Home and Community-based Services were a Majority of LTSS Spending”
- LTSS Presentation 2013 (PDF, 2.02 MB)
- LTSS Expenditure Report 2012 (PDF, 2.38 MB)
Special Reports:
- Selected Characteristics of 10 States With the Greatest Change in Long-Term Services and Supports System Balancing, 2012–2016 (PDF, 752.88 KB)
Medicaid Expenditures for Section 1915(c) Waiver Programs
This report, a companion to the LTSS expenditures report, highlights the subset of LTSS spending that comes specifically from 1915(c) HCBS waivers. Like the LTSS expenditures report, this report is based on the CMS-64 and therefore includes expenditures only. State and national data are included.
Recent reports:
- 1915c Expenditure Report FFY2016 (PDF, 1.73 MB)
- 1915c Expenditure Report FFY2015 (PDF, 1.02 MB)
- 1915c Expenditure Report FFY2014 (PDF, 976.12 KB)
- 1915c Expenditure Report FFY2013 (PDF, 1.99 MB)
- 1915c Expenditure Report FFY2012 (PDF, 1.55 MB)
- 1915c Expenditure Report FFY2011 (PDF, 585.66 KB)
Medicaid 1915(c) Waiver Data Based on the CMS 372 Report
This report summarizes data about 1915(c) waiver programs submitted by states on the CMS 372 report. The CMS 372 identifies the number of people who received HCBS waiver program services, and Medicaid expenditures. Because the data source is different, the expenditures reported here are not exactly the same as those reported in the CMS-64 reports. State and national data are included.
Recent reports:
- 2014-2015 CMS 372 Report (PDF, 2.85 MB)
- 2013-2014 CMS 372 Report (PDF, 1.82 MB)
- 2012-2013 CMS 372 Report (PDF, 1.46 MB)
- 2011-2012 CMS 372 Report (PDF, 2.34 MB)
- 2010-2011 CMS 372 Report (PDF, 1.76 MB)
- 2009-2010 CMS 372 Report (PDF, 1.02 MB)
Medicaid Long-Term Services and Supports Report Beneficiaries
The most recent Medicaid LTSS beneficiaries report updates previous reports estimating the number of people who receive Medicaid LTSS. The report documents the number of individuals in each state who received Medicaid-funded LTSS based on the Medicaid Analytic eXtract (MAX). The MAX data source is a set of Medicaid administrative data files designed to facilitate Medicaid research. The most recent report includes data for three age groups: children, adults age 22 through 64, and older adults. With some exceptions, state and national data are included.
Recent reports:
- CY 2013 LTSS Beneficiaries Report (PDF, 1.15 MB)
- CY 2012 LTSS Beneficiaries Report (PDF, 1.12 MB)
- CY 2011 LTSS Beneficiaries Report (PDF, 1.16 MB)
- CY 2010 LTSS Beneficiaries Report (PDF, 875.52 KB)