MM Curator summary
[MM Curator Summary]: The HCBS rebalancing effort reached a historic high of 59% of long-term care services delivered in the community in 2019.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
Credit: ozgurcankaya/Getty Images
The Centers for Medicare & Medicaid Services expects that Medicaid’s recent trend of spending more on home- and community-based services than institutional care will continue for the foreseeable future, a top program official said Tuesday.
HCBS spending reached 59% in 2019 — a stark difference from when the program was spending just about 13% on HCBS 30 years ago, according to the most recent publicly available data on the percent of total Medicaid long-term services and supports expenditures.
“When the Medicaid program was created in 1965, states were required to cover medically-necessary nursing facility care for most eligible individuals but coverage for HCBS was generally not included,” Jennifer Bowdoin, Ph.D, director of the Division of Community Services Transformation at CMS, said Tuesday. Her comments came while speaking remotely during the National Association for the Support of Long Term Care’s 2022 Winter Legislative & Regulatory Conference.
“This has shifted quite about over the past several decades as states have gotten more flexibility to cover more long-term care services in home- and community-based settings, and as states have increasingly taken advantage of that flexibility,” she added.
Bowdoin also noted that several federally funded grant programs, like Money Follows the Person and the now-ended Balancing Incentive Program, have pushed states to seek additional funding to provide HCBS alternatives to nursing homes.
CMS’ long-standing benchmark for Medicaid HCBS spending within has been about 50%. It has remained above that mark since 2013, while institutional spending has steadily gone down.
Bowdoin added that rebalancing LTSS systems has been a long-standing priority for the Medicaid program and the public health emergency has also “accelerated states’ interest and effort to promote the use of HCBS over institutional services.”
“[It’s] really showing that HCBS has become a really critical component of the Medicaid program, especially the long-term services and supports system, and they’re an important part of the progress of the national progress that has been made towards community integration of older adults and individuals with disabilities,” she said.