CMS Reports Provide Perspective on National LTSS Spending

The Centers for Medicare and Medicaid Services (CMS) issues two reports earlier this year outline Medicaid spending in long-term services and supports (LTSS). The first report includes data and analysis of all LTSS programs within states and compares spending between facility-based and community-based care in federal fiscal year 2020. Community-based spending in Medicaid accounted for 62.5% of LTSS expenditures in 2020; a 3.9% increase from 2019.

The second report details spending only in community-based programs operated under the 1915(c) authority for years 2018 and 2019. Programs operated under this authority continue to grow, serving approximately 1.9 million enrollees in 2019. This was an increase from 2018 of 5.2%. Additionally, per enrollee spending increased to just over $30,000 annually. This is further broken down with average annual spending costs for older adults and people with physical disabilities under $15,000 in 1915(c) programs. These reports provide useful perspective on national trends, including shifts in Medicaid LTSS expenditure patterns in recent years toward greater shares spent on HCBS and insight into how states are using section 1915(c) waiver programs to provide alternatives to institutionalization for eligible Medicaid beneficiaries.