Home And Community Based Services Public Policies To Improve Access Costs And Quality

With the population ageing, the demand for long term care (LTC), particularly services at home, is increasing. Of those individuals receiving LTC services in the US, most paid services were funded by the government. In 2006, of the total $177.6 billion in estimated spending for LTC nationally, $124.9 billion was for nursing homes (excluding hospital-based LTC) and $52.7 billion was spent on home care. Medicaid is the primary payer for LTC services for individuals with low incomes, paying for 45.8 percent of nursing home care and 37.6 percent of home health in the US in 2006. Medicaid is a joint federal and state programme, which covers individuals who are on Supplemental Security Income and those who meet each state's income and asset requirements (the categorically needy). In some states, it also pays for individuals who spend down their incomes to each state Medicaid level because of medical costs (the medically needy). The focus of this report is to examine issues of access, cost, and quality for Medicaid Home and Community-Based Services programmes. The trends in state Medicaid HCBS programmes, target groups, participants, and expenditures are summarised. The paper shows the progress in providing Medicaid HCBS but also identifies many current problems and policies. Inequities in access to services and limited funds result in unmet needs for HCBS. HCBS cost issues have been a primary focus of policy makers and quality problems are largely not addressed. Policy recommendations are made to improve access, costs and quality at the federal and state levels in the future.