State long-term care (LTC) financing and delivery systems and, in particular, Medicaid funded LTC have long been criticized for being “institutionally biased.” Shifting the balance in publicly-funded long-term care provision away from institutional care (nursing homes, long-term hospitals, intermediate care facilities for the intellectually disabled) toward greater reliance on home and community-based services has been a federal goal for the past three decades -- a goal often referred to as “re-balancing” state LTC systems. This report explores inter-state variations in LTC expenditure and service use patterns, not only in terms of institutional and non-institutional services, but also by Medicaid LTC users’ age and type of disability (e.g., intellectual/developmental disabilities or other working-age adult disabilities). [86 PDF pages]
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