In our analyses, we limited the population of LTSS users to those eligible for Medicaid as a result of age or disability and those eligible for comprehensive benefits at some point during the entire year.22 Aged enrollees include all enrollees age 65 and older in 2009. Enrollees with disabilities include people of all ages who were under 65 in 2009 and who were eligible for Medicaid on the basis of disability. These two groups include almost all enrollees using Medicaid LTSS. However, a small number of states have a notable number of Section 1915(c) waiver enrollees reported as eligible on the basis of being children or adults without disabilities: Montana (9 percent), which was excluded from our analysis, and New Hampshire (1 percent) and North Dakota (5 percent), which were included. Total HCBS use and expenditures may be somewhat underestimated in these two states. See Appendix A for further descriptions of the BOE groups.
While we present national averages based on 38 states (or 35 states in our comparative analyses of people with physical disabilities or ID/DD), the excluded states may bias our results. Some excluded states -- Oregon, for example -- are known to have strong community-based LTSS programs. However, others -- Pennsylvania, for example -- typically have spent less on community-based services than institutional care in the past. As a result, it is plausible that our national totals based on the 38 states represented in this study closely match true averages for all Medicaid enrollees, although it is also possible that significant biases are present. The national estimates should be interpreted with a bit of caution.
22 We excluded people reported to be eligible only for family-planning services, unqualified aliens eligible only for emergency services, and restricted-benefit duals receiving coverage only for Medicare premiums and cost-sharing.