Interstate Variation and Progress Toward Balance in Use of and Expenditure for Long-Term Services and Supports in 2009. Appendix D. Additional Tables

03/18/2014

TABLE D.1. Number of Enrollees Who Were Aged or Had Disabilities and Used Medicaid FFS LTSS Compared with the Total Number of Full-Benefit Enrollees in 2009

State All Full-Benefit
Medicaid Enrollees
All Full-Benefit
Enrollees Who Were
Aged or
Had Disabilities
Non-LTSS
Enrolleesa
Total LTSS
Enrolleesb
Total HCBS
Enrolleesb
Enrollees Who Were
Aged of Had
Disabilities Using
Any FFS LTSS
Enrollees Who Were
Aged of Had
Disabilities Enrollees
Using HCBS
Enrollees Who Were
Aged of Had
Disabilities Using ILTC
All 38 States   45,081,240 10,515,083 41,884,297 3,196,943 2,170,127 3,130,010 2,085,312 1,204,507
Alabama 731,954 222,490 667,910 64,044 43,423 63,918 43,256 24,940
Alaska 131,811 24,418 123,940 7,871 7,081 7,764 6,956 1,083
Arkansas 638,989 160,707 595,326 43,663 23,950 41,000 21,011 21,663
California 7,611,377 1,996,587 6,944,186 667,191 567,384 664,249 564,223 124,871
Colorado 619,470 135,281 571,996 47,474 35,216 46,665 34,211 14,575
Connecticut 566,782 115,466 509,173 57,609 32,849 57,372 32,310 29,928
Delaware 186,267 25,866 179,463 6,804 3,341 6,710 3,236 3,776
District of Columbia 171,754 48,988 160,370 11,384 7,907 11,121 7,623 4,001
Florida 3,146,373 757,806 2,987,924 158,449 91,916 140,198 72,723 69,646
Georgia 1,684,389 347,266 1,616,958 67,431 31,903 66,755 30,873 37,266
Idaho 222,086 46,225 201,910 20,176 16,437 19,703 15,772 5,568
Illinois 2,743,532 492,654 2,570,434 173,098 115,800 155,287 89,588 77,642
Indiana 1,108,486 202,327 1,043,916 64,570 27,296 64,197 26,891 39,631
Iowa 495,748 107,783 440,017 55,731 41,868 55,299 41,222 19,956
Kansas 355,745 95,262 309,467 46,278 33,354 41,457 28,154 15,006
Kentucky 858,576 261,201 809,937 48,639 22,685 47,681 21,594 27,654
Louisiana 1,079,361 253,389 1,006,921 72,440 36,158 72,174 35,863 38,868
Maryland 925,138 180,504 870,672 54,466 32,791 53,822 32,088 22,865
Mississippi 625,701 183,660 585,026 40,675 19,201 40,506 18,881 22,679
Missouri 1,071,615 286,262 973,803 97,812 69,613 96,068 67,271 37,877
Nebraska 270,855 57,956 249,125 21,730 12,100 21,549 11,754 11,227
Nevada 281,917 48,819 268,368 13,549 9,288 13,403 9,099 4,728
New Hampshire 152,933 35,423 138,845 14,088 8,039 13,941 7,835 6,915
New Jersey 1,161,066 302,666 1,058,152 102,914 62,490 102,389 61,663 44,157
New York 5,139,173 1,178,954 4,787,146 352,027 230,832 345,398 222,936 140,219
North Carolina 1,689,693 443,798 1,539,986 149,707 110,677 149,371 110,261 45,234
North Dakota 76,868 17,775 67,995 8,873 4,136 8,846 4,101 5,208
Ohio 2,261,497 484,297 2,091,963 169,534 101,606 168,011 99,686 86,304
Oklahoma 788,052 171,017 733,521 54,531 34,618 53,604 33,504 22,096
South Carolina 876,589 223,432 831,267 45,322 28,730 45,072 28,447 17,811
South Dakota 127,020 24,076 116,272 10,748 5,487 10,680 5,398 5,781
Texas 4,222,589 873,046 3,974,721 247,868 154,105 246,814 150,891 104,441
Utah 327,631 54,070 316,092 11,539 6,393 10,975 5,528 5,724
Vermont 165,471 31,983 154,770 10,701 7,871 10,701 7,871 3,620
Virginia 944,921 225,580 885,469 59,452 43,320 59,028 42,854 27,159
Washington 1,158,655 256,877 1,075,684 82,971 67,814 82,971 67,814 19,625
West Virginia 385,905 127,937 356,992 28,913 17,961 28,750 17,575 12,288
Wyoming 75,251 13,235 68,580 6,671 4,487 6,561 4,349 2,475

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin).
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Non-LTSS enrollees include all full-benefit enrollees eligible as children and adults without disabilities. Only enrollees who are aged or had disabilities are included in counts of LTSS enrollees and users.
  2. Individuals who are enrolled in 1915(c) waivers, but do not receive HCBS are included in counts of LTSS and HCBS enrollees but excluded from counts of LTSS and HCBS users.

TABLE D.2. Medicaid LTSS System Performance Indicators for Enrollees Who Were Aged or Had Disabilities and Were Eligible for Full Medicaid

State Total
LTSS $
Total
  LTSS Users  
Percentage of
Medicaid LTSS
$ Allocated
to HCBS
Percentage of Total
Medicaid $ for
LTSS Users
Allocated to
HCBS Users
Percentage of
LTSS Users
Receiving HCBS
Per-User
Spending on
HCBS
Per-User
Spending on
ILTC
Ratio of Per-User
$ on HCBS
Relative to ILTC
All 38 States     90,014,728,763   3,130,010 45.3 55.1 66.6 19,547 40,890 0.478
Alabama 1,332,176,146 63,918 29.7 49.2 67.7 9,154 37,538 0.244
Alaska 344,563,447 7,764 73.8 79.2 89.6 36,547 83,417 0.438
Arkansas 989,454,103 41,000 27.3 42.2 51.2 12,867 33,195 0.388
California 12,064,245,829 664,249 60.8 70.8 84.9 12,993 37,908 0.343
Colorado 1,300,230,159 46,665 57.6 64.4 73.3 21,887 37,835 0.578
Connecticut 2,498,041,847 57,372 36.2 45.5 56.3 27,961 53,282 0.525
Delaware 340,623,579 6,710 35.9 40.2 48.2 37,758 57,849 0.653
District of Columbia 590,462,733 11,121 50.5 58.0 68.5 39,142 73,003 0.536
Florida 4,155,577,858 140,198 30.0 38.4 51.9 17,164 41,745 0.411
Georgia 1,683,701,045 66,755 33.0 43.2 46.2 17,987 30,279 0.594
Idaho 461,085,970 19,703 42.5 64.3 80.0 12,425 47,614 0.261
Illinois 3,540,342,818 155,287 35.4 48.4 57.7 13,974 29,474 0.474
Indiana 2,160,937,796 64,197 36.0 42.3 41.9 28,928 34,898 0.829
Iowa 1,355,006,858 55,299 42.2 60.0 74.5 13,882 39,225 0.354
Kansas 1,006,566,458 41,457 56.2 66.7 67.9 20,087 29,390 0.683
Kentucky 1,342,891,916 47,681 27.2 38.8 45.3 16,914 35,353 0.478
Louisiana 2,035,834,502 72,174 38.0 46.1 49.7 21,569 32,476 0.664
Maryland 1,996,568,849 53,822 45.7 52.0 59.6 28,423 47,433 0.599
Mississippi 1,175,187,746 40,506 14.7 25.6 46.6 9,172 44,183 0.208
Missouri 1,836,511,964 96,068 45.0 62.9 70.0 12,289 26,660 0.461
Nebraska 612,132,766 21,549 42.1 49.8 54.5 21,932 31,562 0.695
Nevada 339,047,042 13,403 45.6 53.4 67.9 16,990 39,014 0.435
New Hampshire 463,202,438 13,941 53.6 60.2 56.2 31,664 31,108 1.018
New Jersey 3,835,410,402 102,389 33.6 40.4 60.2 20,897 57,678 0.362
New York 20,116,573,292 345,398 50.0 56.7 64.5 45,150 71,681 0.630
North Carolina 3,182,180,366 149,371 45.8 59.4 73.8 13,204 38,163 0.346
North Dakota 338,845,939 8,846 28.1 34.1 46.4 23,223 46,776 0.496
Ohio 5,415,944,206 168,011 39.6 49.8 59.3 21,492 37,930 0.567
Oklahoma 1,151,255,033 53,604 43.7 53.9 62.5 15,030 29,312 0.513
South Carolina 1,075,756,276 45,072 41.4 52.8 63.1 15,658 35,390 0.442
South Dakota 286,371,345 10,680 38.2 45.1 50.5 20,285 30,596 0.663
Texas 5,505,748,864 246,814 42.1 51.0 61.1 15,356 30,531 0.503
Utah 369,135,855 10,975 42.7 48.6 50.4 28,505 36,960 0.771
Vermont 298,904,023 10,701 61.2 73.6 73.6 23,243 32,034 0.726
Virginia 1,775,061,683 59,028 48.7 72.5 72.6 20,181 33,514 0.602
Washington 1,930,549,587 82,971 74.8 78.0 81.7 21,284 24,825 0.857
West Virginia 902,596,728 28,750 41.2 50.6 61.1 21,142 43,215 0.489
Wyoming 206,001,295 6,561 56.4 62.6 66.3 26,736 36,252 0.738

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). Potential LTSS Users are based on data from the ACS 2009 Public Use Microdata Sample.
NOTE: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.


TABLE D.3. Medicaid LTSS System Performance Indicators for Aged Enrollees Eligible for Full Medicaid Benefits in 2009

State Total
LTSS $
Total
LTSS Users
Percentage of
Medicaid LTSS
$ Allocated
to HCBS
Percentage of Total
Medicaid $ for
LTSS Users
Allocated to
HCBS Users
Percentage of
LTSS Users
Receiving HCBS
Per-User
Spending on
HCBS
Per-User
Spending on
ILTC
Ratio of
Per-User $
on HCBS
Relative to ILTC
All 38 States     43,542,067,317   1,699,811 30.2 36.8 54.5 14,184 34,769 0.408
Alabama 798,789,081 27,246 10.2 22.2 38.1 7,853 36,938 0.213
Alaska 145,918,539 3,338 58.5 65.1 85.5 29,909 95,972 0.312
Arkansas 545,644,965 25,383 18.8 31.2 45.1 8,975 29,106 0.308
California 6,030,924,709 368,695 50.8 57.8 80.2 10,354 32,954 0.314
Colorado 579,818,876 22,764 27.2 32.9 55.4 12,520 36,365 0.344
Connecticut 1,368,450,337 35,122 17.7 24.2 42.3 16,311 47,888 0.341
Delaware 166,532,142 3,800 12.8 15.2 27.3 20,505 48,935 0.419
District of Columbia 269,103,829 5,410 38.4 44.8 59.1 32,294 66,691 0.484
Florida 2,278,225,670 73,070 7.2 9.9 27.2 8,241 38,819 0.212
Georgia 942,216,129 37,961 10.4 13.5 24.3 10,630 28,603 0.372
Idaho 214,481,724 8,473 25.0 43.1 69.9 9,061 45,712 0.198
Illinois 1,431,772,815 78,717 25.4 32.5 48.9 9,449 24,061 0.393
Indiana 1,029,592,595 35,428 11.9 15.3 19.9 17,342 30,738 0.564
Iowa 567,551,590 28,126 29.1 47.0 62.8 9,354 26,550 0.352
Kansas 440,558,701 20,082 26.4 33.0 44.8 12,918 26,907 0.480
Kentucky 728,444,867 25,184 6.4 9.9 23.4 7,906 34,264 0.231
Louisiana 810,362,044 30,932 25.4 26.4 31.2 21,336 27,681 0.771
Maryland 962,335,502 24,857 17.6 21.5 32.3 21,145 45,559 0.464
Mississippi 661,716,115 23,869 10.1 14.3 37.3 7,518 38,135 0.197
Missouri 880,171,218 50,972 22.5 41.8 57.7 6,736 24,144 0.279
Nebraska 286,634,662 12,105 18.2 25.0 37.4 11,508 27,352 0.421
Nevada 161,830,788 7,299 27.5 32.1 58.8 10,383 36,314 0.286
New Hampshire 230,828,321 8,159 19.7 25.3 32.4 17,181 30,537 0.563
New Jersey 2,086,380,248 66,019 24.4 29.4 51.9 14,886 46,160 0.322
New York 9,178,193,027 192,985 41.9 45.5 51.0 39,051 50,683 0.770
North Carolina 1,556,727,737 77,544 31.7 37.7 61.5 10,345 31,299 0.331
North Dakota 176,746,660 5,297 8.6 13.4 27.6 10,453 38,954 0.268
Ohio 2,729,954,943 95,814 24.5 35.4 50.6 13,803 33,854 0.408
Oklahoma 539,724,212 29,828 24.7 31.5 52.2 8,559 25,995 0.329
South Carolina 544,061,191 24,064 20.5 24.5 44.1 10,496 30,234 0.347
South Dakota 136,855,305 5,881 10.3 14.4 25.7 9,292 26,319 0.353
Texas 2,518,841,602 141,598 28.4 33.2 52.1 9,699 24,584 0.395
Utah 107,862,695 4,118 9.5 11.8 20.4 12,243 28,967 0.423
Vermont 137,190,289 5,276 24.6 42.8 54.3 11,798 34,375 0.343
Virginia 842,951,829 33,746 25.5 49.3 58.5 10,875 29,987 0.363
Washington 905,122,858 43,443 58.5 63.9 74.5 16,368 26,812 0.610
West Virginia 465,807,853 14,250 16.0 19.2 40.7 12,823 43,655 0.294
Wyoming 83,741,649 2,956 16.5 25.3 37.6 12,432 34,591 0.359

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). Potential LTSS Users are based on data from the ACS 2009 Public Use Microdata Sample.
NOTE: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.


TABLE D.4. Medicaid LTSS System Performance Indicators for Enrollees Under 65 with Disabilities Eligible for Full Medicaid Benefits in 2009

State Total
LTSS $
Total
LTSS Users
Percentage of
Medicaid LTSS
$ Allocated
to HCBS
Percentage of Total
Medicaid $ for
LTSS Users
Allocated to
HCBS Users
Percentage of
LTSS Users
Receiving HCBS
Per-User
Spending on
HCBS
Per-User
Spending on
ILTC
Ratio of
Per-User $
on HCBS
Relative to ILTC
All 38 States     46,472,661,446   1,430,199 59.4 68.5 81.0 23,840 57,084 0.418
Alabama 533,387,065 36,672 58.9 77.2 89.6 9,566 39,645 0.241
Alaska 198,644,908 4,426 85.0 87.2 92.7 41,166 65,890 0.625
Arkansas 443,809,138 15,617 37.8 53.2 61.3 17,522 42,849 0.409
California 6,033,321,120 295,554 70.8 80.3 90.9 15,898 50,748 0.313
Colorado 720,411,283 23,901 82.0 85.2 90.4 27,350 43,583 0.628
Connecticut 1,129,591,510 22,250 58.5 66.2 78.5 37,873 73,067 0.518
Delaware 174,091,437 2,910 58.0 61.1 75.6 45,882 90,645 0.506
District of Columbia 321,358,904 5,711 60.7 66.6 77.5 44,093 83,361 0.529
Florida 1,877,352,188 67,128 57.8 64.0 78.8 20,512 52,252 0.393
Georgia 741,484,916 28,794 61.7 69.3 75.2 21,118 36,662 0.576
Idaho 246,604,246 11,230 57.7 75.6 87.7 14,449 50,877 0.284
Illinois 2,108,570,003 76,570 42.1 56.7 66.7 17,384 36,698 0.474
Indiana 1,131,345,201 28,769 58.0 62.6 69.0 33,044 47,040 0.702
Iowa 787,455,268 27,173 51.7 67.1 86.7 17,277 79,224 0.218
Kansas 566,007,757 21,375 79.4 86.8 89.6 23,457 39,521 0.594
Kentucky 614,447,049 22,497 51.9 61.6 69.8 20,288 38,148 0.532
Louisiana 1,225,472,458 41,242 46.3 55.8 63.6 21,655 38,628 0.561
Maryland 1,034,233,347 28,965 71.8 72.9 83.1 30,848 53,398 0.578
Mississippi 513,471,631 16,637 20.7 36.9 60.0 10,648 57,500 0.185
Missouri 956,340,746 45,096 65.7 77.4 83.9 16,609 34,035 0.488
Nebraska 325,498,104 9,444 63.2 68.1 76.6 28,450 45,188 0.630
Nevada 177,216,254 6,104 62.1 66.7 78.7 22,892 44,830 0.511
New Hampshire 232,374,117 5,782 87.2 89.4 89.8 39,037 35,225 1.108
New Jersey 1,749,030,154 36,370 44.5 51.8 75.4 28,405 97,009 0.293
New York 10,938,380,265 152,413 56.9 64.9 81.7 49,973 134,848 0.371
North Carolina 1,625,452,629 71,827 59.2 72.9 87.1 15,386 58,847 0.261
North Dakota 162,099,279 3,549 49.3 54.4 74.4 30,297 77,276 0.392
Ohio 2,685,989,263 72,197 54.9 61.3 71.0 28,761 47,693 0.603
Oklahoma 611,530,821 23,776 60.5 68.2 75.4 20,651 37,340 0.553
South Carolina 531,695,085 21,008 62.8 73.3 84.9 18,728 56,482 0.332
South Dakota 149,516,040 4,799 63.8 67.5 81.0 24,562 48,492 0.507
Texas 2,986,907,262 105,216 53.6 62.8 73.3 20,765 44,566 0.466
Utah 261,273,160 6,857 56.4 60.3 68.4 31,415 48,394 0.649
Vermont 161,713,734 5,425 92.2 94.2 92.3 29,789 20,526 1.451
Virginia 932,109,854 25,282 69.7 89.7 91.4 28,141 45,407 0.620
Washington 1,025,426,729 39,528 89.1 87.7 89.7 25,776 19,887 1.296
West Virginia 436,788,875 14,500 68.0 74.8 81.2 25,237 42,026 0.601
Wyoming 122,259,646 3,605 83.8 85.8 89.8 31,639 43,669 0.725

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). Potential LTSS Users are based on data from the ACS 2009 Public Use Microdata Sample.
NOTE: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.


TABLE D.5. Medicaid LTS System Performance Indicators for Enrollees Under 65 with Physical Disabilities Eligible for Full Medicaid Benefits in 2009

State Total
LTSS $
Total
LTSS Users
Percentage of
Medicaid LTSS
$ Allocated
to HCBS
Percentage of Total
Medicaid $ for
LTSS Users
Allocated to
HCBS Users
Percentage of
LTSS Users
Receiving HCBS
Per-User
Spending on
HCBS
Per-User
Spending on
ILTC
Ratio of
Per-User $
on HCBS
Relative to ILTC
All 35 States     17,073,802,672   920,598 49.0 66.1 78.0 11,638 35,751 0.326
Alabama 256,207,753 31,372 26.8 69.3 88.4 2,474 35,610 0.069
Alaska 101,751,840 3,144 73.2 80.0 90.0 26,324 64,735 0.407
Arkansas 181,376,816 10,449 18.0 49.2 57.0 5,495 31,131 0.176
California 3,021,062,573 211,402 62.6 79.0 90.4 9,891 42,136 0.235
Colorado 329,529,631 16,155 68.1 77.5 86.5 16,054 38,158 0.421
Connecticut 327,864,835 13,838 27.4 56.9 71.9 9,022 45,025 0.200
Delaware 67,955,623 2,028 27.9 42.3 70.6 13,242 71,647 0.185
District of Columbia NA NA NA NA NA NA NA NA
Florida 717,319,710 36,268 32.3 52.2 67.9 9,413 39,122 0.241
Georgia 330,079,730 16,898 39.3 61.7 63.9 12,014 30,312 0.396
Idaho 119,897,920 8,292 57.6 78.2 88.3 9,441 33,474 0.282
Illinois 981,356,841 54,725 35.5 47.8 57.7 11,033 25,247 0.437
Indiana 373,479,830 14,807 47.3 59.3 63.4 18,812 31,037 0.606
Iowa 191,595,130 14,806 53.0 75.9 87.6 7,823 34,776 0.225
Kansas 230,101,110 13,322 75.4 80.3 84.8 15,350 24,026 0.639
Kentucky 264,026,741 17,386 31.2 56.2 64.1 7,397 25,816 0.287
Louisiana 393,260,705 27,126 41.4 60.0 62.1 9,673 19,372 0.499
Maryland 444,512,376 17,497 42.6 57.2 73.1 14,786 49,275 0.300
Mississippi 224,546,931 12,162 28.5 51.2 66.4 7,920 36,139 0.219
Missouri 447,313,596 36,958 49.8 70.6 81.7 7,373 25,937 0.284
Nebraska 119,587,207 5,418 38.9 56.6 66.8 12,862 33,945 0.379
Nevada 88,875,053 4,360 42.3 55.8 72.5 11,891 37,721 0.315
New Hampshire 75,057,654 2,870 62.5 74.9 79.9 20,458 35,123 0.582
New Jersey 646,885,991 24,257 36.2 51.2 72.8 13,261 55,283 0.240
New York 2,958,557,234 85,495 46.4 63.1 74.6 21,532 59,441 0.362
North Carolina 704,911,398 58,265 67.8 82.3 90.4 9,073 30,616 0.296
North Dakota 33,276,471 1,497 28.3 46.3 67.3 9,357 39,941 0.234
Ohio 1,118,956,917 44,090 47.1 59.0 65.9 18,133 31,393 0.578
Oklahoma 232,418,818 17,070 43.9 63.4 74.7 8,008 26,900 0.298
South Carolina 171,792,995 12,645 57.0 76.1 84.8 9,141 34,358 0.266
South Dakota 38,402,961 1,649 19.1 40.0 53.6 8,295 35,307 0.235
Texas 1,265,628,911 73,611 61.4 71.3 75.9 13,912 24,197 0.575
Utah 73,476,789 2,522 14.2 37.5 42.1 9,826 39,705 0.247
Vermont NA NA NA NA NA NA NA NA
Virginia 364,525,160 16,743 48.7 86.4 88.6 11,983 34,001 0.352
Washington NA NA NA NA NA NA NA NA
West Virginia 152,925,918 9,916 44.8 66.6 76.9 8,993 30,075 0.299
Wyoming 25,283,504 1,555 55.8 72.8 80.8 11,236 29,791 0.377

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). Potential LTSS Users are based on data from the ACS 2009 Public Use Microdata Sample.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Enrollees with ID/DD include those enrolled in ID/DD waivers or using ICF/IID services.

NA = not available (ID/DD data were unavailable or unreliable for the District of Columbia, Vermont, and Washington).


TABLE D.6. Medicaid LTSS System Performance Indicators for Enrollees Under 65 with ID/DD and Eligible for Full Medicaid Benefits in 2009

State Total
LTSS $
Total
LTSS Users
Percentage of
Medicaid LTSS
$ Allocated
to HCBS
Percentage of Medicaid
LTSS $ Allocated
to HCBS and
Small ICF Services
Percentage of Total
Medicaid $ for
LTSS Users
Allocated to
HCBS Users
Percentage of
LTSS Users
Receiving HCBS
Percentage of LTSS
Users Receiving
HCBS and
Small ICF Services
Per-User
Spending on
HCBS
Per-User
Spending on
ILTC
Ratio of
Per-User $
on HCBS
Relative to ILTC
All 35 States     27,890,359,407   458,937 64.5 67.7 69.9 86.1 88.5 45,550 125,447 0.363
Alabama 277,179,312 5,300 88.7 88.7 90.7 96.6 96.6 47,977 122,342 0.392
Alaska 96,893,068 1,282 97.4 99.0 98.4 99.2 99.8 74,186 81,567 0.910
Arkansas 262,432,322 5,168 51.4 51.4 58.2 69.9 69.9 37,353 76,354 0.489
California 3,012,258,547 84,152 79.0 87.1 82.4 92.0 96.3 30,722 79,933 0.384
Colorado 390,881,652 7,746 93.8 94.2 95.2 98.5 98.8 48,035 113,773 0.422
Connecticut 801,726,675 8,412 71.3 77.8 73.4 89.3 93.0 76,069 205,255 0.371
Delaware 106,135,814 882 77.3 77.3 78.4 87.2 87.2 106,621 196,292 0.543
District of Columbia NA NA NA NA NA NA NA NA NA NA
Florida 1,160,032,478 30,860 73.5 75.1 76.8 91.6 92.2 30,178 111,343 0.271
Georgia 411,405,186 11,896 79.6 79.6 81.1 91.2 91.2 30,180 73,372 0.411
Idaho 126,706,326 2,938 57.8 67.9 71.3 86.0 92.7 28,951 100,407 0.288
Illinois 1,127,213,162 21,845 47.9 48.6 71.4 89.2 89.2 27,683 71,724 0.386
Indiana 757,865,371 13,962 63.2 72.8 65.4 74.8 80.9 45,839 73,930 0.620
Iowa 595,860,138 12,367 51.3 56.0 62.0 85.6 87.4 28,852 131,355 0.220
Kansas 335,906,647 8,053 82.1 84.0 93.9 97.5 97.6 35,129 100,570 0.349
Kentucky 350,420,308 5,111 67.4 67.4 70.2 89.2 89.2 51,817 158,590 0.327
Louisiana 832,211,753 14,116 48.7 60.5 51.8 66.4 77.1 43,176 83,216 0.519
Maryland 589,720,971 11,468 93.8 93.8 94.7 98.3 98.3 49,085 128,620 0.382
Mississippi 288,924,700 4,475 14.6 14.7 17.5 42.5 42.5 22,241 93,470 0.238
Missouri 509,027,150 8,138 79.7 79.8 88.9 94.0 94.0 53,080 106,368 0.499
Nebraska 205,910,897 4,026 77.3 77.9 79.2 89.7 90.0 44,081 93,655 0.471
Nevada 88,341,201 1,744 82.0 86.0 85.5 94.2 96.6 44,069 113,830 0.387
New Hampshire 157,316,463 2,912 99.0 99.0 99.4 99.6 99.6 53,721 37,222 1.443
New Jersey 1,102,144,163 12,113 49.4 49.4 52.3 80.5 80.5 55,839 219,724 0.254
New York 7,979,823,031 66,918 60.8 61.4 66.0 90.8 91.2 79,815 377,336 0.212
North Carolina 920,541,231 13,562 52.6 64.4 57.5 72.9 81.5 48,997 113,263 0.433
North Dakota 128,822,808 2,052 54.7 62.2 57.4 79.5 83.3 43,239 125,108 0.346
Ohio 1,567,032,346 28,107 60.4 62.3 63.8 78.9 80.1 42,693 94,517 0.452
Oklahoma 379,112,003 6,706 70.7 71.7 73.7 77.2 78.4 51,789 68,615 0.755
South Carolina 359,902,090 8,363 65.6 65.6 70.7 85.1 85.1 33,166 91,656 0.362
South Dakota 111,113,079 3,150 79.3 79.3 84.1 95.3 95.3 29,352 97,867 0.300
Texas 1,721,278,351 31,605 47.9 55.0 52.3 67.2 74.3 38,785 82,236 0.472
Utah 187,796,371 4,335 72.9 72.9 75.7 83.7 83.7 37,729 66,384 0.568
Vermont NA NA NA NA NA NA NA NA NA NA
Virginia 567,584,694 8,539 83.2 84.1 93.1 96.8 97.0 57,111 132,696 0.430
Washington NA NA NA NA NA NA NA NA NA NA
West Virginia 283,862,957 4,584 80.6 83.3 83.0 90.6 91.9 55,058 106,994 0.515
Wyoming 96,976,142 2,050 91.1 91.1 92.6 96.7 96.7 44,562 110,391 0.404

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). Potential LTSS Users are based on data from the ACS 2009 Public Use Microdata Sample.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Enrollees with ID/DD include those enrolled in ID/DD waivers or using ICF/IID services.

NA = not available (ID/DD data were unavailable or unreliable for the District of Columbia, Vermont, and Washington).


TABLE D.7. States Ranked by Percentages of LTSS Expenditures of HCBS for Enrollees Who Were Aged or Had Disabilities and Were Eligible for Full Medicaid Benefits, 2006 and 2009

2006 Rank State Total
LTSS $
(2006)
% of Medicaid
LTSS $ Allocated
to HCBS
(2006)
2009 Rank State Total
LTSS $
(2009)
% of Medicaid
LTSS $ Allocated
to HCBS
(2009)
Percentage Point
Change from
2006 to 2009
--- All 40 States     76,879,134,892   40.8 --- All 38 States     108,499,107,346   44.1 ---
1 Alaska 284,916,040 72.7 1 Washington 1,930,549,587 74.8 9.6
2 New Mexico 687,375,841 70.3 2 Alaska 344,563,447 73.8 1.1
3 Washington 1,510,683,980 65.2 3 Vermont 298,904,023 61.2 3.4
4 Vermont 257,050,002 57.8 4 California 12,064,245,829 60.8 6.0
5 Wyoming 176,243,168 57.0 5 Colorado 1,300,230,159 57.6 6.9
6 California 9,878,514,101 54.7 6 Wyoming 206,001,295 56.4 -0.5
7 Kansas 840,599,103 52.5 7 Kansas 1,006,566,458 56.2 3.7
8 Colorado 1,019,876,958 50.7 8 New Hampshire 463,202,438 53.6 NA
9 New York 17,776,758,555 45.3 9 District of Columbia 590,462,733 50.5 27.3
10 Wisconsin 1,764,144,875 44.5 10 New York 20,116,573,292 50.0 4.7
11 North Carolina 2,701,905,573 43.3 11 Virginia 1,775,061,683 48.7 6.1
12 Nevada 306,338,277 43.3 12 North Carolina 3,182,180,366 45.8 2.4
13 Maryland 1,768,700,598 42.8 13 Maryland 1,996,568,849 45.7 2.8
14 Idaho 371,132,820 42.6 14 Nevada 339,047,042 45.6 2.3
15 Virginia 1,421,468,659 42.6 15 Missouri 1,836,511,964 45.0 4.3
16 Missouri 1,466,773,653 40.7 16 Oklahoma 1,151,255,033 43.7 3.3
17 Oklahoma 1,012,058,004 40.5 17 Utah 369,135,855 42.7 3.7
18 Utah 334,796,035 38.9 18 Idaho 461,085,970 42.5 -0.1
19 Hawaii 329,343,209 38.5 19 Iowa 1,355,006,858 42.2 5.0
20 West Virginia 734,425,562 38.0 20 Nebraska 612,132,766 42.1 4.7
21 Nebraska 562,110,501 37.4 21 Texas 5,505,748,864 42.1 NA
22 Iowa 1,157,728,242 37.2 22 South Carolina 1,075,756,276 41.4 6.9
23 Tennessee 1,854,934,959 37.0 23 West Virginia 902,596,728 41.2 3.2
24 South Dakota 251,692,447 35.9 24 Ohio 5,415,944,206 39.6 6.1
25 South Carolina 909,136,545 34.6 25 South Dakota 286,371,345 38.2 2.3
26 Delaware 301,695,573 34.0 26 Louisiana 2,035,834,502 38.0 10.5
27 Ohio 4,884,852,294 33.5 27 Connecticut 2,498,041,847 36.2 4.6
28 Connecticut 2,238,931,231 31.6 28 Indiana 2,160,937,796 36.0 8.7
29 New Jersey 3,447,275,904 31.2 29 Delaware 340,623,579 35.9 1.8
30 Florida 3,747,337,138 31.1 30 Illinois 3,540,342,818 35.4 4.5
31 Illinois 3,176,627,446 30.8 31 New Jersey 3,835,410,402 33.6 2.4
32 Georgia 1,493,201,190 28.4 32 Georgia 1,683,701,045 33.0 4.6
33 Louisiana 1,525,871,254 27.5 33 Florida 4,155,577,858 30.0 -1.0
34 Indiana 1,828,498,633 27.3 34 Alabama 1,332,176,146 29.7 2.5
35 Alabama 1,130,404,702 27.2 35 North Dakota 338,845,939 28.1 2.3
36 Kentucky 1,209,161,974 25.8 36 Arkansas 989,454,103 27.3 2.4
37 North Dakota 305,327,011 25.8 37 Kentuckya 1,342,891,916 27.2 1.4
38 Arkansas 858,715,978 24.9 38 Mississippi 1,175,187,746 14.7 3.7
39 District of Columbia 315,228,327 23.2 --- --- --- --- ---
40 Mississippi 1,037,298,529 11.1 --- --- --- --- ---

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). 2006 results taken from Wenzlow et al. 2011.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Kentucky incorrectly reported community health claims as HCBS through 2008, so estimates of HCBS use and expenditures from 2006 may be over-reported and are not comparable to rates from 2009.

NA = Data for state were not available for 2006.


TABLE D.8. States Ranked by Percentage of LTSS Users Receiving HCBS for Enrollees Who Were Aged or Had Disabilities and Were Eligible for Full Medicaid Benefits, 2006 and 2004

2006 Rank State Total
LTSS Users
(2006)
% of LTSS
Users Receiving HCBS
(2006)
2009 Rank State Total
LTSS Users
(2009)
% of LTSS
Users Receiving HCBS
(2009)
Percentage Point
Change from
2006 to 2009
--- All 40 States     2,904,883   63.8 --- All 38 States     3,739,847   64.9 ---
1 Alaska 7,591 87.0 1 Alaska 7,764 89.6 2.6
2 California 578,611 82.5 2 California 664,249 84.9 2.4
3 Washington 75,694 78.5 3 Washington 82,971 81.7 3.2
4 Kentucky 50,373 77.5 4 Idaho 19,703 80.0 7.2
5 New Mexico 24,595 76.4 5 Iowa 55,299 74.5 6.4
6 Idaho 17,227 72.9 6 North Carolina 149,371 73.8 1.7
7 North Carolina 145,432 72.2 7 Vermont 10,701 73.6 5.3
8 Colorado 42,632 69.8 8 Colorado 46,665 73.3 3.5
9 Vermont 9,493 68.2 9 Virginia 59,028 72.6 7.0
10 New York 385,991 68.2 10 Missouri 96,068 70.0 3.6
11 Iowa 51,128 68.1 11 District of Columbia 11,121 68.5 23.3
12 Missouri 90,743 66.4 12 Kansas 41,457 67.9 2.5
13 Virginia 52,361 65.6 13 Nevada 13,403 67.9 3.7
14 Kansas 40,507 65.4 14 Alabama 63,918 67.7 6.0
15 Nevada 12,164 64.2 15 Wyoming 6,561 66.3 2.6
16 Wyoming 6,059 63.6 16 New York 345,398 64.5 -3.7
17 Alabama 59,526 61.6 17 South Carolina 45,072 63.1 2.9
18 South Carolina 43,085 60.2 18 Oklahoma 53,604 62.5 4.5
19 Oklahoma 50,793 58.0 19 Texas 246,814 61.1 NA
20 New Jersey 99,441 57.7 20 West Virginia 28,750 61.1 4.1
21 West Virginia 25,825 57.1 21 New Jersey 102,389 60.2 2.5
22 Maryland 52,081 56.7 22 Maryland 53,822 59.6 3.0
23 Hawaii 9,711 56.3 23 Ohio 168,011 59.3 4.0
24 Ohio 163,699 55.3 24 Illinois 155,287 57.7 5.5
25 Connecticut 56,805 53.1 25 Connecticut 57,372 56.3 3.2
26 Illinois 153,120 52.2 26 New Hampshire 13,941 56.2 NA
27 Arkansas 40,947 51.4 27 Nebraska 21,549 54.5 3.4
28 Nebraska 21,186 51.1 28 Florida 140,198 51.9 1.0
29 Florida 153,416 50.9 29 Arkansas 41,000 51.2 -0.2
30 Utah 11,264 49.8 30 South Dakota 10,680 50.5 4.4
31 Wisconsin 61,721 48.4 31 Utah 10,975 50.4 0.5
32 Delaware 6,662 47.9 32 Louisiana 72,174 49.7 11.6
33 South Dakota 10,327 46.2 33 Delaware 6,710 48.2 0.4
34 District of Columbia 7,841 45.3 34 Mississippi 40,506 46.6 5.6
35 North Dakota 9,380 44.3 35 North Dakota 8,846 46.4 2.1
36 Georgia 66,667 43.4 36 Georgia 66,755 46.2 2.8
37 Mississippi 39,336 41.0 37 Kentuckya 47,681 45.3 -32.2
38 Louisiana 60,275 38.1 38 Indiana 64,197 41.9 9.4
39 Tennessee 51,989 35.2 --- --- --- --- ---
40 Indiana 59,185 32.5 --- --- --- --- ---

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). 2006 data taken from Wenzlow et al. 2011.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Kentucky incorrectly reported community health claims as HCBS through 2008, so estimates of HCBS use and expenditures from 2006 may be over-reported and are not comparable to rates from 2009.

NA = Data for state were not available for 2006.


TABLE D.9. States Ranked by Percentage of LTSS Expenditures for HCBS for Enrollees Who Were Aged and Were Eligible for Full Medicaid Benefits, 2006 and 2009

2006 Rank State Total LTSS $
(2006)
% of Medicaid
LTSS $ Allocated
to HCBS
(2006)
2009 Rank State Total LTSS $
(2009)
% of Medicaid
LTSS $ Allocated
to HCBS
(2009)
Percentage Point
Change from
2006 to 2009
--- All 40 states     38,970,178,862   25.8 --- All 38 States     43,542,067,317   30.2 ---
1 Alaska 128,395,747 59.0 1 Washington 905,122,858 58.5 12.1
2 New Mexico 289,303,163 48.0 2 Alaska 145,918,539 58.5 -0.5
3 California 5,037,150,509 46.7 3 California 6,030,924,709 50.8 4.0
4 Washington 779,745,608 46.4 4 New York 9,178,193,027 41.9 5.6
5 New York 8,670,454,546 36.3 5 District of Columbia 269,103,829 38.4 12.5
6 North Carolina 1,409,902,537 32.0 6 North Carolina 1,556,727,737 31.7 -0.3
7 Idaho 170,029,106 27.1 7 Iowa 567,551,590 29.1 8.1
8 Nevada 153,086,456 27.0 8 Texas 2,518,841,602 28.4 NA
9 District of Columbia 180,684,788 25.9 9 Nevada 161,830,788 27.5 0.5
10 Kansas 381,859,547 22.7 10 Colorado 579,818,876 27.2 4.9
11 Colorado 504,301,801 22.3 11 Kansas 440,558,701 26.4 3.7
12 New Jersey 1,883,875,180 21.4 12 Virginia 842,951,829 25.5 6.0
13 Iowa 502,596,147 21.0 13 Illinois 1,431,772,815 25.4 6.5
14 Oklahoma 480,456,706 20.9 14 Louisiana 810,362,044 25.4 9.8
15 Vermont 121,855,143 20.3 15 Idaho 214,481,724 25.0 -2.1
16 Virginia 734,087,006 19.4 16 Oklahoma 539,724,212 24.7 3.8
17 Missouri 763,286,271 19.3 17 Vermont 137,190,289 24.6 4.3
18 Ohio 2,571,660,709 19.0 18 Ohio 2,729,954,943 24.5 5.5
19 Illinois 1,301,097,539 18.9 19 New Jersey 2,086,380,248 24.4 3.1
20 Arkansas 487,483,212 17.1 20 Missouri 880,171,218 22.5 3.2
21 Wisconsin 882,718,934 17.0 21 South Carolina 544,061,191 20.5 5.5
22 Nebraska 275,941,618 16.6 22 New Hampshire 230,828,321 19.7 NA
23 Maryland 876,247,758 16.0 23 Arkansas 545,644,965 18.8 1.7
24 Connecticut 1,297,631,176 15.6 24 Nebraska 286,634,662 18.2 1.5
25 Louisiana 627,400,315 15.6 25 Connecticut 1,368,450,337 17.7 2.1
26 South Carolina 462,115,519 14.9 26 Maryland 962,335,502 17.6 1.6
27 Wyoming 68,010,623 14.8 27 Wyoming 83,741,649 16.5 1.7
28 Hawaii 194,837,917 14.1 28 West Virginia 465,807,853 16.0 2.4
29 West Virginia 391,330,106 13.6 29 Delaware 166,532,142 12.8 2.5
30 Tennessee 890,405,688 12.5 30 Indiana 1,029,592,595 11.9 5.9
31 Delaware 155,128,400 10.2 31 Georgia 942,216,129 10.4 0.4
32 Georgia 893,273,614 10.0 32 South Dakota 136,855,305 10.3 1.6
33 Florida 2,109,846,021 9.7 33 Alabama 798,789,081 10.2 1.3
34 Alabama 727,083,255 8.9 34 Mississippi 661,716,115 10.1 3.0
35 South Dakota 127,027,358 8.7 35 Utah 107,862,695 9.5 0.9
36 Utah 106,803,128 8.6 36 North Dakota 176,746,660 8.6 1.1
37 Kentucky 662,878,165 8.0 37 Florida 2,278,225,670 7.2 -2.5
38 North Dakota 166,576,261 7.6 38 Kentuckya 728,444,867 6.4 -1.6
39 Mississippi 616,636,525 7.1 --- --- --- --- ---
40 Indiana 886,974,760 5.9 --- --- --- --- ---

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). 2006 data taken from Wenzlow et al. 2011.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Kentucky incorrectly reported community health claims as HCBS through 2008, so estimates of HCBS use and expenditures from 2006 may be over-reported and are not comparable to rates from 2009.

NA = Data for state were not available for 2006.


TABLE D.10. States Ranked by Percentage of LTSS Users Receiving HCBS for Enrollees Who Were Aged and Eligible for Full Medicaid Benefits, 2006 and 2009

2006 Rank State Total
LTSS Users
(2006)
% of LTSS
Users Receiving HCBS
(2006)
2009 Rank State Total
LTSS Users
(2009)
% of LTSS
Users Receiving HCBS
(2009)
Percentage Point
Change from
2006 to 2009
--- All 40 states   1,648,932 51.4 --- All 38 States   1,699,811 54.5 ---
1 Alaska 3,507 82.2 1 Alaska 3,338 85.5 3.3
2 California 332,832 77.5 2 California 368,695 80.2 2.7
3 Kentucky 27,858 73.5 3 Washington 43,443 74.5 4.6
4 Washington 41,395 69.9 4 Idaho 8,473 69.9 8.5
5 New Mexico 13,160 63.5 5 Iowa 28,126 62.8 8.1
6 Idaho 8,017 61.4 6 North Carolina 77,544 61.5 0.5
7 North Carolina 80,627 61.1 7 District of Columbia 5,410 59.1 16.7
8 New York 215,851 55.5 8 Nevada 7,299 58.8 3.5
9 Nevada 6,952 55.3 9 Virginia 33,746 58.5 8.0
10 Missouri 52,382 55.3 10 Missouri 50,972 57.7 2.5
11 Iowa 27,483 54.7 11 Colorado 22,764 55.4 3.8
12 Colorado 22,023 51.6 12 Vermont 5,276 54.3 7.9
13 Virginia 31,989 50.6 13 Oklahoma 29,828 52.2 4.6
14 New Jersey 64,057 48.1 14 Texas 141,598 52.1 NA
15 Oklahoma 30,023 47.6 15 New Jersey 66,019 51.9 3.8
16 Vermont 4,889 46.3 16 New York 192,985 51.0 -4.5
17 Arkansas 26,288 45.7 17 Ohio 95,814 50.6 5.1
18 Ohio 94,670 45.4 18 Illinois 78,717 48.9 8.1
19 District of Columbia 4,650 42.5 19 Arkansas 25,383 45.1 -0.6
20 Kansas 20,601 42.4 20 Kansas 20,082 44.8 2.4
21 South Carolina 23,702 42.1 21 South Carolina 24,064 44.1 2.0
22 Illinois 80,876 40.8 22 Connecticut 35,122 42.3 2.3
23 Alabama 32,141 40.1 23 West Virginia 14,250 40.7 4.2
24 Connecticut 35,589 39.9 24 Alabama 27,246 38.1 -2.0
25 Hawaii 5,758 38.2 25 Wyoming 2,956 37.6 4.1
26 West Virginia 13,616 36.4 26 Nebraska 12,105 37.4 1.7
27 Nebraska 12,463 35.6 27 Mississippi 23,869 37.3 4.0
28 Florida 91,269 33.6 28 New Hampshire 8,159 32.4 NA
29 Wyoming 2,799 33.5 29 Maryland 24,857 32.3 2.6
30 Mississippi 24,700 33.3 30 Louisiana 30,932 31.2 10.9
31 Maryland 24,857 29.7 31 North Dakota 5,297 27.6 1.6
32 Wisconsin 36,521 26.5 32 Delaware 3,800 27.3 0.9
33 Delaware 3,837 26.3 33 Florida 73,070 27.2 -6.4
34 North Dakota 5,751 26.0 34 South Dakota 5,881 25.7 0.8
35 South Dakota 6,175 24.9 35 Georgia 37,961 24.3 -0.6
36 Georgia 41,087 24.9 36 Kentuckya 25,184 23.4 -50.2
37 Utah 4,558 22.2 37 Utah 4,118 20.4 -1.8
38 Louisiana 29,365 20.2 38 Indiana 35,428 19.9 9.0
39 Indiana 34,198 10.9 --- --- --- --- ---
40 Tennessee 30,416 10.7 --- --- --- --- ---

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). 2006 data taken from Wenzlow et al. 2011.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Kentucky incorrectly reported community health claims as HCBS through 2008, so estimates of HCBS use and expenditures from 2006 may be over-reported and are not comparable to rates from 2009.

NA = Data for state were not available for 2006.


TABLE D.11. States Ranked by Percentage of LTSS Expenditures for HCBS for Enrollees Who Had Disabilities and Were Eligible for Full Medicaid Benefits, 2006 and 2009

2006 Rank State Total LTSS $
(2006)
% of Medicaid
LTSS $ Allocated
to HCBS
(2006)
2009 Rank State Total LTSS $
(2009)
% of Medicaid
LTSS $ Allocated
to HCBS
(2009)
Percentage Point
Change from
2006 to 2009
--- All 40 states     37,908,956,030   56.1 --- All 38 States     46,472,661,446   59.4 ---
1 Vermont 135,194,859 91.5 1 Vermont 161,713,734 92.2 0.7
2 New Mexico 398,072,679 86.5 2 Washington 1,025,426,729 89.1 3.8
3 Washington 730,938,372 85.2 3 New Hampshire 232,374,117 87.2 NA
4 Alaska 156,520,293 84.0 4 Alaska 198,644,908 85.0 1.0
5 Wyoming 108,232,545 83.5 5 Wyoming 122,259,646 83.8 0.3
6 Colorado 515,575,157 78.5 6 Colorado 720,411,283 82.0 3.5
7 Kansas 458,739,556 77.3 7 Kansas 566,007,757 79.4 2.1
8 Hawaii 134,505,292 73.8 8 Maryland 1,034,233,347 71.8 2.6
9 Wisconsin 881,425,941 72.0 9 California 6,033,321,120 70.8 7.7
10 Maryland 892,452,840 69.2 10 Virginia 932,109,854 69.7 2.4
11 Virginia 687,381,653 67.3 11 West Virginia 436,788,875 68.0 2.3
12 West Virginia 343,095,456 65.8 12 Missouri 956,340,746 65.7 1.8
13 Missouri 703,487,382 63.9 13 South Dakota 149,516,040 63.8 0.2
14 South Dakota 124,665,089 63.7 14 Nebraska 325,498,104 63.2 5.8
15 California 4,841,363,592 63.0 15 South Carolina 531,695,085 62.8 8.0
16 Alabama 403,321,447 60.3 16 Nevada 177,216,254 62.1 2.5
17 Tennessee 964,529,271 59.7 17 Georgia 741,484,916 61.7 6.0
18 Nevada 153,251,821 59.6 18 District of Columbia 321,358,904 60.7 41.1
19 Delaware 146,567,173 59.2 19 Oklahoma 611,530,821 60.5 2.5
20 Florida 1,637,491,117 58.6 20 North Carolina 1,625,452,629 59.2 3.6
21 Oklahoma 531,601,298 58.1 21 Alabama 533,387,065 58.9 -1.3
22 Nebraska 286,168,883 57.5 22 Connecticut 1,129,591,510 58.5 4.9
23 Idaho 201,103,714 55.7 23 Delaware 174,091,437 58.0 -1.2
24 Georgia 599,927,576 55.7 24 Indiana 1,131,345,201 58.0 10.5
25 North Carolina 1,292,003,036 55.6 25 Florida 1,877,352,188 57.8 -0.8
26 South Carolina 447,021,026 54.8 26 Idaho 246,604,246 57.7 2.0
27 New York 9,106,304,009 53.9 27 New York 10,938,380,265 56.9 3.0
28 Connecticut 941,300,055 53.7 28 Utah 261,273,160 56.4 3.2
29 Utah 227,992,907 53.2 29 Ohio 2,685,989,263 54.9 5.3
30 Iowa 655,132,095 49.7 30 Texas 2,986,907,262 53.6 NA
31 Ohio 2,313,191,585 49.5 31 Kentuckya 614,447,049 51.9 4.5
32 North Dakota 138,750,750 47.6 32 Iowa 787,455,268 51.7 2.0
33 Indiana 941,523,873 47.4 33 North Dakota 162,099,279 49.3 1.7
34 Kentucky 546,283,809 47.4 34 Louisiana 1,225,472,458 46.3 10.5
35 New Jersey 1,563,400,724 43.1 35 New Jersey 1,749,030,154 44.5 1.5
36 Illinois 1,875,529,907 39.1 36 Illinois 2,108,570,003 42.1 3.0
37 Louisiana 898,470,939 35.8 37 Arkansas 443,809,138 37.8 2.5
38 Arkansas 371,232,766 35.2 38 Mississippi 513,471,631 20.7 3.8
39 District of Columbia 134,543,539 19.6 --- --- --- --- ---
40 Mississippi 420,662,004 16.9 --- --- --- --- ---

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). 2006 data taken from Wenzlow et al. 2011.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Kentucky incorrectly reported community health claims as HCBS through 2008, so estimates of HCBS use and expenditures from 2006 may be over-reported and are not comparable to rates from 2009.

NA = Data for state were not available for 2006.


TABLE D.12. States Ranked by Percentage of LTSS Users Receiving HCBS for Enrollees Who Had Disabilities and Were Eligible for Full Medicaid Benefits, 2006 and 2009

2006 Rank State Total
LTSS Users
(2006)
% of LTSS
Users Receiving HCBS
(2006)
2009 Rank State Total
LTSS Users
(2009)
% of LTSS
Users Receiving HCBS
(2009)
Percentage Point
Change from
2006 to 2009
--- All 40 states 1,255,951 80.0 --- All States 1,430,199 81.0 ---
1 Vermont 4,604 91.5 1 Alaska 4,426 92.7 1.6
2 New Mexico 11,435 91.1 2 Vermont 5,425 92.3 0.8
3 Alaska 4,084 91.1 3 Virginia 25,282 91.4 2.1
4 Wyoming 3,260 89.5 4 California 295,554 90.9 1.6
5 Colorado 20,609 89.4 5 Colorado 23,901 90.4 1.0
6 Kansas 19,906 89.3 6 Wyoming 3,605 89.8 0.3
7 Virginia 20,372 89.3 7 New Hampshire 5,782 89.8 NA
8 California 245,779 89.2 8 Washington 39,528 89.7 0.7
9 Washington 34,299 89.0 9 Alabama 36,672 89.6 2.7
10 Alabama 27,385 86.9 10 Kansas 21,375 89.6 0.3
11 North Carolina 64,805 86.0 11 Idaho 11,230 87.7 4.8
12 New York 170,140 84.3 12 North Carolina 71,827 87.1 1.1
13 Iowa 23,645 83.8 13 Iowa 27,173 86.7 2.9
14 Idaho 9,210 82.9 14 South Carolina 21,008 84.9 2.5
15 Hawaii 3,953 82.6 15 Missouri 45,096 83.9 2.3
16 Kentucky 22,515 82.5 16 Maryland 28,965 83.1 1.8
17 South Carolina 19,383 82.4 17 New York 152,413 81.7 -2.7
18 Missouri 38,361 81.6 18 West Virginia 14,500 81.2 1.1
19 Maryland 27,224 81.3 19 South Dakota 4,799 81.0 3.2
20 Wisconsin 25,200 80.2 20 Florida 67,128 78.8 2.5
21 West Virginia 12,209 80.1 21 Nevada 6,104 78.7 2.7
22 South Dakota 4,152 77.8 22 Connecticut 22,250 78.5 3.2
23 Delaware 2,825 77.1 23 District of Columbia 5,711 77.5 28.1
24 Florida 62,147 76.3 24 Nebraska 9,444 76.6 3.2
25 Nevada 5,212 76.1 25 Delaware 2,910 75.6 -1.5
26 Connecticut 21,216 75.2 26 Oklahoma 23,776 75.4 2.4
27 New Jersey 35,384 75.0 27 New Jersey 36,370 75.4 0.3
28 North Dakota 3,629 73.4 28 Georgia 28,794 75.2 2.0
29 Nebraska 8,723 73.3 29 North Dakota 3,549 74.4 1.0
30 Georgia 25,580 73.2 30 Texas 105,216 73.3 NA
31 Oklahoma 20,770 73.0 31 Ohio 72,197 71.0 2.0
32 Tennessee 21,573 69.9 32 Kentuckya 22,497 69.8 -12.6
33 Ohio 69,029 68.9 33 Indiana 28,769 69.0 6.9
34 Utah 6,706 68.6 34 Utah 6,857 68.4 -0.2
35 Illinois 72,244 64.9 35 Illinois 76,570 66.7 1.8
36 Indiana 24,987 62.0 36 Louisiana 41,242 63.6 8.5
37 Arkansas 14,659 61.8 37 Arkansas 15,617 61.3 -0.5
38 Louisiana 30,910 55.1 38 Mississippi 16,637 60.0 5.8
39 Mississippi 14,636 54.2 --- --- --- --- ---
40 District of Columbia 3,191 49.4 --- --- --- --- ---

SOURCE: Mathematica analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin). 2006 data taken from Wenzlow et al. 2011.
NOTES: Enrollees in managed LTSS and those eligible for only restricted Medicaid benefits are excluded. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21.

  1. Kentucky incorrectly reported community health claims as HCBS through 2008, so estimates of HCBS use and expenditures from 2006 may be over-reported and are not comparable to rates from 2009.

NA = Data for state were not available for 2006.


TABLE D.13. Percentage of Medicaid LTSS Expenditures for HCBS in 2009, by Eligibility Group

State   Total     Aged     Disabled  
Mississippi 14.7 10.1 20.7
Kentucky 27.2 6.4 51.9
Arkansas 27.3 18.8 37.8
North Dakota 28.1 8.6 49.3
Alabama 29.7 10.2 58.9
Florida 30.0 7.2 57.8
Georgia 33.0 10.4 61.7
New Jersey 33.6 24.4 44.5
Illinois 35.4 25.4 42.1
Delaware 35.9 12.8 58.0
Indiana 36.0 11.9 58.0
Connecticut 36.2 17.7 58.5
Louisiana 38.0 25.4 46.3
South Dakota 38.2 10.3 63.8
Ohio 39.6 24.5 54.9
West Virginia 41.2 16.0 68.0
South Carolina 41.4 20.5 62.8
Texas 42.1 28.4 53.6
Nebraska 42.1 18.2 63.2
Iowa 42.2 29.1 51.7
Idaho 42.5 25.0 57.7
Utah 42.7 9.5 56.4
Oklahoma 43.7 24.7 60.5
Missouri 45.0 22.5 65.7
Nevada 45.6 27.5 62.1
Maryland 45.7 17.6 71.8
North Carolina 45.8 31.7 59.2
Virginia 48.7 25.5 69.7
New York 50.0 41.9 56.9
District of Columbia   50.5 38.4 60.7
New Hampshire 53.6 19.7 87.2
Kansas 56.2 26.4 79.4
Wyoming 56.4 16.5 83.8
Colorado 57.6 27.2 82.0
California 60.8 50.8 70.8
Vermont 61.2 24.6 92.2
Alaska 73.8 58.5 85.0
Washington 74.8 58.5 89.1

SOURCE: Mathematica Policy Research analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin).
NOTES: Excludes enrollees in managed care and those eligible for only restricted Medicaid benefits. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21. States in figure are sorted based on percentage of Medicaid LTSS expenditures overall for aged and enrollees with disabilities. The data in this table was used to generate Figure II.3.


TABLE D.14. Percentage of LTSS Users Receiving HCBS in 2009, by Eligibility Group

State   Total     Aged     Disabled  
Indiana 41.9 19.9 69.0
Kentucky 45.3 23.4 69.8
Georgia 46.2 24.3 75.2
North Dakota 46.4 27.6 74.4
Mississippi 46.6 37.3 60.0
Delaware 48.2 27.3 75.6
Louisiana 49.7 31.2 63.6
Utah 50.4 20.4 68.4
South Dakota 50.5 25.7 81.0
Arkansas 51.2 45.1 61.3
Florida 51.9 27.2 78.8
Nebraska 54.5 37.4 76.6
New Hampshire 56.2 32.4 89.8
Connecticut 56.3 42.3 78.5
Illinois 57.7 48.9 66.7
Ohio 59.3 50.6 71.0
Maryland 59.6 32.3 83.1
New Jersey 60.2 51.9 75.4
West Virginia 61.1 40.7 81.2
Texas 61.1 52.1 73.3
Oklahoma 62.5 52.2 75.4
South Carolina 63.1 44.1 84.9
New York 64.5 51.0 81.7
Wyoming 66.3 37.6 89.8
Alabama 67.7 38.1 89.6
Nevada 67.9 58.8 78.7
Kansas 67.9 44.8 89.6
District of Columbia   68.5 59.1 77.5
Missouri 70.0 57.7 83.9
Virginia 72.6 58.5 91.4
Colorado 73.3 55.4 90.4
Vermont 73.6 54.3 92.3
North Carolina 73.8 61.5 87.1
Iowa 74.5 62.8 86.7
Idaho 80.0 69.9 87.7
Washington 81.7 74.5 89.7
California 84.9 80.2 90.9
Alaska 89.6 85.5 92.7

SOURCE: Mathematica Policy Research analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data (excludes data from Arizona, Hawaii, Maine, Massachusetts, Michigan, Minnesota, Montana, New Mexico, Oregon, Pennsylvania, Rhode Island, Tennessee, and Wisconsin).
NOTES: Excludes enrollees in managed care and those eligible for only restricted Medicaid benefits. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21. States in figure are sorted based on percentage of Medicaid LTSS users receiving HCBS among all aged and enrollees with disabilities. The data in this table was used to generate Figure II.4.


TABLE D.15. Progress in Re-Balancing Toward HCBS from 2006 to 2009, 35 States

State   Percentage Point Change  
in $ to HCBS,
2006 to 2009
  Percentage Point Change  
in HCBS Users,
2006 to 2009
Alabama 3 6.0
Alaska 1 2.6
Arkansas 2 -0.2
California 6 2.4
Colorado 7 3.5
Connecticut 5 3.2
District of Columbia   27 23.3
Delaware 2 0.4
Florida -1 1.0
Georgia 5 2.8
Idaho 0 7.2
Illinois 5 5.5
Indiana 9 9.4
Iowa 5 6.4
Kansas 4 2.5
Louisiana 11 11.6
Maryland 3 3.0
Mississippi 4 5.6
Missouri 4 3.6
Nebraska 5 3.4
Nevada 2 3.7
New Jersey 2 2.5
New York 5 -3.7
North Carolina 2 1.7
North Dakota 2 2.1
Ohio 6 4.0
Oklahoma 3 4.5
South Carolina 7 2.9
South Dakota 2 4.4
Utah 4 0.5
Vermont 3 5.3
Virginia 6 7.0
Washington 10 3.2
West Virginia 3 4.1
Wyoming -1 2.6

SOURCE: Mathematica Policy Research analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data. Analysis of 2006 MAX data taken from Wenzlow et al. 2011. Figure includes all states with reliable LTSS data in both years.
NOTE: Excludes enrollees in managed care and those eligible for only restricted Medicaid benefits. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21. The data in this table was used to generate Figure II.5.


TABLE D.16. Percentage Point Differences in Percentage of Medicaid LTSS Expenditures for HCBS for 2006 to 2009, 35 States

State   Total     Aged     Disabled  
Alaska -0.5 -1.9 1.5
Alabama 1.3 0.0 1.0
Arkansas 1.7 6.6 -1.8
California 4.0 9.5 6.3
Colorado 4.9 0.9 7.7
Connecticut 2.1 4.2 0.8
District of Columbia   12.5 --- ---
Delaware 2.5 1.6 -7.6
Florida -2.5 0.3 3.5
Georgia 0.4 8.0 2.5
Iowa 8.1 2.6 -0.1
Idaho -2.1 7.3 -4.9
Illinois 6.5 4.2 2.5
Indiana 5.9 10.6 12.7
Kansas 3.7 3.8 -0.2
Kentucky -1.6 8.2 -1.8
Louisiana 9.8 10.4 11.5
Maryland 1.6 4.6 1.5
Missouri 3.2 30.6 -19.1
Mississippi 3.0 0.5 7.0
North Carolina -0.3 6.6 -0.8
North Dakota 1.1 1.5 3.9
Nebraska 1.5 8.1 1.9
New Jersey 3.1 2.5 0.2
Nevada 0.5 8.6 -1.9
New York 5.6 3.2 0.6
Ohio 5.5 5.0 6.5
Oklahoma 3.8 2.8 5.7
South Carolina 5.5 8.3 7.7
South Dakota 1.6 0.3 3.1
Utah 0.9 5.2 -1.2
Virginia 6.0 1.8 3.4
Vermont 4.3 --- ---
Washington 12.1 --- ---
West Virginia 2.4 2.9 3.6
Wyoming 1.7 0.6 3.7

SOURCE: Mathematica Policy Research analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data. Analysis of 2006 MAX data taken from Wenzlow et al. 2011. Figure includes all states with reliable LTSS data in both years.
NOTES: Excludes enrollees in managed care and those eligible for only restricted Medicaid benefits. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21. In the District of Columbia, Vermont, and Washington, individuals with ID/DD could not be distinguished from enrollees with other disabilities. As a result, these states are excluded from analyses of the population under age 65 with ID/DD and enrollees with other disabilities. The data in this table was used to generate Figure II.6.


TABLE D.17. Percentage Point Changes in Percentage of LTSS Users Receiving HCBS from 2006 to 2009, 35 States

State   Total     Aged     Disabled  
Alaska -2.0 -0.6 1.6
Alabama 3.3 0.5 3.6
Arkansas -0.6 2.6 -2.0
California 2.7 2.3 1.4
Colorado 3.8 -0.1 2.2
Connecticut 2.3 2.7 2.9
District of Columbia   16.7 --- ---
Delaware 0.9 1.7 -2.9
Florida -6.4 0.4 7.2
Georgia -0.6 1.8 0.3
Iowa 8.5 3.3 2.4
Idaho 8.1 4.7 4.9
Illinois 9.0 2.6 1.7
Indiana 8.1 4.2 9.9
Kansas 2.4 5.5 -2.9
Louisiana 10.9 15.1 5.1
Maryland 2.6 1.2 1.6
Missouri 4.0 23.4 -0.9
Mississippi 2.5 0.5 7.0
North Carolina 1.7 2.2 0.6
North Dakota 3.5 1.3 1.2
Nebraska 3.8 4.5 2.3
New Jersey -4.5 1.9 -0.3
Nevada 0.5 3.0 2.8
New York 1.6 -1.2 -5.6
Ohio 5.1 5.5 -0.6
Oklahoma 4.6 0.8 3.4
South Carolina 2.0 7.7 0.0
South Dakota 0.8 0.6 9.4
Utah -1.8 1.0 -2.4
Virginia 7.9 1.3 2.9
Vermont 8.0 --- ---
Washington 4.6 --- ---
West Virginia 4.2 1.7 1.2
Wyoming 4.1 0.4 2.5

SOURCE: Mathematica Policy Research analysis of 2009 MAX data for 37 states and the District of Columbia with representative FFS LTSS data. Analysis of 2006 MAX data taken from Wenzlow et al. 2011. Figure includes all states with reliable LTSS data in both years.
NOTES: Excludes enrollees in managed care and those eligible for only restricted Medicaid benefits. HCBS include 1915(c) waiver services and state plan services for personal care, residential care, home health, adult day care, and private duty nursing. ILTC includes services provided in nursing homes, ICFs/IID, mental hospitals for the aged, and inpatient psychiatric facilities for people under age 21. In the District of Columbia, Vermont, and Washington, individuals with ID/DD could not be distinguished from enrollees with other disabilities. As a result, these states are excluded from analyses of the population under age 65 with ID/DD and enrollees with other disabilities. The data in this table was used to generate Figure II.7.

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