Interstate Variation and Progress Toward Balance in Use of and Expenditure for Long-Term Services and Supports in 2009. D. Measuring and Understanding LTSS System Performance


This report examines patterns in LTSS use across states and subgroups of enrollees in 2009, just after many states began to experience fiscal constraints and increased demand for services from the national recession. The analysis updates findings from a previous study based on 2006 data and expands on state-level factors linked to LTSS systems that exhibit greater HCBS use.4 In addition, the ACA of 2010 expanded states' options for offering HCBS through Medicaid.5 Analyses based on data from 2009 provide a baseline of HCBS balance across and within states for future comparison to state policy and program changes that resulted from options made available in 2010.

4 In this report, the word "states" is meant to include the 50 states and the District of Columbia.

5 The ACA gave states new options and financial incentives for providing HCBS to Medicaid enrollees. New options include the Community First Choice program (which allows states to cover personal care and other services for eligible individuals through their Medicaid state plans) and the BIP (which provides incentives for eligible states to re-balance their LTC system toward HCBS). The ACA also expanded the scope of covered services and eligibility requirements for Section 1915(i) programs and extended the MFP program with additional funding. For more information on states' adoption of new HCBS options, see Walker (2010); KFF (2011); and U.S. Government Accountability Office (2012).

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