Community & Work Disparities
A Program of the ADA Participatory Action Research Consortium (ADA-PARC)

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Ratio of Home and Community-Based Services (HCBS) Participants to Total Long-Term Support Services (LTSS), 2011

One of the main ways states provide services to persons with disabilities living at home and in communities is through Medicaid home and community based services (HCBS). These services are provided mainly in three programs, the 1915(c) waiver program, the Medicaid home health program and Medicaid personal care services program. Participation in these programs is an alternative to receiving services while residing in an institution. To illustrate how many persons are served at home and in communities with HCBS, this map shows the ratio of HCBS participation to total long term support and services (LTSS), which include all HCBS and institutional participation. The higher the ratio, the more persons are served at home compared to institutions. This map shows that states with the highest ratios are concentrated in the west and parts of the south, while a cluster of states in the south and southeast have the lowest ration. Arizona had the highest ratio of HCBS to total LTSS participants at 97.7% while Rhode Island had the lowest at 12.9%.

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Ratio of Home and Community-Based Services (HCBS) Participants to Total Long-Term Support Services (LTSS) Color coded map of the United States.  States have been grouped into four quartile ranges. The first quartile ranges from 12.9% to 55.2% and includes the states Alabama, Delaware, Florida, Georgia, Indiana, Maryland, Mississippi, North Dakota, Ohio, Pennsylvania, Rhode Island & Tennessee.  The second quartile ranges from 55.3% to 65.1% and includes the states Arkansas, Connecticut, Illinois, Kentucky, Louisiana, Massachusetts, Maine, Montana, New Hampshire, New Jersey, Virginia, Vermont & West Virginia.  The third quartile ranges from 65.2% to 71.7% and includes the states Washington DC, Iowa, Idaho, Michigan, Missouri, Nebraska, Nevada, New York, Oklahoma, South Carolina, South Dakota, United States, Utah & Wyoming.  The fourth quartile ranges from 71.8% to 97.7% and includes the states Alaska, Arizona, California, Colorado, Hawaii, Kansas, Minnesota, North Carolina, New Mexico, Oregon, Texas, Washington & Wisconsin. Alaska, 90.2% Alabama, 44.8% Arkansas, 56.4% Arizona, 97.7% California, 82.1% Colorado, 71.8% Connecticut, 55.3% Washington DC, 71% Delaware, 51.7% Florida, 54.4% Georgia, 46.3% Hawaii, 76.9% Iowa, 67% Idaho, 66.7% Illinois, 57.2% Indiana, 45.9% Kansas, 71.9% Kentucky, 56.3% Louisiana, 58.9% Massachusetts, 56.3% Maryland, 54.2% Maine, 56.8% Michigan, 68% Minnesota, 80.1% Missouri, 71.2% Mississippi, 41.8% Montana, 64.8% North Carolina, 72.5% North Dakota, 52.1% Nebraska, 67.4% New Hampshire, 60.4% New Jersey, 56.8% New Mexico, 93.7% Nevada, 70.2% New York, 65.3% Ohio, 54.8% Oklahoma, 65.2% Oregon, 82.1% Pennsylvania, 53.7% Rhode Island, 12.9% South Carolina, 67% South Dakota, 65.3% Tennessee, 46.7% Texas, 77.5% Utah, 71.4% Virginia, 57.3% Vermont, 61.9% Wisconsin, 73.3% West Virginia, 64.9% Wyoming, 70.3%
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Data source. 2011, HCBS Participants & Expenditures from UCSF Annual Data Collection; Nursing Homes and ICF/DD participants from MSIS;
Nursing Homes and ICF/DD Expenditures from Burwell et al. 2010.
Note. HCBS includes 1915(c) waivers, Home Health & State Plan PCS; Long Term Support & Services (LTSS) includes HCBS, nursing homes and ICF/DD. AZ, HI, RI & VT served most of their HHBS population within managed care programs.

Ratio of Home and Community-Based Services (HCBS) Participants to Total Long-Term Support Services (LTSS) by region

Ratio of Home and Community-Based Services (HCBS) Participants to Total Long-Term Support Services (LTSS) by Region
RegionRatio of HCBS Participants to Total LTSS
United States68.4%
Alaska90.2%
Alabama44.8%
Arkansas56.4%
Arizona97.7%
California82.1%
Colorado71.8%
Connecticut55.3%
District of Columbia71.0%
Delaware51.7%
Florida54.4%
Georgia46.3%
Hawaii76.9%
Iowa67.0%
Idaho66.7%
Illinois57.2%
Indiana45.9%
Ratio of Home and Community-Based Services (HCBS) Participants to Total Long-Term Support Services (LTSS) by Region
RegionRatio of HCBS Participants to Total LTSS
Kansas71.9%
Kentucky56.3%
Louisiana58.9%
Massachusetts56.3%
Maryland54.2%
Maine56.8%
Michigan68.0%
Minnesota80.1%
Missouri71.2%
Mississippi41.8%
Montana64.8%
North Carolina72.5%
North Dakota52.1%
Nebraska67.4%
New Hampshire60.4%
New Jersey56.8%
New Mexico93.7%
Ratio of Home and Community-Based Services (HCBS) Participants to Total Long-Term Support Services (LTSS) by Region
RegionRatio of HCBS Participants to Total LTSS
Nevada70.2%
New York65.3%
Ohio54.8%
Oklahoma65.2%
Oregon82.1%
Pennsylvania53.7%
Rhode Island12.9%
South Carolina67.0%
South Dakota65.3%
Tennessee46.7%
Texas77.5%
Utah71.4%
Virginia57.3%
Vermont61.9%
Washington81.0%
Wisconsin73.3%
West Virginia64.9%
Wyoming70.3%