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

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Ratio of HCBS Expenditures to Total LTSS, 2015

An important component of state policy to the expansion of Medicaid HCBS (Home and Community-Based Services) is state spending on such services as a ratio of overall long term support and services (LTSS) spending. The more a state chooses to spend on HCBS as part of overall LTSS spending, the less it can spend on institutional care. In the United States, the ratio of HCBS expenditures to LTSS is 54.8%. The map and table show western states, northeastern states, and some midwest spend more than 50% of their LTSS budgets on HCBS while most of the states east of the Mississippi River and south of New York spend less than 50% of their LTSS budgets on HCBS.

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Ratio of HCBS Expenditures to Total LTSS Color coded map of the United States.  States have been grouped into four quartile ranges. The first quartile ranges from 30.6% to 45.5% and includes the states Alabama, Delaware, Florida, Hawaii, Indiana, Kentucky, Louisiana, Michigan, Mississippi, New Jersey, North Dakota & Oklahoma.  The second quartile ranges from 45.6% to 51.1% and includes the states Connecticut, Georgia, Illinois, Kansas, Nebraska, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, West Virginia & Wyoming.  The third quartile ranges from 51.2% to 57.8% and includes the states Arkansas, Washington DC, Idaho, Iowa, Maine, Maryland, Montana, Nevada, New Hampshire, Rhode Island, United States, Utah & Virginia.  The fourth quartile ranges from 57.9% to 82.2% and includes the states Alaska, Arizona, Colorado, Massachusetts, Minnesota, Missouri, New Mexico, New York, Oregon, Texas, Vermont, Washington & Wisconsin. Alaska, 62.80% Alabama, 42.10% Arkansas, 52.00% Arizona, 69.80% California, N% Colorado, 65.00% Connecticut, 50.70% Washington DC, 54.40% Delaware, 44.90% Florida, 32.90% Georgia, 47.20% Hawaii, 40.30% Iowa, 51.90% Idaho, 51.20% Illinois, 45.60% Indiana, 33.70% Kansas, 49.40% Kentucky, 41.30% Louisiana, 37.70% Massachusetts, 65.40% Maryland, 56.50% Maine, 54.60% Michigan, 40.30% Minnesota, 76.70% Missouri, 57.90% Mississippi, 30.60% Montana, 57.20% North Carolina, N% North Dakota, 42.10% Nebraska, 50.80% New Hampshire, 52.00% New Jersey, 44.10% New Mexico, 78.70% Nevada, 53.60% New York, 58.40% Ohio, 50.50% Oklahoma, 45.10% Oregon, 82.20% Pennsylvania, 46.50% Rhode Island, 57.30% South Carolina, 47.90% South Dakota, 47.90% Tennessee, 48.20% Texas, 57.90% Utah, 51.30% Virginia, 55.50% Vermont, 69.30% Wisconsin, 65.10% West Virginia, 47.20% Wyoming, 49.10%
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Data source. 2015, Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2015 from Eiken et al. 2017.
Note. HCBS includes 1915(c) waivers, Home Health & State Pan PCS; Long Term Support & Services (LTSS) includes HCBS, nursing homes and ICF/DD. AZ, HI, RI & VT served most of their HCBS population within managed care programs.

Ratio of HCBS Expenditures to Total LTSS by region

Ratio of HCBS Expenditures to Total LTSS by Region
RegionRatio of HCBS Expenditures to Total LTSS
United States54.8%
Alabama42.1%
Alaska62.8%
Arizona69.8%
Arkansas52.0%
CaliforniaN
Colorado65.0%
Connecticut50.7%
Delaware44.9%
Dist. of Columbia54.4%
Florida32.9%
Georgia47.2%
Hawaii40.3%
Idaho51.2%
Illinois45.6%
Indiana33.7%
Iowa51.9%
Ratio of HCBS Expenditures to Total LTSS by Region
RegionRatio of HCBS Expenditures to Total LTSS
Kansas49.4%
Kentucky41.3%
Louisiana37.7%
Maine54.6%
Maryland56.5%
Massachusetts65.4%
Michigan40.3%
Minnesota76.7%
Mississippi30.6%
Missouri57.9%
Montana57.2%
Nebraska50.8%
Nevada53.6%
New Hampshire52.0%
New Jersey44.1%
New Mexico78.7%
New York58.4%
Ratio of HCBS Expenditures to Total LTSS by Region
RegionRatio of HCBS Expenditures to Total LTSS
North CarolinaN
North Dakota42.1%
Ohio50.5%
Oklahoma45.1%
Oregon82.2%
Pennsylvania46.5%
Rhode Island57.3%
South Carolina47.9%
South Dakota47.9%
Tennessee48.2%
Texas57.9%
Utah51.3%
Vermont69.3%
Virginia55.5%
Washington68.1%
West Virginia47.2%
Wisconsin65.1%
Wyoming49.1%