Medicaid long-term care services expenditures in the U.S. 1990-2020

Medicaid spent approximately 135.8 billion U.S. dollars on long-term care services in 2020, which was an increase of around six billion U.S. dollars on the previous year. California, New York, and Pennsylvania were the states with the highest long-term care expenditures.

States support home- and community-based care

Combined spending on nursing care facilities, home health care, and other health care made up roughly one-third of Medicaid’s total costs in 2019. Other health care costs include home- and community-based waiver programs that allow people to receive long-term care at home or in their community. Nearly all states offer the waivers, which can substantially reduce expenditures for Medicaid enrollees who would otherwise have to enter a long-term institutional service, such as a nursing home. In recent decades, the distribution of Medicaid’s long-term care services expenditures has shifted toward home- and community-based care.

The costs of in-home care are rising

Long-term care expenditures vary depending on the setting, location, and level of care required. In 2020, the annual median cost of long-term care in the United States ranged from 19,240 U.S. dollars for adult day health care services to 105,850 U.S. dollars for a private room in a nursing home. In general, the costs of nursing home facilities were considerably higher than those for home care and community living options. However, in-home care reported the highest year-on-year cost increases, and growing demand for the services has led to a rise in spending on home health care over recent years.