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Medicaid long-term care services expenditures by type of service 1990-2019

There has been a noticeable shift in the distribution of expenditures among Medicaid long-term care services over the past three decades. In 1990, home- and community-based care accounted for 13 percent of the program’s long-term care costs, but this had risen to a majority share of nearly 60 percent by 2019.

Institutional care rates continue to fall

Medicaid spent approximately 32 billion U.S. dollars on long-term care services in 1990, and close to 90 percent of that went towards institutional care, such as nursing homes and other residential facilities. The decrease over recent years in the proportion of spending devoted to institutional care can be partly attributed to a push towards home- and community-based care. This expansion of services is growing in popularity because individuals can receive treatment in familiar surroundings and benefit from increased levels of comfort.

State variations in long-term care costs

Medicaid expenditures for long-term care services vary significantly from state to state, which is primarily due to each state being able to administer its Medicaid program differently. New York and Pennsylvania were among the states that spent the most on Medicaid long-term care expenditures in 2019. However, there is a big difference between the two states when long-term care expenditures are represented as a share of overall Medicaid costs.

Distribution of Medicaid long-term care services expenditures from FY 1990 to FY 2019, by type of service

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Release date

December 2020


United States

Survey time period

fiscal years 1990 to 2019

Supplementary notes

This statistic was assembled from several of KFF's publications and data tables. All years are Federal Fiscal Years, which run from October 1 through September 30.
This statistic shows fee-for-service LTC spending only. States with noticeably small spending may have sizeable portions of their Medicaid population enrolled in managed care. All spending includes state and federal expenditures. Expenditures do not include administrative costs, accounting adjustments, or expenditures in the U.S. territories.
All figures are rounded.

* Home health and personal care includes standard home health services, personal care, home and community-based care for the functionally disabled elderly, and services provided under home and community-based services waivers.

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Statistics on "Long-term care"

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