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States in the U.S. participating in LTC actions 2019 and 2020

Nearly all states in the U.S. are employing strategies to expand home- and community-based services (HCBS). Furthermore, a large number of states are using HCBS waivers or state plan amendments (SPA) to serve individuals in the community.

The groups in need of long-term care

Medicaid provides health coverage to millions of Americans, and over the years, many states have chosen to expand the availability of long-term care services. Home- and community-based services allow beneficiaries to receive care in their own home or other community settings, as opposed to institutional care provided in nursing facilities. These services target and support several population groups, including older adults, individuals with physical disabilities, and those with mental illnesses.

The rising costs of long-term care

Medicaid is responsible for covering large numbers of senior citizens and individuals with disabilities, and these two enrollment groups accounted for more than half of all Medicaid expenditure in 2017 – spending per enrollee was also significantly higher for these two groups. States are being encouraged to design long-term care plans that allow individuals to live in their homes or community setting, and it is hoped that this will reduce expenditures for enrollees who would otherwise have had to enter nursing homes.

Number of U.S. states participating in selected long-term care actions in FY 2019 to FY 2020

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Release date

October 2019


United States

Survey time period

as of October 2019

Special properties

Medicaid officials in 50 states

Method of interview

Face-to-face interview

Supplementary notes

LTC = long-term care.
HCBS = home and community-based services.
MLTSS = managed long-term care services and support.
PACE = programs of all-Inclusive care for the elderly.
SPAs = SPA - state plan amendments.
* Projected.

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Statistics on "Long-term care"

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