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Medicaid Home and Community-Based Services for the Elderly: Trends in Programs and Policies

University of California, San Francisco, Martin.Kitchener{at}ucsf.edu

Terence Ng

University of California, San Francisco

Charlene Harrington

University of California, San Francisco

This article presents the latest available expenditure and participation trends (1999-2002) for three Medicaid home and community-based (HCBS) programs that serve the elderly (home health, waivers, and personal care services [PCS]) and reports a national survey of policies used on these programs in 2002. Although the trend data show a rise in elderly waiver and PCS programs and participation, they also reveal falling per participant expenditures in PCS programs, declining annual growth in total HCBS expenditures, and large interstate variations in elderly waivers. The use of cost control policies such as spending caps and large waiver waiting lists in many states contribute to the gap between demand and supply for Medicaid HCBS for the elderly.

Key Words: home and community-based care • Medicaid • waiver policy • state variation

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