AARP Releases Article on Home and Community-Based Services

On August 19th, AARP released an article entitled Home- and Community-Based Services [HCBS]: The Right Place and the Right Time,” where it called on the federal Commission on Long-Term Care (the Commission) to embrace HCBS.

Cost Effectiveness of HCBS

The article provided ample support for the cost effectiveness of HCBS over institutionalization.  For example, it cited that the cost of institutionalizing one person with physical disabilities in a nursing home is equal to the cost of providing HCBS to three such people.  Citing its own March 2009 and March 2013 studies, AARP mentioned that not only was HCBS cost effective, but it has slowed Medicaid cost growth even while including more people. 

Mixed Results of Rebalancing

The article painted a mixed picture of rebalancing.  Some states have now met the objective of rebalancing by spending over half of their Medicaid LTSS budgets on HCBS; these include Texas, California, Alaska, Oregon, Minnesota, Washington, and New Mexico.  However, the other states have not met this benchmark.  According to AARP’s LTSS Scorecard, in 2011, the percentages spent on HCBS varied from 64 percent (New Mexico) to 11 percent (North Dakota).  The median percentage for all states, according to the Scorecard, was only 30%.  

Rebalancing has also occurred much more successfully in younger than older people.  Citing Diane Rowland of the Kaiser Family Foundation’s recent testimony to the Commission, HCBS amounted to 63% of Medicaid LTSS spending in younger people, but only 28% for those over 65.

The Impact of Benchmarking

The article further commented that its rankings have had an impact on behavior.  When AARP ranked Tennessee as the worst in rebalancing, with only 1 percent of spending going towards HCBS in 2006, the state decided to take action.  From 2005 to 2010, the state’s spending on HCBS has increased by a factor of ten.  Now, Tennessee’s Medicaid Director, Patti Killingsworth, is calling on national Medicaid reform in favor of HCBS.

For the full AARP article, click here.

For previous briefs on HCBS from the National Council on Medicaid Home Care, a NAHC affiliate, click here and here.


The push towards rebalancing Medicaid spending to HCBS continues with full force. While there is a lot of work still to do, progress continues. Council encourages providers to continue to advocate in their state associations, as well as state and federal governments for greater support of HCBS. The Long-Term Care Commission has been deluged with advocates all demanding that reforms give the highest priority to access to HCBS. Home care providers are encouraged to keep abreast of HCBS developments in their states, and nationally, and to contact the Council with any questions or concerns.

Source: NAHC Report

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