Community-based spending by state governments on long-term care now accounts for 30% of total Medicaid long-term care spending, up from 15% in 1992, according to a report released by Health Strategies Consultancy. Spending on home- and community-based services waiver programs increased to 66% in 2001 from 37% of community-based spending in 1992.

“The increased popularity of HCBS waiver programs demands careful attention, as state budget limitations have forced many administrators to reconsider spending for these programs,” said Anne Tumlinson, director of long-term and post-acute care at Health Strategies.

The survey provides information about 171 waivers out of 221 total HCBS waiver programs nationwide. While growth in enrollment and spending has leveled off somewhat after years of explosive growth in the 1990s, it still remains high compared to traditional institutional spending growth and overall Medicaid spending growth.

The report’s authors use data compiled by the University of California, San Francisco for the Kaiser Commission on Medicaid and the Uninsured.