New State- and County-Based Dashboard Shows Where Critical Medicaid Services are Used by Older Adults and People With Disabilities

Current Policy Proposals Could Impact Millions Who Depend on Home- and Community-Based Services

Just under 6 million older adults and people with disabilities nationwide rely on health and supportive services through Medicaid’s Home- and Community-Based Services (HCBS) program, according to a new database showing where these individuals reside. Experts say proposed Medicaid changes under debate in Congress could force states to limit these much-needed supports.

A new interactive tool released today by ATI Advisory, and supported by The SCAN Foundation, quantifies the number of older adults and people with disabilities who use the vital services provided by HCBS across all 50 states and, for the first time, at the county level as well.

With nearly nine out of 10 older adults saying they prefer to age at home, these services are incredibly popular but are out of reach for most older adults without help from Medicaid. The HCBS program currently has a waitlist of more than 700,000 people, as long-term care continues shifting towards people’s homes, a trend intensified by the pandemic.

“If current congressional proposals become law, states may be forced to scale back, or even eliminate, essential services that millions of older adults and people with disabilities rely on,” said Sarita A. Mohanty, M.D., MBA, MPH, president and CEO of The SCAN Foundation. “Reducing access to vital support such as help with personal care, adult daycare, home-delivered meals, and transportation, limits services people need to live with dignity in their communities.”

Considered “an optional program” under the Medicaid statute, HCBS is at significant risk if states need to reduce Medicaid expenditures.

“Policymakers throughout the country face difficult decisions about how to care for older adults and people with disabilities if federal Medicaid spending is reduced,” said Narda Ipakchi, MBA, vice president of policy and programs at The SCAN Foundation. “These benefits are a core element of what makes it possible for people to age in place. With record and increasing numbers of older adults needing long-term care, the focus should be on strengthening—not shrinking—these programs.”

Researchers identified states and counties with the most HCBS users among their Medicaid populations.

Top 10 States by Percentage of Medicaid Enrollees Using Home- & Community-Based Services

1. Pennsylvania- 9% of Medicaid enrollees use HCBS
2. Texas- 5% of Medicaid enrollees use HCBS
3. New York- 3% of Medicaid enrollees use HCBS
4. Minnesota- 9% of Medicaid enrollees use HCBS
5. West Virginia- 4% of Medicaid enrollees use HCBS
6. Kansas- 2% of Medicaid enrollees use HCBS
7. Oregon- 1% of Medicaid enrollees use HCBS
8. New Mexico- 1% of Medicaid enrollees use HCBS
9. South Dakota- 6% of Medicaid enrollees use HCBS
10. New Hampshire- 4% of Medicaid enrollees use HCBS

Top 10 Counties by Percentage of Medicaid Enrollees Using Home- & Community-Based Services

Explore the data: “Medicaid Long-Term Services and Supports Users Dashboard”

About The SCAN Foundation

The SCAN Foundation envisions a society where all of us can age well with purpose. We pursue this vision by igniting bold and equitable changes in how older adults age in both home and community. For more information, visit TheSCANFoundation.org.