ANCOR Analysis of MACPAC HCBS Report by ANCOR Policy Intern

As mentioned in a previous article, ANCOR has been analyzing a report issued by MACPAC on Home and Community Based Services (HCBS) utilization. The analysis laid out below was developed by Gabrielle Pickover, whom ANCOR is pleased to have as a policy intern this summer as she completes her Ph.D. in special education. Having previously taught in elementary school, Gabrielle then transitioned to working with high school students with emotional and behavioral disorders (EBD). She is obtaining her Ph.D. through a grant from Virginia Commonwealth University (VCU) designed to encourage special education teachers to stay in the field. Her dissertation will be on transitioning youths from special education programs to employment.

In addition to the article below, Gabrielle also developed a summary PowerPoint presentation of the MACPAC report for the benefit of ANCOR members.

The Medicaid and CHIP Payment and Access Commission (MACPAC) issued a report on December 15, 2017 of an analysis of the characteristics and service use of Medicaid enrollees who used Home and Community Based Services (HCBS) and Medicaid spending for these HCBS users.

              They examined the median FFS Medicaid HCBS expenditure per HCBS user. They found twenty-three states had a median less than $1000.  The range was as low as $100 in Alabama to as high as $20,132 in Tennessee.  In addition, they computed the average spending per participant on HCBS state plan services and HCBS 1915 waiver services.  The averages on HCBS state plan were $4,330 in 2010, $4,254 in 2011, and $4,253 in 2012.  The averages on HCBS 1915 waiver services were $26,444 in 2010, $26,419 in 2011, and $26,083 in 2012.

              Non-long-term services & supports (LTSS) spending for HCBS users was also reported.  Impatient hospital services incorporated 85 to 86% of the budget across all the years reported.   The cost ranged from $19.3 to $21.6 billion per year.  Outpatient hospital services was about 14% of hospital spending and prescription drugs made up the largest share of non-hospital services. 

              In 2012, the five most common chronic conditions reported were Diabetes (21%), Depression (16.6%), Hyperlipidemia (11.8%), Chronic Obstructive Pulmonary Disease (11.5%), and Ischemic Heart Disease (10.9%).  The average costs per HCBS user with any health condition in 2012 was $22,324.  However, three conditions had an average cost over $50,000 per HCB user: intellectual disabilities, mobility impairments, and epilepsy.

              Information on HCBS services use was also revealed.  Round-the-clock services, home-based services, and day services comprised about 80 percent or more of total Medicaid HCBS FFS expenditures for high-cost HCBS waiver users. Round-the clock (56.1 percent) and day services (52.0 percent) were the most commonly used taxonomy services.  No HCBS taxonomy category was universally reported by all states for the high-cost HCBS population.  The highest average spending per person in 2012 for round-the-clock services was $93,635 and for home-based services was $48,510.

In conclusion, the report provided findings on total HCBS users and the spending. From 2010 to 2012, the 44 states had approximately 6 million individual HCBS users each year.  In 2012, approximately 1.3 million HCBS users had 1915(c) waiver claims in the 44 study states.  In all 50 states and the District of Columbia, 86.8% of the 1.5 million HCBS users reported as receiving 1915(c) waiver services. In 2012, the 44 study states reported $58.1 billion on Medicaid HCBS claims and 83.5% of total HCBS expenditures by all states.

The researchers recognized many limitations and suggested future studies.  First, to study populations in isolation that are common across states, so one can make better comparisons. Second, provide more detailed subgroup analysis. Finally, to expand analyses to managed care expenditures, or expand the application of the HCBS taxonomy to state plan services.

For more information on this study please contact Esme Grant Grewal, Vice President of Government Relations, at [email protected]