Interstate Variation and Progress Toward Balance in Use of and Expenditure for Long-Term Services and Supports in 2009

State long-term care (LTC) financing and delivery systems and, in particular, Medicaid funded LTC have long been criticized for being “institutionally biased.” Shifting the balance in publicly-funded LTC provision away from institutional care (nursing homes, long-term hospitals, intermediate care facilities for the intellectually disabled) toward greater reliance on home and community-based services has been a federal goal for the past three decades--a goal often referred to as “re-balancing” state LTC systems. This report explores inter-state variations in LTC expenditure and service use patterns, not only in terms of institutional and non-institutional services, but also by Medicaid LTC users’ age and type of disability (e.g., intellectual and/or developmental disabilities or other working-age adult disabilities).