DSS: Long‑term services spending increasing, about 70% now in home‑and‑community‑based services
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Summary
Agency staff told the Appropriations panel that long‑term services and supports (LTSS) expenditures have grown year‑over‑year and that about 70% of LTSS spending now goes to home‑and‑community‑based services (HCBS). Officials cited shifting acuity in nursing homes and ICF rate rebasing as cost drivers.
Department of Social Services staff presented six years of LTSS spending and said the program has shifted toward home‑and‑community‑based services. DSS staff said roughly 70% of LTSS spending is now on HCBS, with the remaining share going to institutional settings such as nursing homes, intermediate care facilities (ICFs) and chronic disease hospitals.
Agency witnesses said the number of people receiving LTSS has grown and that spending has increased year‑over‑year. DSS noted two drivers of higher costs in the institutional space: higher clinical acuity among persons in nursing homes (which raises per‑patient reimbursement under acuity‑based rates) and a multiyear rebasing process for ICF rates. In HCBS, DSS staff said growth reflects both increased enrollment and expanded access to home‑based services.
Committee members asked whether the shift to HCBS produced net savings relative to institutional care. DSS responded that while HCBS is generally less costly on a per‑person basis, total HCBS spending can still be large because it serves a larger share of the population; the department agreed to provide additional population‑level breakdowns linking counts served with expenditures.
DSS said it could produce a follow‑up that shows the number of individuals served in each LTSS category and compares per‑person costs across settings. No formal action was taken at the hearing.
