Medicaid long-term care expenditures share by type U.S.

There has been a noticeable shift in the distribution of expenditures among Medicaid long-term care services over the past three decades. In 1990, home- and community-based care accounted for 13 percent of the program’s long-term care costs, but this has risen to a majority share of approximately 65 percent by 2022.

Institutional care rates continue to fall

Medicaid spent approximately 32 billion U.S. dollars on long-term care services in 1990, and close to 90 percent of that went towards institutional care, such as nursing homes and other residential facilities. The decrease over recent years in the proportion of spending devoted to institutional care can be partly attributed to a push towards home- and community-based care. This expansion of services is growing in popularity because individuals can receive treatment in familiar surroundings and benefit from increased levels of comfort.

State variations in long-term care costs

Medicaid expenditures for long-term care services vary significantly from state to state, which is primarily due to each state being able to administer its Medicaid program differently. On average, Medicaid spent 19 percent on long-term care in 2022.

Distribution of Medicaid long-term care services expenditures in the U.S. from FY 1990 to FY 2022, by type of service

Characteristic	Home health and community based care	Institutional care*
2022	65%	35%
2021	64%	36%
2020	61%	39%
2019	59%	41%
2018	57%	43%
2017	54%	46%
2016	52%	48%
2015	51%	49%
2014	46%	54%
2012	45%	55%
2011	45%	55%
2010	45%	55%
2008	42%	58%
2006	41%	59%
2004	37%	63%
2002	32%	68%
2000	30%	70%
1995	20%	80%
1990	13%	87%

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Release date

October 2024

More information

Region

United States

Survey time period

fiscal years 1990 to 2022

Supplementary notes

Release date represents the date figures were accessed.

All years are Federal Fiscal Years, which run from October 1 through September 30.

The source adds the following:
This statistic shows fee-for-service LTC spending only. States with noticeably small spending may have sizeable portions of their Medicaid population enrolled in managed care. All spending includes state and federal expenditures. Expenditures do not include administrative costs, accounting adjustments, or expenditures in the U.S. territories.
All figures are rounded.

*Institutional care includes nursing facilities, intermediate care facility for the intellectually disabled (ICF-ID), and mental health facilities (inpatient psychiatric services for individuals age 21 and under, and other mental health facilities for people age 65 and older)
Home Health and Personal Care includes standard home health services, personal care, home and community-based care for the functionally disabled elderly, and services provided under home and community-based services waivers.

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