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June 2003
GAO Report
 Long-Term Care:
Federal Oversight of Growing
Medicaid Home and
Community-Based Waivers
Should Be Strengthened
From 1991 through
2001, Medicaid long-term care spending more than doubled to over
$75 billion, while the proportion spent on institutional care
declined. Over a similar time period, HCBS waivers grew from 5
percent to 19 percent of such expenditures from $1.6 billion to
$14.4 billion and the number of waivers, participants, and
average state per capita spending also grew significantly. Since
1992, the number of waivers increased by almost 70 percent to 263
in June 2002, and the number of beneficiaries, as of 1999, had
nearly tripled to almost 700,000, of which 55 percent were
elderly.
In the absence of
specific federal requirements for HCBS quality assurance systems,
states provide limited information to the Centers for Medicare
& Medicaid Services (CMS), the federal agency that administers
the Medicaid program, on how they assure quality of care in their
waiver programs for the elderly.
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