This report from the Kaiser Family Foundation provides an overview of spending and participation for home and community-based services financed by Medicaid. It notes that though spending on such services has more than doubled since 1995 and continued progress is hopeful because of certain provisions in the Affordable Care Act, progress may also be slowed with the budget challenges that many states are facing.

From the report:

Two decades after the passage of the Americans with Disabilities Act, developing home and community-based service (HCBS) alternatives to institutional care has remained a priority for many state Medicaid programs. While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19 percent in 1995 to 42 percent in 2008. Building on previous policy initiatives to rebalance long-term services and supports, the 2010 Patient Protection and Affordable Care Act (ACA) provides new opportunities to further state efforts to expand community-based care for seniors and people with disabilities under Medicaid. However, many states continue to wrestle with the ongoing impacts of the worst recession in decades, resulting in difficult budget situations and creating uncertainties for continued progress. This report, based on annual data tracking conducted by the Kaiser Commission on Medicaid and the Uninsured and researchers at the University of California, San Francisco over the past nine years, presents a summary of the main trends to emerge from the latest (2007) expenditures and participant data for the three main Medicaid HCBS programs: (1) optional 1915(c) HCBS waivers, (2) the mandatory home health benefit, and (3) the optional state plan personal care services benefit. It also presents 2009 findings on the policies used in these three programs, including eligibility criteria, provider, service and waiting list data, as well as provider reimbursement rates for the home health benefit and the personal care services benefit.

Full Report: Medicaid Home and Community-Based Service Programs: Data Update (PDF | 1.16 MB) 

Kaiser Family Foundation. (2011). Medicaid Home and Community-Based Services Programs: Data Update.