States’ Management of Medicaid Home Care Spending Ahead of H.R. 1 Effects
Article Publication Date
Summary
Last month, KFF released an issue brief describing how states are currently limiting Medicaid spending on home care programs and states’ plans for adopting new mechanisms in fiscal year (FY) 2026.
This issue brief uses data from the annual KFF survey of officials administering Medicaid home care programs. Key takeaways include:
• 44 out of the 50 responding states constrain spending through limits on either total enrollment (37 states) or on total spending (15 states).
• Most states (37) cap waiver spending per participant for at least one waiver.
• Most states (44) reported using mechanisms in at least one waiver to restrain spending that applies to specific services, such as limiting the amount of spending for services per participant (38 states) or limiting the quantity of personal care enrollees may receive (34 states).
• Nearly a third of responding states (15) reported planning to adopt new strategies in FY 2026 to contain home care costs.
• Fewer mechanisms are available to states in managing spending for home care services provided outside of waivers, but nearly all states use prior authorization as a tool to manage that type of spending.
This issue brief uses data from the annual KFF survey of officials administering Medicaid home care programs. Key takeaways include:
• 44 out of the 50 responding states constrain spending through limits on either total enrollment (37 states) or on total spending (15 states).
• Most states (37) cap waiver spending per participant for at least one waiver.
• Most states (44) reported using mechanisms in at least one waiver to restrain spending that applies to specific services, such as limiting the amount of spending for services per participant (38 states) or limiting the quantity of personal care enrollees may receive (34 states).
• Nearly a third of responding states (15) reported planning to adopt new strategies in FY 2026 to contain home care costs.
• Fewer mechanisms are available to states in managing spending for home care services provided outside of waivers, but nearly all states use prior authorization as a tool to manage that type of spending.