United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1994-08-11 monographic deposited born digital GA 1.13:HEHS-94-167 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-94-167 P0b002ee18037daa6 f:he94167 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-94-167 machine generated eng fdlp REPORT GAOREPORTS-HEHS-94-167 HEHS-94-167 Health care cost control Health care programs Health care planning Health services administration Long-term care Home health care services State-administered programs Community health services Oregon Washington Wisconsin Medicaid Program Supplemental Security Income Program Wisconsin Community Options Program Letter Report HEHS Because nearly one-third of the nation's Medicaid expenditures are now spent on long-term care ($42 billion in 1993), GAO was asked to review the experience of states in expanding government-funded home and community-based services. GAO's review focused on Oregon, Washington, and Wisconsin. These three states have expanded home and community-based long-term care in part as a strategy to help control rapidly increasing Medicaid expenditures for institutional care. As they expanded home and community-based care, the three states restricted how large most of the programs can grow. Some restrictions were mandated by the federal government, which approves capacity limits on programs operated under Medicaid waivers. Other restrictions result from constrained state budgets. Despite these deliberate limits on program size, one impact of the shift to home and community-based care is that the three states have been able to provide services to more people with the dollars available, primarily because home and community-based care is less expensive per person than institutional care. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-94-167/html/GAOREPORTS-HEHS-94-167.htm GAO/HEHS-94-167 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-94-167 Letter Report GAO/HEHS-94-167; Medicaid Long-Term Care: Successful State Efforts to Expand Home Services While Limiting Costs; Health care cost control Health care programs Health care planning Health services administration Long-term care Home health care services State-administered programs Community health services Oregon Washington Wisconsin Medicaid Program Supplemental Security Income Program Wisconsin Community Options Program Public Law 93-641 Public Law 97-35 Public Law 100-203 Public Law 103-66