Medicaid Home- and Community-Based Services Rebalancing Is Concentrated in Large Urban Areas

In aggregate, state Medicaid programs spend more on home- and community-based services (HCBS) than institutional long-term services and supports (LTSS). However, there are well-established differences in LTSS use across states. Rural-urban variation in LTSS use is less understood, particularly following changes to HCBS spending under the Affordable Care Act and American Rescue Plan. We examine differences in the probability of receiving HCBS among Medicaid LTSS users by rurality at both the state and national level.