The HCBS taxonomy: a new language for classifying home- and community-based services

Area of Science:

• Health Services Research
• Public Health Policy
• Health Economics

Background:

• Increasing accessibility of home- and community-based services (HCBS) has heightened research interest in service utilization and expenditure patterns.
• Analyzing national-level HCBS data is complex due to variations in state Medicaid program offerings and reporting methods.

Purpose of the Study:

• To introduce a standardized taxonomy for home- and community-based services (HCBS).
• To present findings on HCBS waiver expenditures and user demographics.

Main Methods:

• Analysis of fee-for-service claims from 28 states using 2010 Medicaid Analytic eXtract (MAX) files.
• Summation of expenditures and unique user counts across HCBS taxonomy services and categories.
• Utilized a taxonomy developed with stakeholder input, organized into 18 categories and over 60 services.

Main Results:

• In 2010, 28 states collectively spent nearly $23.6 billion on HCBS.
• Approximately 80% of expenditures were allocated to round-the-clock, home-based, and day services.
• While services like case management and assistive technology were widely used, they constituted a smaller portion of overall spending.

Conclusions:

• The developed HCBS taxonomy provides a common language for detailed service information.
• This standardization facilitates the assessment and identification of state-level variations in HCBS provision and spending.