February 26, 2026  – The majority of Medicaid beneficiaries who rely on long-term services and supports are now receiving care in their homes or communities rather than institutional settings. However, new federal data shows that access to these services still differs significantly depending on where a person lives.

According to a recent analysis of federal Medicaid data, 87.1% of individuals using long-term services and supports (LTSS) in 2023 received care through home- and community-based services (HCBS). These services allow individuals with disabilities or chronic health conditions to receive assistance while remaining in their homes or community settings instead of moving into nursing facilities or other institutions.

Despite the overall national shift toward community-based care, the share of LTSS users receiving HCBS varies dramatically from state to state. In Kentucky, only 55.8% of Medicaid long-term care users relied on home-based or community services in 2023, the lowest rate in the country. By contrast, Oregon reported the highest share, with 99.4% of LTSS users receiving HCBS.

Several other states also reported extremely high levels of community-based care. Wisconsin ranked near the top with 99.1%, followed by Minnesota at 94.0%. Hawaii, New Mexico, Ohio, Alaska, and New York also reported HCBS utilization rates above 93%. Colorado, Michigan, Nevada, West Virginia, and Texas each reported rates above 90%.

At the other end of the spectrum, several states continue to rely more heavily on institutional long-term care settings. Mississippi reported that 60.6% of LTSS users received HCBS services, while Oklahoma recorded 63.4%. South Dakota, Arkansas, Louisiana, Tennessee, Nebraska, Indiana, Utah, Maine, Florida, and Missouri also had lower rates compared with the national average.

Researchers said the findings highlight the continued efforts by many states to “rebalance” their long-term care systems. Over the past two decades, policymakers have increasingly focused on expanding access to home-based care options in order to reduce reliance on institutional facilities and support individuals living independently in their communities.

The report found that both the number of people receiving services and overall spending on long-term care have continued to grow. In 2023, approximately 9.7 million Medicaid beneficiaries received LTSS, up from 9.1 million the year before.

As demand for long-term care continues to grow alongside the aging population, policymakers are expected to continue evaluating how best to expand community-based services while maintaining adequate institutional care options.