ACROSS THE STATES - AARP...funded home and community-based services has increased over the past five years. 9: Long-term care spending is not the primary cause of Medicaid spending

2009E IGHTH EDIT ION

ACROSS THE STATESPROFILES OF LONG-TERM CARE

AND INDEPENDENT LIVING

by Ari HouserWendy Fox-Grage

Mary Jo Gibson

EXECUTIVE SUMMARY, STATE DATA, AND RANKINGS

©1994-2009 AARP

2

IntroductIon

Across the States 2009: Profiles of Long-Term Care and Independent Living is the eighth edition of the AARP Public Policy Institute’s state long-term care reference report.

Published approximately every two years, the Across the States series was developed to help inform policy discussions among public and private sector leaders in long-term care throughout the United States. Across the States 2009 presents comparable state-level and national data for more than 140 indicators, drawn together from a wide variety of sources into a single convenient reference. This publication presents the most up-to-date data available at the time of production, and is displayed in easy-to-use maps, graphics, tables, and state profiles.

Across the States 2009 comes in two volumes:

• A full report with an overview of key findings and trends, maps and graphs, and individual profiles for each state, the District of Columbia, Puerto Rico, the Virgin Islands, and the nation as a whole. The full report provides a complete picture of long-term services and supports in each state.

• An executive summary with an overview of key findings and trends, and ranking tables for each indicator, such as percentage of Medicaid long-term care spending for older people and adults with physical disabilities going to home and community-based services, which permit readers to easily see variation among states.

Some of the indicators in Across the States 2009 may be found in prior editions. Please exercise caution when making comparisons with information in earlier editions because of possible changes in the source or definition. Complete descriptions of all indicators, and how they may differ from previous editions, can be found in the Data Documentation section in the back of the full report. Data sources and descriptions of indicators are only found in the full report, not in the executive summary.

Copies of Across the States 2009 are available free of charge. To order, please call the AARP Public Policy Institute at (202) 434-3890 or email [email protected].

The full report and executive summary are also available on the web. The most recent edition of Across the States can always be found at http://www.aarp.org/acrossthestates.

AARP Public Policy Institute

oVErVIEW

Across the States 2009: Profiles of Long-Term Care and Independent Living contains thousands of numbers. Taken alone, each number is simply that—a number. However, when these numbers are woven together, they tell a compelling story about the changing demand for long-term services and supports, more commonly known as long-term care, in the United States and the strategies for delivering such services and paying for them across all of the states.

The report focuses on comparative state data, because much of the policymaking and innovation in long-term care is governed by the states. Given the growing older population, the rising demand for long-term care and the increasing cost of services, consistent data across all the states are critical in order to understand how to improve the lives of those with long-term care needs, their family caregivers, and others around them. In this overview we present 10 key findings from the state and national data, a small sampling of the data presented in this volume.

1: the population age 85 or older—the age group that is most likely to need long-term care services—is growing at a dramatic rate.

2: the older population is more racially and ethnically diverse than ever before.

3: the older population is financially and socially diverse.

4: Family caregivers are the main providers of long-term care services in all states.

5: older people with disabilities have a growing array of service options, but the services are costly and can deplete the life savings of older households.

6: nursing facility residents, beds, and occupancy rates have remained nearly constant over the last five years, despite an increase in the older population.

7: the bulk of Medicaid long-term care dollars go to nursing homes rather than home and community-based services.

8: the number of older people and adults with physical disabilities receiving Medicaid-funded home and community-based services has increased over the past five years.

9: Long-term care spending is not the primary cause of Medicaid spending growth.

10: on average, Medicaid dollars can support nearly three older people and adults with

physical disabilities in home and community-based settings for every person in a nursing facility.

2000 2005 2010 2015 2020 2025 2030

Po

pul

atio

n (%

of

2000

Cen

sus)

85+

50-64

65-74

Blue line = 50-64Purple line = 65-74Yellow line = 75-84Red line = 85+

75-84

80%

100%

120%

140%

160%

180%

200%

220%

240%

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

From 2007 to 2030, the population age 65+ is projected to grow by 89%, more than four times as fast as the population as a whole (+21%). Most of this growth, especially over the next 10 to 15 years, will be among the young old (age 65-74) because of the aging of the baby boomers.

A better barometer for the potential demand for long-term care services is the growth in the population age 85 or older, which is expected to increase by 74% between 2007 and 2030. The oldest old not only have much higher rates of disability, but they also are much more likely to be widowed and without someone to provide assistance with daily activities.

The 85+ population will grow even faster after 2030. The increase in the 85+ population between now and 2030 is largely driven by the aging of the parents of the baby boom generation; the baby boomers will begin to turn age 85 in 2031. Between 2030 and 2050, the age 85+ population is projected to increase by another 118 percent.

The states with the greatest projected age 85+ population growth from 2007 to 2030 are: Alaska (+297%), nevada (+176%), Arizona (+135%), Wyoming (+126%), and new Mexico (+123%). The age 85+ population is also projected to more than double during this time period in Virginia, Vermont, colorado, and texas.

the population age 85 or older—the age group that is most likely to need long-term care services—is growing at a dramatic rate.1:

Projected Growth in the older Population in united States as a Percentage of 2000 census, by Age Group, 2000-2030

the older population is more racially and ethnically diverse than ever before.2:

Nearly one out of every five people (19.3%) age 65+ is non-White or Hispanic, a percentage that is projected to increase in the coming decades. The growing racial and ethnic diversity of the older population has enormous implications for meeting diverse long-term care preferences, addressing the role of paid and unpaid caregivers, providing services with cultural sensitivity, and training the paid long-term care workforce in cultural competence in meeting diverse needs.

Aging populations of color in Hawaii (Asian), Puerto rico (Hispanic), and the district of columbia and the Virgin Islands (Black) outnumber Whites. More than 30% of people age 65+ in new Mexico, california, and texas—the states with the highest proportion of Hispanic elders—are people of color.

The older population will continue to become more racially and ethnically diverse in the coming years. By 2030, when the last of the baby boomers have turned age 65, the Census Bureau projects that 29% of Americans age 65 or older will be people of color. By 2050, the proportion who are people of color will reach 42%.

Older Peopleof Color: 19.3%

Hispanic: 6.6%

Black: 8.7%

Asia

n/Pacific Islander: 3.6% Other: 1%

Categories do not sum to total because individuals may belong to more than one racial/ethnic group.

the older population is financially and socially diverse.3:

Age is not the only factor affecting the need for and access to long-term care services. The demand for long-term care services is also driven by social and economic characteristics like income, assets, education, marital status, and the availability of a family member or friend to provide care. Economic and even geographic factors can greatly affect a person’s ability to gain access to needed services.

Poverty: Roughly one-half (51%) of people age 65+ have incomes at or below 300% of poverty (about $30,000 for a single person over age 65+ or $38,000 for a family of two), an income level that makes them financially vulnerable and unlikely to be able to afford to pay for long-term care services out-of-pocket.

Geography: One out of every five people age 65+ lives in rural, non-metropolitan areas where home and community-based services are typically harder to find.

Education: Level of education is one of the strongest predictors of the likelihood of having a long-term care need as well as having the economic capacity to pay for services. Less than one out of five (19%) people age 65+ has a bachelor’s degree or higher.

Living Alone: One-third of people age 75+ live alone, which means that there is no one in the household to provide assistance if they need help with daily activities. People living alone are more likely to have to move to a care facility if they need long-term care.

disability: More than four out of 10 (41%) people age 65+ have one or more of the following disabilities that affects their ability to accomplish common tasks of everyday living: sensory, physical, mobility, self-care, and cognitive/mental. By 2010, 13% of people age 65+ are projected to have Alzheimer’s disease.

Economic Value of FamilyCaregiving in 2007: $375 billion

Medicaid LTC Spendingin 2007 (Largest payer offormal LTC): $97 billion

$ $

Need for Long-Term

Care

Poverty

Housing

Disability

Geography

Education

Economic Value of FamilyCaregiving in 2007: $375 billion

Medicaid LTC Spendingin 2007 (Largest payer offormal LTC): $97 billion

$ $Economic Value of Family

Caregiving in 2007: $375 billionMedicaid LTC Spendingin 2007 (Largest payer offormal LTC): $97 billion

$ $

Family caregivers are the main providers of long-term care services in all states.4:

In the U.S., 34 million caregivers age 18 or older were providing unpaid care to friends and family at any given time during 2007. They provided an average of 21 hours of care per week, at an average value of $10.10 per hour. Since periods of caregiving may begin or end during the year, the number of adults providing care during the year is significantly higher, estimated at 52 million in 2007. Although Medicaid is the largest payer of long-term care services ($97 billion), the foundation of long-term care in all states is family caregivers. The estimated economic value of the 34 million caregivers’ unpaid contributions was $375 billion in 2007, and the economic value of family caregiving exceeded Medicaid long-term care spending in all states.1

A critical dimension of home and community-based services is support for family caregivers. By providing personal care and help with everyday tasks as well as health-related interventions, such as administering complex medications, family caregivers help to contain health and long-term care costs by delaying or preventing the use of nursing home and hospital care. Any strategy to promote home and community-based services will depend heavily on the continued support of family caregivers. They are essential to the financing and delivery of long-term care, yet they often are at risk of becoming “patients” themselves because of the physical and mental health effects of caregiving.2

1 Houser A., and Gibson, M.J. “Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update.” Washington DC: AARP Public Policy Institute. November 2008. 2 Reinhard, S., Brooks-Danso, A., Kelly, K. and Mason, D. “How Are You Doing? State the Science: Professional Partners Supporting Family Caregivers.” American Journal of Nursing 108(9) Supplement. September 2008.

older people with disabilities have a growing array of service options, but the services are costly and can deplete the life savings of older households.

5:

In the United States, the primary responsibility for paying for long-term care services remains with the individuals who need those services. Medicare will pay for limited nursing home and home health services but only for a limited time after a major acute care episode, typically after a hospital stay. Medicaid pays for services only after beneficiaries have depleted their income and assets.

Medicaid has lower payment rates for long-term care services than private pay, while Medicare has higher payment rates (Medicare spending for nursing home services is generally for medically intensive post-acute care, rehabilitation, or end-of-life care). For nursing facility care, the average private pay rate was $209 per day for a private room. Medicaid nursing facility reimbursement averaged $158 per day in 2007, and Medicare reimbursement averaged $305 per day in 2006.

Assisted living has emerged as a major option for many older people with less intensive care needs than are typical in most nursing homes. The average private-pay base rate for assisted living services is about $3,000 per month, roughly half the private pay rate in a nursing home, though this does not typically include skilled nursing or other intensive health-related services that are included in nursing facility rates. While nearly two-thirds of nursing facility residents have Medicaid as the primary payer, the share of assisted living residents receiving such assistance ranges is far lower.1

The costs of home and community-based services vary significantly, depending primarily on the hours of care needed. Personal care services or adult day services a few times a week costs far less than 24-hour home care. The private pay daily rate for adult day services, often for older people with relatively mild cognitive disorders, averaged $59 per day in 2008.

The private pay hourly rate for home health services was $19 in 2008, and $38 for Medicare-certified home health aides, who are often associated with a skilled nursing visit that could include specialized care such as bathing. The average Medicare reimbursement for a home health visit was $134 in 2006.

1 In 2007, there were about 1 million units in assisted living and residential care facilities; roughly 117,000 residents in these facilities were supported by Medicaid or state financing. The number of assisted living residents supported by Medicaid is down slightly and the number of units up slightly from 2004. See Mollica, R., Sims-Kastelein, K., and O’Keeffe, J. “Residential Care and Assisted Living Compendium: 2007.” National Academy for State Health Policy and RTI International. November 30, 2007.

Nursing facility residents, beds, and occupancy rates have remained nearly constant over the last five years, despite an increase in the older population.

6:

-2

0

2

4

6

8

-2%

0%

+2%

+4%

+6%

+8%

+0.9%

+1.7%

-0.7%

+6.5%

Nursing FacilityResidents

Per

cent

Cha

nge,

200

2-20

07

Nursing FacilityBeds

Occupancy Rate Age 85+Population

About 1.44 million Americans live in nursing facilities, occupying 85% of a total of 1.7 million nursing home beds. Although people tend to associate long-term care with nursing homes, the great majority of people with disabilities live in community settings. Only 3.3% of people age 65+ live in nursing facilities, though this rises to 14% of people age 85+. From 2002 to 2007, the number of nursing facility residents increased about 0.9% and the number of nursing facility beds increased about 1.7%, while the age 85+ population increased 6.5%. The average nursing facility occupancy rate declined 0.7 percentage points over this time period.

South Carolina and Alabama had the largest increases in nursing facility beds and residents between 2002 and 2007, with South Carolina increasing the number of beds by 16% and residents by 18% and Alabama increasing beds by 14% and residents by 11%. In contrast, Louisiana had the largest nursing home bed and resident reduction of any state, in part because of the devastation of Hurricane Katrina: nursing facility beds declined by 15% and residents by 20%. South Dakota (-11%) and Wisconsin (-12%) also had large bed reductions. Minnesota and Iowa saw 10% declines in the number of nursing facility residents.

In 2007, nearly one-half (46%) of residents had dementia, and most (64%) had Medicaid as the primary payer of nursing facility costs. These residents have low incomes and little savings or spent their life savings paying for long-term care services before becoming eligible for Medicaid coverage. The percentage of nursing facility residents with Medicaid as the primary payer has declined somewhat from 67% in 2002, while Medicare’s share increased from 11% in 2002 to 14% in 2007, illustrating a decline in the use of nursing homes for long-term care as providers increasingly move to providing post-acute care services, much of it funded by Medicare.

Percent Change in Number of Nursing Facility Residents andBeds, Occupancy Rate, and Population Age 85 or older, 2002-2007

the bulk of Medicaid long-term care dollars go to nursing homes rather than home and community-based services.7:

Medicaid Long-term care Spending for older People and Adults with Physical disabilities in the united States, 2007

Medicaid—jointly financed by the federal and state governments—pays for most formal long-term care in the United States. In 2007, nearly three out of every four (73%) Medicaid long-term care dollars for older people and adults with physical disabilities went toward nursing facility care even though most people prefer to live at home or in their communities.1 Medicaid home and community-based spending was $17 billion for older people and adults with physical disabilities compared to $47 billion for Medicaid nursing home spending. Many states maintain waiting lists or interest lists for Medicaid aged/disabled home and community-based waiver programs because of the great demand. In 2007, nearly 90,000 were reported to be on such lists.

Despite its institutional bias, Medicaid plays an important and growing role in the funding of home and community-based services. Every state Medicaid program has federal waivers to provide a wide range of such services. Also, 30 states and the district of columbia (see map) cover personal care services for adults in the home under their Medicaid state plans.

However, the percentage of Medicaid long-term care funds going toward home and community-based services for older people and adults with physical disabilities varies enormously among the states, ranging from 1% to 61% of such spending.

1 These data update the analysis from Kassner, E. et al. “A Balancing Act: State Long-Term Care Reform.” Washington, DC: AARP Public Policy Institute. July 2008.

Aged/Disabled Waivers PCS and other HCBS Nursing Homes

10%

17%

73%

Percentage of Medicaid Long-term care Spending for older People and Adults with Physical disabilities going to HcBS, by State, 2007

ME

NH

NJ

MA

CTRIPA

VA MDWV

OHIN

MI

IL

IA

MN

WI

NDMT

IDOR

WA

CA

NV UT

AZ

AK

HI

NM

CO

WY

TX

OK

KS MO

AR

LA

FL

MS AL GASC

TN NC

KY

NE

SD

DC

DE

NYVT

> 40% 20 - 40% ≤ 20%

"Medicaid HCBS spending for older people and adults with physical disabilities, as a % of LTC spending, 2007" > 40% 20 - 40% ≤ 20%

In 2007, five states— new Mexico, oregon, Washington, Alaska, and california—spent more than 50% of their Medicaid long-term care funds on home and community-based services. On the other end of the range, tennessee, Indiana, north dakota, utah, South dakota, Kentucky, Alabama, connecticut, and delaware had the lowest percentages: 10% or less.

Medicaid is not the only source of public funding for home and community-based services. State-funded home and community-based services totaled $1.2 billion in 2007. While the total amount of state-funding spending is only about 7% of Medicaid home and community-based services expenditures for older people and adults with physical disabilities, in some states these programs provide important services to people who might not qualify for Medicaid.

the number of older people and adults with physical disabilities receiving Medicaid-funded home and community-based services (HcBS) has increased over the past five years.

8:

The number of older people and adults with physical disabilities receiving Medicaid-funded home and community-based services increased by about one-third from 2000 to 2005, to a total of nearly 1.4 million beneficiaries in 2005. From 2002 to 2007, Medicaid home and community-based spending for older people and adults with physical disabilities increased by 68% to $17 billion in 2007.1

1 These measures of Medicaid home and community-based services exclude home health services, since home health programs in many states provide mostly or entirely post-acute care services, not long-term care, and it is not possible to differentiate the spending and participants between post-acute and long-term care. This choice is further discussed in Kassner, E. et al. “A Balancing Act: State Long-Term Care Reform.” Washington, DC: AARP Public Policy Institute. July 2008.

older People and Adults with Physical disabilities receiving Medicaid HcBS, 2000-2005


0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.5

1.4

1.3

1.2

1.1

1.0

0.92000 2001 2002 2003 2004 2005

Year

Per

sons

Ser

ved

(Mill

ions

)

+34%

Medicaid HcBS Spending for older People and Adults with Physical disabilities, 2002-2007


6

9

12

15

18

21

Year

Sp

end

ing

(Bill

ions

of

Do

llars

) $21

$18

$15

$12

$9

$6

2002 2003 2004 2005 2006 2007

+68%

The number of older people and adults with physical disabilities receiving Medicaid home and community-based services increased from 2000 to 2005 in 46 states and declined in only five states: Kentucky, West Virginia, Arkansas, South carolina, and new York. The states with the biggest percentage gains in home and community-based participants were new Mexico, north dakota, and Louisiana. From 2002 to 2007, all states—except Kentucky—increased Medicaid home and community-based expenditures. The largest percentage increases in Medicaid home and community expenditures were in the district of columbia, Louisiana, nevada, and Pennsylvania. The district of columbia, Louisiana, and Minnesota had the greatest percentage point increases in the proportion of Medicaid long-term care spending going to home community-based services from 2002 to 2007.

Although Medicaid spending on home and community-based services increased for older people and adults with physical disabilities, people with mental retardation or developmental disabilities (MR/DD) made even more progress toward access to Medicaid-funded home and community-based services and can serve as a model for reform. More Medicaid funding goes toward MR/DD waiver programs, serving people in their homes and communities, than goes to institutional Intermediate Care Facilities for Mental Retardation (ICF-MRs). The spending increase for MR/DD waiver programs from 2002 to 2007 ($7.712 billion) was more than 10 times as great as the spending increase for ICF-MRs ($629 million). In comparison, the spending increase for home and community-based services for older people and adults with physical disabilities ($6.984 billion) was about three times the spending increase for nursing homes ($2.651 billion).

0100020003000400050006000700080009000

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

ICF-MR

Mill

ions

of

Do

llars

MR/DDWaivers

NursingFacilities

Aged/DisabledWaivers

PCS andotherHCBS

$629

$7,712

$2,651 $2,433

$4,551

Increase in Medicaid Long-term care Spending in the united States, 2002-2007, by Service

Long-term care spending is not the primary cause of Medicaid spending growth.9:

Percent Increase in total Medicaid Spending and Medicaid Long-term care Spending for older People and Adults with Physical disabilities, 2002-2007

Year

Per

cent

Cha

nge

Rel

ativ

e to

200

2 S

pen

din

g


0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0%

+5%

+10%

+15%

+20%

+25%

+30%

+35%

+28%

+18%

2002 2003 2004 2005 2006 2007

Total Medicaid Spending

Medicaid LTC for Older People and Adults with Physical Disabilities

Despite the growth in the older population who are primary users of long-term care services, total Medicaid spending has increased at a faster rate than Medicaid long-term care spending for older people and adults with physical disabilities over the past five years.

Total Medicaid spending increased from $243 billion in 2002 to $312 billion in 2007, an increase of 28%. During the same time period, Medicaid long-term care spending for older people and adults with physical disabilities increased by 18%, from $54 billion to $64 billion.

on average, Medicaid dollars can support nearly three older people and adults with physical disabilities in home and community-based settings for every person in a nursing facility.

10:

0 10000 20000 30000$0

$9,176

$9,666

$26,096

$10,000 $20,000 $30,000

Aged/DisabledWaiver Services

Spending per Person Served

Personal CareServices

Nursing FacilityServices

}Home and Community-Based Services

Per person served, nursing facility services are generally more costly than home and community-based services. On average, Medicaid spending for home and community-based services for each older person and adult with physical disabilities receiving services was $9,459 in 2005, compared to $26,096 for each person receiving services in a nursing facility.

It is important to note, however, that a dollar spent on home and community-based services is not equivalent to a dollar spent on nursing home services. Medicaid pays for services and room and board costs in nursing homes. In contrast, Medicaid is required by law to exclude coverage of room and board costs for home and community-based beneficiaries, even if they live in residential care settings such as assisted living. It is also the case that people receiving home and community-based services may have less intense needs, especially for medically oriented services.

conclusionThis report provides the latest available data on long-term care in the United States at a time of rapid change in the delivery and financing of such services. Each state is unique, and the states exhibit great diversity in demographics, service delivery, and financing.

Across the States offers a picture of past and present trends at both the national and state levels as well as factors that could potentially drive future trends. It provides comparable data across all the states, so policymakers in each state can use it to benchmark progress in improving the quality of life for those who need, use, and provide long-term care services.

Medicaid Long-term care Spending per Person Served, by Service, 2005

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national Long-term care andIndependent Living Profile

18

Value

All ages 2007 2030 % change

Age 50-64 2007 2030 % change

Age 65+ 2007 2030 % change

Age 65-74 2007 2030 % change

Age 75-84 2007 2030 % change

Age 85+ 2007 2030 % change

Year

301,621363,584

+21%

53,72559,928+12%

37,88871,453+89%

19,35237,948+96%

13,02423,903+84%

5,5129,603+74%

17.8%16.5%

12.6%19.7%

6.4%10.4%

4.3%6.6%

1.8%2.6%

Population (thousands)% of totalPopulation

Projected Growth in the older Population in the united States as a Percentage of

2000 census, by Age Group, 2000-2030


unItEd StAtES

race & Ethnicity, Age 65+

Older People of Color (%), 2007

Asian/Pacific Islander

Black

Hispanic

19.3%

3.6%

8.7%

6.6%

Po

pul

atio

n (%

of

2000

Cen

sus) 85+

50-64

65-74


75-84

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

80%

100%

120%

140%

160%

180%

200%

220%

240%

2000 2005 2010 2015 2020 2025 2030

19

un

ItE

d St

At

ES

Population characteristics

Men per 100 women age 85+, 2007

Persons age 75+ living alone, 2007

Non-metropolitan population age 65+, 2007/2008

Bachelor level education or higher age 65+, 2007

Persons age 60+ raising grandchildren, 2007

Value

48

33%

20%

19%

1.6%

Income & Poverty

Median household income age 65+, 2007

At/below poverty level age 65+, 2007

At/below 200% of poverty level age 65+, 2007

At/below 300% of poverty level age 65+, 2007

Women age 75+ at/below poverty level, 2007

Value

$32,158

9.5%

32%

51%

13%

disability rates

Persons age 65+ with disabilities, 2007

Sensory disability

Physical disability

Mobility disability

Self-care disability

Cognitive/mental disability

Any disability (one or more of the five listed above)

Cognitive/mental disability + any other disability

Persons age 18-64 with disabilities, 2007

Any disability

Cognitive/mental disability + any other disability

Persons age 65+ with Alzheimer’s disease, 2010 (projected)

number(1,000s) Percent

5,893

11,285

6,354

3,772

4,467

14,735

4,010

21,460

6,002

5,300

16%

31%

18%

10%

12%

41%

11%

11%

3.2%

13%

Family caregivers

Family caregivers (thousands), 2007

Economic value of family caregiving (millions), 2007

Economic value per hour, 2007

Ratio of the economic value of family caregiving to Medicaid long-term care spending, 2007

Value

34,000

$375,000

$10.10

3.7

PoPulation & CharaCteristiCs

20

un

ItE

d S

tA

tE

S long-term Care FinanCing

Medicaid Expenditures

Total Medicaid expenditures (millions), 2007Medicaid home and community-based services (HCBS) spending

for older people and adults with physical disabilities, as a % of long-term care (LTC) spending, 2007 *

Value

$311,84827%

Medicaid Long-term care Spending for older People and Adultswith Physical disabilities in the united States, 2007

Aged/Disabled Waivers PCS and other HCBS Nursing Homes

10%

17%

73%

united States

Long-term care Expenditures by Service

Medicaid LTC expenditures for older people and adults with physical disabilities, 2007

Nursing facilitiesHCBS

Personal care services (PCS) **Aged/disabled waiver services

Medicaid LTC expenditures for all populations, 2007Institutional servicesHCBS

Waiver services (all populations)Medicaid home health expenditures *

total (millions)

Per Person in the State

$64,168

$46,980$17,188$10,396$6,340

$97,295$58,993$38,303$27,455$3,966

$213

$156$57$34$21

$323$196$127$91$13

* Medicaid LTC for older people and adults with physical disabilities include nursing facilities, PCS, aged/disabled waivers, and additional HCBS programs in a few states. Medicaid home health is no longer considered LTC, but is listed separately for comparison to earlier editions of Across the States.

Expenditures Per Person Served

Medicaid nursing facility expenditures per person served, 2005Medicaid HCBS expenditures for older people and adults with

physical disabilities per person served, 2005Personal care services **Aged/disabled waiver services

HCBS waiver services (all populations)

Value

$26,096$9,459

$9,666$9,176

$21,681

21

Federal/State/Personal contributions

Federal Medical Assistance Percentage (FMAP), 2007Medicaid personal needs allowance (per month), 2007 ***State-funded HCBS for older people (millions), 2007

Value

NA$50

$1,192.4

long-term Care utilization

ValueMedicare HcBS utilization

Medicare beneficiaries receiving home health services, 2006Medicare home health visits per user, 2006

8.4%35

Medicaid HcBS utilization

Medicaid HCBS participants, 2005Personal care services **HCBS waiver services

Aged/disabled waiver servicesMedicaid aged/disabled waiver participants per

100 beneficiaries using nursing facilities, 2005Persons in assisted living/residential care covered by

Medicaid or state funding, 2007Medicaid home health participants, 2005 *

ValuePer 1,000

Population

1,854,998794,642

1,060,356582,342

34117,265924,259

6.32.73.62.034

0.39

3.1

Valuenursing Facility utilization

Total nursing facility residents, 2007Nursing facility residents per 100 age 65+, 2007Nursing facility residents per 100 age 75+, 2007 Total nursing facility stays, 2006Residents with Medicaid as primary payer, 2007Residents with Medicare as primary payer, 2007Residents with “other” as primary payer, 2007Residents with dementia, 2007

1,440,3583.87.8

3,176,11964%14%22%46%

long-term Care Costs

ValuePublic & Private Payment rates

Medicaid payment per day for nursing facility care, 2007Medicare payment per day for nursing facility care, 2006Average private pay rate per day in nursing facility, 2008Average private pay rate per month in assisted living, 2008

Medicare reimbursement per home health visit, 2006Average private pay hourly rate for home health aide, 2008

Medicare-certified home health aide, 2008Average private pay daily rate for adult day care, 2008

$158$305$209

$3,008

$134$19$38$59

un

ItE

d St

At

ES

22

un

ItE

d S

tA

tE

S long-term Care resourCes

HcBS resources ValuePer 1,000 Age 65+

Medicare-certified home health agencies, 2006Adult day facilities, 2001-02Assisted living and residential care facilities, 2007Assisted living and residential care units, 2007Personal and home care aides, 2007

Median hourly wage, 2007Home health aides, 2007

Median hourly wage, 2007Medicaid aged/disabled waiver waiting list, 2007

8,4483,407

39,0051,000,476

595,350$8.89

834,580$9.62

89,938

0.220.091.02616

$8.8922

$9.6289,938

nursing Facility resources ValuePer 1,000 Age 65+

Total nursing facilities, 2007Nursing facility beds, 2007Nursing facility occupancy rate, 2007

1,699,494

1

18%

0.4345

85%

Direct care nursing hours per patient day, 2007Nursing facilities with deficiency for actual harm or jeopardy of

residents, 2007Residents with physical restraints (%), 2007Long-term care facility beds per FTE ombudsman, 2006Nursing facilities visited by ombudsman at least quarterly, 2006

Quality & oversight of nursing Facilities Value

3.718%

6%

2,19279%

change in Medicaid Ltc Spending, 2002–2007, by Service

Percent change in Medicaid Ltc Spending, 2002–2007, by Service

0100020003000400050006000700080009000

$629

$7,712

$2,651 $2,433

$4,551

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

ICF-MR MR/DD Waivers

Nursing Facilities

Aged/Disabled Waivers

PCS and otherHCBS

Mill

ions

of

Do

llars

0

20

40

60

80

0%

20%

40%

60%

80%

ICF-MR MR/DD Waivers

Nursing Facilities

Aged/Disabled Waivers

PCS and otherHCBS

Scale 80% Vertically

6%

60%

72%

6%

62%

23

trends

un

ItE

d St

At

ES

Home & community-Based Services

Medicaid HCBS participants, older people and adults with physical disabilities

Medicaid aged/disabled waiver participants

Medicare home health visits per user

Year Value

20002005

% change

20002005

% change

20012006

% change

1,026,3741,376,984

+34%

448,167582,342

+30%

3135

+13%

nursing Facilities

Nursing facility residents

Nursing facility beds

Nursing facility occupancy rate

Year Value

20022007

% change

20022007

% change

20022007

change

1,428,1171,440,358

+1%

1,671,7441,699,494

+2%

85%85%-1%

Long-term care Financing

Total Medicaid spending (millions)

Medicaid LTC spending for older people and adults with physical disabilities (millions)

Medicaid HCBS spending for older people and adults with physical disabilities (millions)

Medicaid nursing facility spending (millions)

Medicaid HCBS spending for older people and adults with physical disabilities, as a percentage of total LTC spending

Year Value

20022007

% change

20022007

% change

20022007

% change

20022007

% change

20022007

change

$243,497$311,848

+28%

$54,261$64,168

+18%

$10,204$17,188

+68%

$44,057$46,980

+7%

19%27%+8%

24

In addition to the national long-term care and independent living profile, you can find profiles for every state, the District of Columbia, Puerto Rico, and the Virgin Islands in the full report volume of Across the States 2009.

Copies are available free of charge. To order, please call the AARP Public Policy Institute at (202) 434-3890 or email [email protected]. The full report and executive summary are also available on the web. The most recent edition of Across the States can always be found at http://www.aarp.org/acrossthestates.

State data and rankings


26

PoPulation & ProjeCtions

Alabama 4,628 23 4,874 24 +5% 39Alaska 683 47 868 46 +27% 12Arizona 6,339 16 10,712 10 +69% 1Arkansas 2,835 32 3,240 32 +14% 22California 36,553 1 46,445 1 +27% 11Colorado 4,862 22 5,792 22 +19% 18Connecticut 3,502 29 3,689 30 +5% 39Delaware 865 45 1,013 45 +17% 19District of Columbia 588 50 433 51 -26% 51Florida 18,251 4 28,686 3 +57% 3Georgia 9,545 9 12,018 8 +26% 13Hawaii 1,283 42 1,466 41 +14% 23Idaho 1,499 39 1,970 37 +31% 8Illinois 12,853 5 13,433 5 +5% 41Indiana 6,345 15 6,810 18 +7% 33Iowa 2,988 30 2,955 34 -1% 48Kansas 2,776 33 2,940 35 +6% 37Kentucky 4,241 26 4,555 27 +7% 32Louisiana 4,293 25 4,803 26 +12% 25Maine 1,317 40 1,411 42 +7% 34Maryland 5,618 19 7,022 16 +25% 15Massachusetts 6,450 14 7,012 17 +9% 30Michigan 10,072 8 10,694 11 +6% 36Minnesota 5,198 21 6,306 20 +21% 16Mississippi 2,919 31 3,092 33 +6% 37Missouri 5,878 18 6,430 19 +9% 27Montana 958 44 1,045 44 +9% 28Nebraska 1,775 38 1,820 38 +3% 43Nevada 2,565 35 4,282 28 +67% 2New Hampshire 1,316 41 1,646 40 +25% 14New Jersey 8,686 11 9,802 13 +13% 24New Mexico 1,970 36 2,100 36 +7% 35New York 19,298 3 19,477 4 +1% 44North Carolina 9,061 10 12,228 7 +35% 5North Dakota 640 48 607 49 -5% 50Ohio 11,467 7 11,551 9 +1% 45Oklahoma 3,617 28 3,913 29 +8% 31Oregon 3,747 27 4,834 25 +29% 9Pennsylvania 12,433 6 12,768 6 +3% 42Rhode Island 1,058 43 1,153 43 +9% 29South Carolina 4,408 24 5,149 23 +17% 20South Dakota 796 46 800 47 +1% 46Tennessee 6,157 17 7,381 15 +20% 17Texas 23,904 2 33,318 2 +39% 4Utah 2,645 34 3,485 31 +32% 7Vermont 621 49 712 48 +15% 21Virginia 7,712 12 9,825 12 +27% 10Washington 6,468 13 8,625 14 +33% 6West Virginia 1,812 37 1,720 39 -5% 49Wisconsin 5,602 20 6,151 21 +10% 26Wyoming 523 51 523 50 +0% 47united States 301,621 363,584 +21%

Population, All Ages, 2007

Value (Millions) Rank

Population, All Ages, 2007


Percent Change in Population, All Ages, 2007

Value Rank

Note: The highest data value within each ranking is indicated by a rank of 1.

27



Alabama 853 18.4% 20 880 18.0% 8Alaska 126 18.4% 20 100 11.6% 51Arizona 1,045 16.5% 48 1,762 16.4% 34Arkansas 515 18.2% 29 574 17.7% 12California 5,966 16.3% 49 7,069 15.2% 44Colorado 875 18.0% 35 881 15.2% 44Connecticut 664 18.9% 10 611 16.6% 30Delaware 160 18.4% 20 189 18.7% 4District of Columbia 99 16.8% 47 63 14.5% 49Florida 3,331 18.3% 26 5,120 17.8% 11Georgia 1,609 16.9% 46 1,992 16.6% 30Hawaii 241 18.7% 12 217 14.8% 48Idaho 262 17.5% 43 336 17.1% 19Illinois 2,216 17.2% 45 2,188 16.3% 36Indiana 1,140 18.0% 35 1,123 16.5% 33Iowa 550 18.4% 20 517 17.5% 13Kansas 492 17.7% 41 474 16.1% 39Kentucky 792 18.7% 12 814 17.9% 9Louisiana 767 17.9% 37 781 16.3% 36Maine 280 21.3% 2 266 18.9% 3Maryland 1,033 18.4% 20 1,056 15.0% 46Massachusetts 1,198 18.6% 17 1,193 17.0% 23Michigan 1,886 18.7% 12 1,851 17.3% 15Minnesota 940 18.1% 33 1,018 16.1% 39Mississippi 509 17.4% 44 579 18.7% 4Missouri 1,072 18.2% 29 1,057 16.4% 34Montana 198 20.7% 3 192 18.4% 6Nebraska 313 17.6% 42 289 15.9% 41Nevada 457 17.8% 39 821 19.2% 2New Hampshire 264 20.1% 5 282 17.1% 19New Jersey 1,589 18.3% 26 1,711 17.5% 13New Mexico 352 17.9% 37 360 17.2% 17New York 3,498 18.1% 33 3,246 16.7% 28North Carolina 1,648 18.2% 29 2,092 17.1% 19North Dakota 117 18.3% 26 101 16.7% 28Ohio 2,143 18.7% 12 1,950 16.9% 25Oklahoma 645 17.8% 39 632 16.2% 38Oregon 740 19.7% 7 814 16.8% 27Pennsylvania 2,384 19.2% 8 2,190 17.2% 17Rhode Island 196 18.5% 19 196 17.0% 23South Carolina 834 18.9% 10 924 17.9% 9South Dakota 146 18.4% 20 133 16.6% 30Tennessee 1,150 18.7% 12 1,245 16.9% 25Texas 3,787 15.8% 50 5,002 15.0% 46Utah 359 13.6% 51 494 14.2% 50Vermont 134 21.5% 1 122 17.1% 19Virginia 1,403 18.2% 29 1,553 15.8% 42Washington 1,228 19.0% 9 1,358 15.7% 43West Virginia 374 20.6% 4 354 20.6% 1Wisconsin 1,040 18.6% 17 1,064 17.3% 15Wyoming 104 19.9% 6 94 18.1% 7united States 53,725 17.8% 59,928 16.5%

Population, Age 50-64, 2007 Value Percent of (Millions) Total Population Rank


28

Alabama +3% 21 626 13.5% 14Alaska -20% 50 48 7.0% 51Arizona +69% 2 820 12.9% 28Arkansas +11% 12 397 14.0% 9California +18% 10 4,004 11.0% 46Colorado +1% 27 493 10.1% 47Connecticut -8% 41 472 13.5% 14Delaware +19% 9 118 13.6% 12District of Columbia -36% 51 70 11.9% 40Florida +54% 3 3,098 17.0% 1Georgia +24% 8 943 9.9% 49Hawaii -10% 48 184 14.3% 7Idaho +28% 6 175 11.7% 43Illinois -1% 30 1,549 12.1% 39Indiana -1% 30 795 12.5% 33Iowa -6% 39 438 14.7% 5Kansas -4% 36 360 13.0% 24Kentucky +3% 21 550 13.0% 24Louisiana +2% 23 522 12.2% 35Maine -5% 37 195 14.8% 4Maryland +2% 23 662 11.8% 41Massachusetts +0% 28 859 13.3% 18Michigan -2% 33 1,280 12.7% 30Minnesota +8% 17 636 12.2% 35Mississippi +14% 11 365 12.5% 33Missouri -1% 30 788 13.4% 17Montana -3% 35 134 13.9% 10Nebraska -8% 41 237 13.3% 18Nevada +80% 1 286 11.1% 45New Hampshire +7% 20 166 12.6% 32New Jersey +8% 17 1,135 13.1% 22New Mexico +2% 23 250 12.7% 30New York -7% 40 2,546 13.2% 21North Carolina +27% 7 1,103 12.2% 35North Dakota -13% 49 93 14.6% 6Ohio -9% 44 1,545 13.5% 14Oklahoma -2% 33 480 13.3% 18Oregon +10% 16 489 13.0% 24Pennsylvania -8% 41 1,890 15.2% 3Rhode Island +0% 28 147 13.9% 10South Carolina +11% 12 573 13.0% 24South Dakota -9% 44 114 14.3% 7Tennessee +8% 17 793 12.9% 28Texas +32% 5 2,394 10.0% 48Utah +37% 4 234 8.8% 50Vermont -9% 44 84 13.6% 12Virginia +11% 12 910 11.8% 41Washington +11% 12 758 11.7% 43West Virginia -5% 37 281 15.5% 2Wisconsin +2% 23 736 13.1% 22Wyoming -9% 44 64 12.2% 35united States +12% 37,888 12.6%


Percent Change in Population, Age 50-64, 2007-2030

Value Rank

Population, Age 65+, 2007 Value Percent of (Millions) Total Population Rank


29


Percent Change in Population, Age 65+, 2007-2030

Value Rank



Alabama 1,039 21.3% 19 +66% 34Alaska 127 14.7% 49 +165% 3Arizona 2,371 22.1% 14 +189% 1Arkansas 656 20.3% 25 +65% 35California 8,288 17.8% 43 +107% 9Colorado 956 16.5% 46 +94% 20Connecticut 794 21.5% 16 +68% 32Delaware 238 23.5% 9 +102% 14District of Columbia 58 13.4% 50 -16% 51Florida 7,769 27.1% 1 +151% 4Georgia 1,908 15.9% 47 +102% 14Hawaii 327 22.3% 13 +78% 27Idaho 361 18.3% 38 +106% 10Illinois 2,412 18.0% 42 +56% 44Indiana 1,232 18.1% 40 +55% 45Iowa 663 22.4% 12 +51% 50Kansas 593 20.2% 26 +65% 35Kentucky 903 19.8% 30 +64% 38Louisiana 944 19.7% 31 +81% 24Maine 374 26.5% 2 +92% 21Maryland 1,236 17.6% 45 +87% 23Massachusetts 1,463 20.9% 21 +70% 31Michigan 2,081 19.5% 32 +63% 39Minnesota 1,193 18.9% 35 +88% 22Mississippi 634 20.5% 23 +74% 29Missouri 1,302 20.2% 26 +65% 35Montana 270 25.8% 5 +102% 14Nebraska 376 20.6% 22 +59% 42Nevada 797 18.6% 37 +179% 2New Hampshire 353 21.4% 17 +113% 8New Jersey 1,960 20.0% 29 +73% 30New Mexico 555 26.4% 4 +122% 5New York 3,917 20.1% 28 +54% 46North Carolina 2,173 17.8% 43 +97% 18North Dakota 152 25.1% 6 +63% 39Ohio 2,357 20.4% 24 +53% 47Oklahoma 758 19.4% 33 +58% 43Oregon 882 18.2% 39 +80% 25Pennsylvania 2,890 22.6% 11 +53% 47Rhode Island 247 21.4% 17 +68% 32South Carolina 1,134 22.0% 15 +98% 17South Dakota 185 23.1% 10 +63% 39Tennessee 1,418 19.2% 34 +79% 26Texas 5,186 15.6% 48 +117% 6Utah 461 13.2% 51 +97% 18Vermont 174 24.4% 8 +106% 10Virginia 1,844 18.8% 36 +103% 13Washington 1,564 18.1% 40 +106% 10West Virginia 426 24.8% 7 +52% 49Wisconsin 1,312 21.3% 19 +78% 27Wyoming 139 26.5% 2 +117% 6united States 71,453 19.7% +89%

30



Alabama 333 7.2% 5 559 11.5% 14Alaska 29 4.3% 51 64 7.4% 49Arizona 421 6.6% 22 1,318 12.3% 9Arkansas 207 7.3% 4 360 11.1% 18California 2,049 5.6% 46 4,332 9.3% 42Colorado 265 5.5% 47 491 8.5% 47Connecticut 229 6.5% 25 395 10.7% 26Delaware 62 7.1% 8 131 12.9% 5District of Columbia 36 6.1% 41 29 6.8% 51Florida 1,479 8.1% 1 4,306 15.0% 1Georgia 524 5.5% 47 1,068 8.9% 46Hawaii 87 6.8% 15 159 10.9% 22Idaho 92 6.1% 41 188 9.6% 39Illinois 785 6.1% 41 1,259 9.4% 41Indiana 408 6.4% 32 648 9.5% 40Iowa 207 6.9% 13 330 11.2% 17Kansas 174 6.3% 39 301 10.2% 34Kentucky 295 7.0% 10 497 10.9% 22Louisiana 277 6.4% 32 500 10.4% 29Maine 99 7.5% 3 190 13.5% 2Maryland 350 6.2% 40 647 9.2% 44Massachusetts 415 6.4% 32 764 10.9% 22Michigan 655 6.5% 25 1,090 10.2% 34Minnesota 317 6.1% 41 627 9.9% 36Mississippi 193 6.6% 22 355 11.5% 14Missouri 402 6.8% 15 694 10.8% 25Montana 69 7.2% 5 134 12.8% 6Nebraska 114 6.4% 32 189 10.4% 29Nevada 163 6.4% 32 471 11.0% 20New Hampshire 85 6.5% 25 189 11.5% 14New Jersey 569 6.5% 25 1,027 10.5% 28New Mexico 132 6.7% 18 284 13.5% 2New York 1,282 6.6% 22 2,003 10.3% 31North Carolina 592 6.5% 25 1,199 9.8% 38North Dakota 43 6.7% 18 76 12.5% 8Ohio 781 6.8% 15 1,225 10.6% 27Oklahoma 251 6.9% 13 403 10.3% 31Oregon 249 6.7% 18 444 9.2% 44Pennsylvania 896 7.2% 5 1,485 11.6% 12Rhode Island 68 6.4% 32 127 11.0% 20South Carolina 311 7.1% 8 613 11.9% 11South Dakota 54 6.7% 18 93 11.6% 12Tennessee 429 7.0% 10 761 10.3% 31Texas 1,278 5.3% 49 2,838 8.5% 47Utah 124 4.7% 50 242 6.9% 50Vermont 44 7.0% 10 87 12.3% 9Virginia 490 6.4% 32 974 9.9% 36Washington 394 6.1% 41 806 9.3% 42West Virginia 146 8.0% 2 221 12.8% 6Wisconsin 365 6.5% 25 685 11.1% 18Wyoming 34 6.5% 25 68 13.1% 4united States 19,352 6.4% 37,948 10.4%



31

Alabama +68% 39 210 4.5% 22Alaska +119% 6 14 2.1% 51Arizona +213% 1 287 4.5% 22Arkansas +74% 34 133 4.7% 10California +111% 9 1,370 3.7% 45Colorado +85% 24 163 3.3% 47Connecticut +73% 35 166 4.7% 10Delaware +112% 8 41 4.7% 10District of Columbia -18% 51 23 3.9% 41Florida +191% 2 1,126 6.2% 1Georgia +104% 10 300 3.1% 49Hawaii +84% 26 68 5.3% 4Idaho +104% 10 58 3.9% 41Illinois +60% 45 530 4.1% 35Indiana +59% 46 273 4.3% 28Iowa +59% 46 154 5.1% 6Kansas +73% 35 125 4.5% 22Kentucky +68% 39 182 4.3% 28Louisiana +81% 29 177 4.1% 35Maine +92% 21 68 5.1% 6Maryland +85% 24 222 4.0% 40Massachusetts +84% 26 304 4.7% 10Michigan +66% 41 443 4.4% 26Minnesota +98% 17 215 4.1% 35Mississippi +84% 26 121 4.2% 33Missouri +73% 35 268 4.6% 17Montana +95% 20 45 4.7% 10Nebraska +66% 41 83 4.7% 10Nevada +188% 3 92 3.6% 46New Hampshire +122% 4 56 4.3% 28New Jersey +81% 29 397 4.6% 17New Mexico +116% 7 85 4.3% 28New York +56% 49 880 4.6% 17North Carolina +103% 13 369 4.1% 35North Dakota +77% 32 33 5.2% 5Ohio +57% 48 542 4.7% 10Oklahoma +61% 44 161 4.5% 22Oregon +78% 31 166 4.4% 26Pennsylvania +66% 41 692 5.6% 2Rhode Island +86% 23 53 5.0% 8South Carolina +97% 18 189 4.3% 28South Dakota +73% 35 40 5.0% 8Tennessee +77% 32 261 4.2% 33Texas +122% 4 798 3.3% 47Utah +96% 19 79 3.0% 50Vermont +100% 14 29 4.6% 17Virginia +99% 16 302 3.9% 41Washington +104% 10 252 3.9% 41West Virginia +52% 50 98 5.4% 3Wisconsin +88% 22 256 4.6% 17Wyoming +100% 14 21 4.1% 35united States +96% 13,024 4.3%



Value Rank



32



Value Rank (Millions)



Alabama 348 7.1% 21 +66% 30Alaska 45 5.2% 47 +218% 1Arizona 788 7.4% 14 +175% 2Arkansas 214 6.6% 26 +61% 36California 2,797 6.0% 41 +104% 16Colorado 333 5.8% 44 +105% 13Connecticut 267 7.2% 16 +61% 36Delaware 78 7.7% 11 +92% 20District of Columbia 20 4.6% 50 -14% 51Florida 2,519 8.8% 6 +124% 6Georgia 615 5.1% 48 +105% 13Hawaii 119 8.1% 9 +76% 27Idaho 126 6.4% 36 +116% 8Illinois 801 6.0% 41 +51% 46Indiana 415 6.1% 40 +52% 45Iowa 228 7.7% 11 +49% 47Kansas 204 7.0% 22 +63% 32Kentucky 301 6.6% 26 +65% 31Louisiana 318 6.6% 26 +80% 26Maine 131 9.3% 3 +94% 19Maryland 412 5.9% 43 +85% 23Massachusetts 487 7.0% 22 +60% 39Michigan 703 6.6% 26 +59% 40Minnesota 398 6.3% 37 +85% 23Mississippi 205 6.6% 26 +69% 29Missouri 433 6.7% 25 +62% 33Montana 98 9.4% 2 +118% 7Nebraska 131 7.2% 16 +58% 41Nevada 244 5.7% 46 +164% 3New Hampshire 119 7.2% 16 +110% 12New Jersey 641 6.5% 32 +62% 33New Mexico 196 9.3% 3 +131% 5New York 1,292 6.6% 26 +47% 49North Carolina 707 5.8% 44 +92% 20North Dakota 54 8.8% 6 +62% 33Ohio 809 7.0% 22 +49% 47Oklahoma 255 6.5% 32 +58% 41Oregon 316 6.5% 32 +90% 22Pennsylvania 989 7.7% 11 +43% 50Rhode Island 83 7.2% 16 +55% 44South Carolina 380 7.4% 14 +101% 17South Dakota 64 8.0% 10 +61% 36Tennessee 477 6.5% 32 +82% 25Texas 1,710 5.1% 48 +114% 11Utah 159 4.6% 50 +100% 18Vermont 62 8.7% 8 +115% 9Virginia 620 6.3% 37 +105% 13Washington 542 6.3% 37 +115% 9West Virginia 152 8.9% 5 +56% 43Wisconsin 444 7.2% 16 +73% 28Wyoming 51 9.7% 1 +140% 4united States 23,903 6.6% +84%

33



Alabama 82 1.8% 25 132 2.7% 23Alaska 5 0.7% 51 18 2.1% 46Arizona 113 1.8% 25 265 2.5% 31Arkansas 57 2.0% 16 82 2.5% 31California 585 1.6% 38 1,159 2.5% 31Colorado 65 1.3% 46 132 2.3% 43Connecticut 78 2.2% 9 132 3.6% 4Delaware 15 1.8% 25 29 2.9% 21District of Columbia 11 1.8% 25 9 2.0% 47Florida 494 2.7% 1 944 3.3% 10Georgia 118 1.2% 48 225 1.9% 48Hawaii 29 2.3% 7 48 3.3% 10Idaho 25 1.6% 38 47 2.4% 40Illinois 234 1.8% 25 352 2.6% 29Indiana 115 1.8% 25 169 2.5% 31Iowa 77 2.6% 3 105 3.6% 4Kansas 61 2.2% 9 88 3.0% 17Kentucky 72 1.7% 33 106 2.3% 43Louisiana 69 1.6% 38 126 2.6% 29Maine 28 2.1% 12 52 3.7% 2Maryland 89 1.6% 38 177 2.5% 31Massachusetts 140 2.2% 9 212 3.0% 17Michigan 182 1.8% 25 287 2.7% 23Minnesota 105 2.0% 16 168 2.7% 23Mississippi 51 1.7% 33 74 2.4% 40Missouri 118 2.0% 16 174 2.7% 23Montana 20 2.1% 12 37 3.6% 4Nebraska 40 2.3% 7 56 3.1% 15Nevada 30 1.2% 48 83 1.9% 48New Hampshire 24 1.8% 25 45 2.7% 23New Jersey 169 1.9% 21 291 3.0% 17New Mexico 34 1.7% 33 76 3.6% 4New York 385 2.0% 16 622 3.2% 13North Carolina 143 1.6% 38 267 2.2% 45North Dakota 17 2.7% 1 23 3.8% 1Ohio 222 1.9% 21 322 2.8% 22Oklahoma 68 1.9% 21 100 2.5% 31Oregon 73 2.0% 16 122 2.5% 31Pennsylvania 302 2.4% 5 415 3.3% 10Rhode Island 25 2.4% 5 37 3.2% 13South Carolina 72 1.6% 38 141 2.7% 23South Dakota 20 2.5% 4 28 3.5% 8Tennessee 102 1.7% 33 180 2.4% 40Texas 318 1.3% 46 639 1.9% 48Utah 31 1.2% 48 59 1.7% 51Vermont 12 1.9% 21 25 3.5% 8Virginia 117 1.5% 45 250 2.5% 31Washington 111 1.7% 33 216 2.5% 31West Virginia 37 2.1% 12 53 3.1% 15Wisconsin 115 2.1% 12 183 3.0% 17Wyoming 9 1.6% 38 19 3.7% 2united States 5,512 1.8% 9,603 2.6%



34


Alabama +61% 30 20.3% 17 0.6% 41Alaska +297% 1 27.5% 6 6.2% 4Arizona +135% 3 16.6% 20 1.8% 18Arkansas +45% 41 12.2% 26 0.6% 41California +98% 10 36.2% 4 13.6% 2Colorado +104% 8 15.3% 22 2.2% 14Connecticut +70% 26 11.6% 27 1.6% 19Delaware +89% 18 16.2% 21 1.6% 19District of Columbia -17% 51 70.8% 2 2.2% 14Florida +91% 15 21.4% 15 1.4% 21Georgia +91% 15 24.6% 11 1.9% 17Hawaii +64% 28 77.5% 1 78.5% 1Idaho +91% 15 5.1% 43 1.0% 28Illinois +51% 35 19.4% 18 3.0% 10Indiana +48% 36 8.5% 33 0.7% 37Iowa +36% 49 2.8% 48 0.6% 41Kansas +45% 41 8.3% 34 1.1% 26Kentucky +48% 36 6.9% 38 0.5% 46Louisiana +84% 23 26.1% 9 1.0% 28Maine +87% 20 1.7% 51 0.5% 46Maryland +98% 10 27.4% 7 4.0% 8Massachusetts +52% 34 8.8% 32 2.5% 12Michigan +58% 33 13.0% 24 1.2% 24Minnesota +61% 30 4.2% 45 1.4% 21Mississippi +45% 41 26.5% 8 0.6% 41Missouri +48% 36 10.0% 30 0.9% 32Montana +88% 19 5.2% 41 0.5% 46Nebraska +40% 46 5.2% 41 0.7% 37Nevada +176% 2 22.4% 13 7.0% 3New Hampshire +87% 20 2.5% 49 0.9% 32New Jersey +72% 25 21.9% 14 4.5% 7New Mexico +123% 5 39.4% 3 1.1% 26New York +62% 29 25.5% 10 4.9% 6North Carolina +87% 20 19.0% 19 1.0% 28North Dakota +34% 50 3.0% 47 0.3% 50Ohio +45% 41 10.7% 29 0.9% 32Oklahoma +46% 39 14.6% 23 1.0% 28Oregon +66% 27 7.2% 37 2.6% 11Pennsylvania +37% 48 9.4% 31 1.2% 24Rhode Island +46% 39 7.6% 36 1.4% 21South Carolina +95% 12 22.6% 12 0.8% 35South Dakota +39% 47 4.6% 44 0.3% 50Tennessee +76% 24 12.5% 25 0.7% 37Texas +101% 9 31.3% 5 2.4% 13Utah +92% 14 7.8% 35 2.2% 14Vermont +106% 7 2.3% 50 0.6% 41Virginia +114% 6 20.9% 16 3.3% 9Washington +94% 13 11.4% 28 5.8% 5West Virginia +43% 45 4.1% 46 0.5% 46Wisconsin +59% 32 5.3% 40 0.8% 35Wyoming +126% 4 6.6% 39 0.7% 37united States +74% 19.3% 3.6%

Percent Change in Population, Age 85+, 2007-2030

Value Rank

People of Color, Age 65+ (%), 2007

Value Rank

Asian Age 65+ (%), 2007

Value Rank


35



Alabama 18.2% 7 0.9% 39Alaska 2.3% 34 2.3% 22Arizona 2.1% 36 10.5% 5Arkansas 9.5% 16 1.2% 35California 5.5% 25 16.8% 3Colorado 2.8% 31 9.8% 6Connecticut 6.0% 22 4.0% 12Delaware 12.5% 11 1.7% 29District of Columbia 65.1% 1 3.9% 13Florida 7.6% 19 12.6% 4Georgia 20.5% 5 2.1% 25Hawaii 1.0% 40 2.7% 16Idaho 0.2% 48 2.7% 16Illinois 11.2% 12 5.0% 10Indiana 6.0% 22 1.5% 30Iowa 1.0% 40 0.9% 39Kansas 3.6% 29 2.6% 18Kentucky 5.2% 26 0.7% 46Louisiana 22.4% 3 2.2% 24Maine 0.3% 46 0.5% 50Maryland 21.0% 4 2.3% 22Massachusetts 3.8% 28 2.6% 18Michigan 9.9% 15 1.4% 31Minnesota 1.3% 39 0.9% 39Mississippi 24.6% 2 0.9% 39Missouri 7.4% 20 1.0% 37Montana 0.2% 48 1.0% 37Nebraska 2.2% 35 1.8% 28Nevada 5.8% 24 8.9% 8New Hampshire 0.4% 45 0.9% 39New Jersey 10.0% 14 7.7% 9New Mexico 1.7% 38 31.4% 1New York 12.8% 10 9.0% 7North Carolina 15.8% 8 1.3% 32North Dakota 0.1% 51 0.4% 51Ohio 8.6% 18 0.9% 39Oklahoma 4.7% 27 1.9% 27Oregon 1.0% 40 2.4% 21Pennsylvania 6.8% 21 1.3% 32Rhode Island 3.0% 30 3.3% 15South Carolina 20.5% 5 1.1% 36South Dakota 0.2% 48 0.7% 46Tennessee 10.4% 13 0.9% 39Texas 8.7% 17 19.8% 2Utah 0.5% 43 4.4% 11Vermont 0.3% 46 0.7% 46Virginia 15.4% 9 2.0% 26Washington 1.9% 37 2.5% 20West Virginia 2.5% 33 0.6% 49Wisconsin 2.7% 32 1.3% 32Wyoming 0.5% 43 3.8% 14united States 8.7% 6.6%

Black Age 65+ (%), 2007 Value Rank

Hispanic Age 65+ (%), 2007

Value Rank

36


Alabama 43 37 36% 10 40% 18Alaska 56 8 28% 47 37% 20Arizona 62 2 28% 47 16% 35Arkansas 48 16 34% 24 42% 14California 53 10 30% 44 3% 44Colorado 48 16 34% 24 NAConnecticut 44 32 34% 24 5% 42Delaware 49 14 33% 33 30% 24District of Columbia 41 50 40% 1 0% 45Florida 61 4 30% 44 6% 40Georgia 41 50 32% 36 19% 33Hawaii 62 2 23% 51 27% 27Idaho 57 6 32% 36 38% 19Illinois 43 37 35% 16 15% 37Indiana 43 37 34% 24 27% 27Iowa 43 37 39% 2 52% 9Kansas 44 32 35% 16 44% 12Kentucky 43 37 35% 16 54% 8Louisiana 45 22 32% 36 NAMaine 45 22 37% 6 61% 7Maryland 45 22 32% 36 6% 40Massachusetts 42 48 35% 16 4% 43Michigan 46 20 35% 16 18% 34Minnesota 45 22 38% 4 31% 23Mississippi 43 37 36% 10 63% 6Missouri 43 37 36% 10 30% 24Montana 53 10 32% 36 70% 3Nebraska 44 32 37% 6 47% 10Nevada 65 1 27% 49 NANew Hampshire 44 32 31% 42 42% 14New Jersey 45 22 33% 33 0% 45New Mexico 57 6 31% 42 37% 20New York 45 22 34% 24 10% 39North Carolina 43 37 34% 24 44% 12North Dakota 49 14 38% 4 66% 4Ohio 43 37 36% 10 24% 31Oklahoma 46 20 36% 10 41% 17Oregon 54 9 35% 16 33% 22Pennsylvania 43 37 34% 24 20% 32Rhode Island 42 48 35% 16 0% 45South Carolina 45 22 33% 33 42% 14South Dakota 48 16 39% 2 65% 5Tennessee 43 37 34% 24 27% 27Texas 48 16 30% 44 16% 35Utah 59 5 27% 49 NAVermont 45 22 35% 16 74% 2Virginia 44 32 36% 10 26% 30Washington 52 12 34% 24 11% 38West Virginia 45 22 37% 6 46% 11Wisconsin 45 22 37% 6 29% 26Wyoming 51 13 32% 36 77% 1united States 48 33% 20%

Men per 100 Women Age 85+

Value Rank

Persons Age 75+ Living Alone

Value Rank

Non-Metropolitan Population, 2007/2008

Value Rank


37


Alabama 15% 39 2.1% 11 $27,112 45Alaska 21% 17 2.9% 1 $41,109 3Arizona 23% 11 1.7% 21 $35,480 15Arkansas 14% 46 2.3% 8 $26,189 47California 24% 5 1.8% 17 $38,154 6Colorado 27% 2 1.4% 26 $36,759 13Connecticut 24% 5 1.1% 35 $37,965 8Delaware 21% 17 1.6% 23 $37,445 10District of Columbia 34% 1 2.4% 5 $39,186 4Florida 21% 17 1.3% 31 $33,469 17Georgia 17% 33 2.4% 5 $31,143 26Hawaii 22% 13 2.4% 5 $52,393 1Idaho 19% 24 1.1% 35 $30,813 28Illinois 18% 31 1.5% 24 $32,731 19Indiana 14% 46 1.3% 31 $30,931 27Iowa 15% 39 0.7% 46 $29,228 38Kansas 19% 24 1.1% 35 $31,634 24Kentucky 13% 49 1.8% 17 $25,834 48Louisiana 15% 39 2.7% 3 $26,344 46Maine 20% 22 1.0% 39 $29,101 39Maryland 25% 4 1.7% 21 $41,707 2Massachusetts 24% 5 0.9% 42 $33,332 18Michigan 16% 37 1.2% 33 $31,513 25Minnesota 19% 24 0.8% 44 $32,714 20Mississippi 14% 46 2.9% 1 $23,892 51Missouri 15% 39 1.4% 26 $29,833 35Montana 22% 13 1.8% 17 $30,767 30Nebraska 17% 33 0.7% 46 $30,468 31Nevada 20% 22 2.1% 11 $38,993 5New Hampshire 24% 5 0.8% 44 $37,156 11New Jersey 21% 17 1.2% 33 $37,507 9New Mexico 22% 13 2.0% 14 $30,441 32New York 21% 17 1.4% 26 $31,734 23North Carolina 18% 31 1.9% 15 $28,535 41North Dakota 11% 51 0.9% 42 $25,658 50Ohio 15% 39 1.4% 26 $30,117 34Oklahoma 17% 33 2.2% 9 $29,327 37Oregon 22% 13 1.0% 39 $33,565 16Pennsylvania 15% 39 1.0% 39 $28,937 40Rhode Island 19% 24 0.5% 50 $28,250 42South Carolina 19% 24 1.8% 17 $29,791 36South Dakota 17% 33 1.1% 35 $28,244 43Tennessee 15% 39 2.1% 11 $27,740 44Texas 19% 24 2.6% 4 $31,918 22Utah 24% 5 2.2% 9 $38,022 7Vermont 27% 2 0.5% 50 $30,784 29Virginia 23% 11 1.5% 24 $36,561 14Washington 24% 5 1.4% 26 $36,908 12West Virginia 12% 50 1.9% 15 $25,795 49Wisconsin 16% 37 0.7% 46 $30,184 33Wyoming 19% 24 0.6% 49 $32,280 21united States 19% 1.6% $32,158

Bachelor-Level Education or Higher, Age 65+, 2007

Value Rank

Persons Age 60+ Raising Grandchildren, 2007

Value Rank

Median Household Income, Age 65+, 2007

Value Rank


38


Alabama 11.9% 12 39% 7 59% 6 16% 11Alaska 5.4% 50 25% 46 38% 50 6% 51Arizona 8.6% 26 29% 39 48% 36 10% 43Arkansas 12.1% 7 40% 4 60% 4 17% 6California 8.2% 33 30% 35 47% 37 10% 43Colorado 8.5% 27 28% 40 45% 40 13% 24Connecticut 6.4% 48 24% 48 41% 48 9% 46Delaware 7.8% 41 28% 40 45% 40 10% 43District of Columbia 13.7% 2 33% 21 43% 45 16% 11Florida 9.4% 19 31% 29 50% 32 12% 28Georgia 12.1% 7 35% 15 53% 22 18% 4Hawaii 6.3% 49 21% 51 36% 51 9% 46Idaho 8.0% 37 32% 25 55% 14 14% 19Illinois 8.5% 27 31% 29 51% 29 11% 35Indiana 7.8% 41 32% 25 54% 19 11% 35Iowa 7.7% 43 34% 18 56% 11 13% 24Kansas 8.1% 36 30% 35 49% 35 12% 28Kentucky 12.9% 5 40% 4 61% 3 17% 6Louisiana 13.3% 3 40% 4 59% 6 18% 4Maine 9.2% 23 39% 7 57% 9 14% 19Maryland 8.2% 33 24% 48 40% 49 12% 28Massachusetts 9.3% 20 30% 35 47% 37 12% 28Michigan 8.0% 37 31% 29 53% 22 11% 35Minnesota 8.0% 37 30% 35 50% 32 13% 24Mississippi 14.9% 1 44% 1 63% 2 19% 2Missouri 9.3% 20 35% 15 55% 14 14% 19Montana 10.0% 18 33% 21 52% 26 16% 11Nebraska 8.3% 31 31% 29 52% 26 14% 19Nevada 6.8% 45 27% 43 44% 44 9% 46New Hampshire 6.5% 47 25% 46 43% 45 9% 46New Jersey 8.4% 29 26% 44 43% 45 12% 28New Mexico 13.3% 3 37% 10 56% 11 17% 6New York 11.7% 13 33% 21 51% 29 15% 16North Carolina 11.0% 15 37% 10 55% 14 16% 11North Dakota 12.6% 6 41% 2 60% 4 20% 1Ohio 8.2% 33 32% 25 54% 19 11% 35Oklahoma 10.1% 17 36% 12 55% 14 14% 19Oregon 8.4% 29 31% 29 50% 32 12% 28Pennsylvania 8.7% 25 34% 18 56% 11 12% 28Rhode Island 9.3% 20 34% 18 53% 22 11% 35South Carolina 12.0% 9 36% 12 55% 14 17% 6South Dakota 11.5% 14 36% 12 58% 8 19% 2Tennessee 12.0% 9 38% 9 57% 9 17% 6Texas 12.0% 9 35% 15 53% 22 16% 11Utah 6.8% 45 24% 48 46% 39 9% 46Vermont 7.5% 44 32% 25 51% 29 11% 35Virginia 9.2% 23 28% 40 45% 40 15% 16Washington 7.9% 40 26% 44 45% 40 11% 35West Virginia 10.4% 16 41% 2 64% 1 15% 16Wisconsin 8.3% 31 33% 21 54% 19 13% 24Wyoming 5.3% 51 31% 29 52% 26 11% 35united States 9.5% 32% 51% 13%

Pct of Age 65+ Below Poverty, 2007

Value Rank

Pct of Age 65+ Below 200% of Poverty, 2007

Value Rank

Pct of Age 65+ Below 300% of Poverty, 2007

Value Rank


Pct of Women Age 75+ Below Poverty, 2007

Value Rank

39



Alabama 125 21% 4 237 40% 2Alaska 11 23% 1 16 35% 10Arizona 132 16% 25 237 29% 30Arkansas 82 22% 2 147 39% 3California 628 16% 25 1,213 31% 17Colorado 75 16% 25 126 26% 46Connecticut 63 14% 43 116 26% 46Delaware 16 14% 43 32 28% 35District of Columbia 9 14% 43 19 29% 30Florida 460 15% 34 873 29% 30Georgia 158 17% 18 313 35% 10Hawaii 26 14% 43 51 28% 35Idaho 30 18% 13 50 30% 24Illinois 213 14% 43 440 30% 24Indiana 120 16% 25 229 31% 17Iowa 61 15% 34 107 26% 46Kansas 52 16% 25 99 30% 24Kentucky 110 21% 4 201 39% 3Louisiana 97 20% 8 184 37% 6Maine 35 19% 10 58 31% 17Maryland 85 13% 50 177 28% 35Massachusetts 120 15% 34 224 28% 35Michigan 198 16% 25 381 31% 17Minnesota 85 14% 43 153 26% 46Mississippi 76 22% 2 146 42% 1Missouri 125 17% 18 245 33% 14Montana 25 20% 8 39 31% 17Nebraska 32 15% 34 59 27% 42Nevada 41 15% 34 79 28% 35New Hampshire 25 16% 25 40 26% 46New Jersey 136 13% 50 298 27% 42New Mexico 51 21% 4 88 36% 8New York 365 15% 34 738 30% 24North Carolina 182 17% 18 359 34% 13North Dakota 15 17% 18 25 30% 24Ohio 224 15% 34 438 30% 24Oklahoma 89 19% 10 167 37% 6Oregon 84 18% 13 151 32% 16Pennsylvania 266 15% 34 514 29% 30Rhode Island 21 16% 25 39 28% 35South Carolina 92 17% 18 185 33% 14South Dakota 18 17% 18 29 27% 42Tennessee 144 19% 10 266 35% 10Texas 418 18% 13 819 36% 8Utah 38 17% 18 64 28% 35Vermont 13 16% 25 22 27% 42Virginia 128 15% 34 266 31% 17Washington 131 18% 13 227 31% 17West Virginia 57 21% 4 103 38% 5Wisconsin 96 14% 43 181 26% 46Wyoming 10 18% 13 17 29% 30united States 5,893 16% 11,285 31%

Persons Age 65+ w/ Sensory Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

Persons Age 65+ w/ Physical Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

40



Alabama 135 22% 2 83 14% 2Alaska 9 19% 10 5 12% 7Arizona 127 16% 27 73 9% 30Arkansas 72 19% 10 43 11% 13California 749 19% 10 457 12% 7Colorado 72 15% 35 41 9% 30Connecticut 70 16% 27 39 9% 30Delaware 16 14% 41 10 9% 30District of Columbia 12 19% 10 8 11% 13Florida 473 16% 27 269 9% 30Georgia 182 20% 7 105 12% 7Hawaii 32 18% 16 18 10% 19Idaho 24 15% 35 14 8% 40Illinois 247 17% 20 140 10% 19Indiana 121 16% 27 72 10% 19Iowa 51 13% 48 29 7% 48Kansas 46 14% 41 26 8% 40Kentucky 113 22% 2 65 13% 4Louisiana 106 21% 5 68 14% 2Maine 26 14% 41 15 8% 40Maryland 102 16% 27 60 9% 30Massachusetts 125 15% 35 72 9% 30Michigan 212 17% 20 123 10% 19Minnesota 78 13% 48 43 7% 48Mississippi 80 23% 1 52 15% 1Missouri 132 18% 16 77 10% 19Montana 19 15% 35 10 8% 40Nebraska 31 14% 41 18 8% 40Nevada 41 15% 35 24 9% 30New Hampshire 21 14% 41 12 8% 40New Jersey 185 17% 20 112 10% 19New Mexico 49 20% 7 32 13% 4New York 455 19% 10 271 11% 13North Carolina 190 18% 16 114 11% 13North Dakota 11 13% 48 5 6% 51Ohio 241 16% 27 142 10% 19Oklahoma 80 18% 16 49 11% 13Oregon 81 17% 20 50 11% 13Pennsylvania 292 16% 27 162 9% 30Rhode Island 21 15% 35 13 10% 19South Carolina 103 19% 10 64 12% 7South Dakota 13 12% 51 7 7% 48Tennessee 153 20% 7 92 12% 7Texas 471 21% 5 306 13% 4Utah 35 16% 27 19 9% 30Vermont 11 14% 41 7 8% 40Virginia 149 17% 20 87 10% 19Washington 122 17% 20 75 10% 19West Virginia 58 22% 2 33 12% 7Wisconsin 101 14% 41 56 8% 40Wyoming 10 17% 20 6 10% 19united States 6,354 18% 3,772 10%

Persons Age 65+ w/ Mobility Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

Persons Age 65+ w/ Self-Care Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

41



Alabama 99 16% 2 298 50% 2Alaska 8 16% 2 22 48% 5Arizona 95 12% 21 313 39% 27Arkansas 61 16% 2 188 50% 2California 534 14% 11 1,582 41% 19Colorado 49 10% 34 175 37% 40Connecticut 44 10% 34 159 36% 43Delaware 11 10% 34 42 38% 34District of Columbia 9 13% 17 25 38% 34Florida 348 12% 21 1,157 38% 34Georgia 137 15% 6 405 45% 11Hawaii 24 13% 17 69 38% 34Idaho 18 11% 27 66 40% 23Illinois 158 11% 27 567 39% 27Indiana 83 11% 27 303 40% 23Iowa 35 9% 45 147 36% 43Kansas 32 10% 34 133 40% 23Kentucky 86 16% 2 254 49% 4Louisiana 77 15% 6 236 47% 7Maine 20 11% 27 79 43% 13Maryland 69 11% 27 235 37% 40Massachusetts 80 10% 34 294 36% 43Michigan 142 12% 21 501 41% 19Minnesota 51 9% 45 210 35% 49Mississippi 66 19% 1 182 53% 1Missouri 94 13% 17 315 42% 16Montana 15 12% 21 53 42% 16Nebraska 20 9% 45 79 36% 43Nevada 28 10% 34 102 36% 43New Hampshire 14 9% 45 56 36% 43New Jersey 108 10% 34 384 35% 49New Mexico 36 15% 6 113 46% 9New York 297 12% 21 954 39% 27North Carolina 148 14% 11 458 43% 13North Dakota 7 9% 45 34 40% 23Ohio 166 11% 27 576 39% 27Oklahoma 63 14% 11 212 47% 7Oregon 66 14% 11 200 42% 16Pennsylvania 182 10% 34 688 39% 27Rhode Island 14 10% 34 52 38% 34South Carolina 76 14% 11 239 43% 13South Dakota 10 9% 45 39 38% 34Tennessee 113 15% 6 347 46% 9Texas 333 15% 6 1,032 45% 11Utah 26 11% 27 88 39% 27Vermont 8 10% 34 30 37% 40Virginia 102 12% 21 343 39% 27Washington 97 13% 17 299 41% 19West Virginia 38 14% 11 130 48% 5Wisconsin 62 9% 45 247 35% 49Wyoming 6 10% 34 24 41% 19united States 4,467 12% 14,735 41%

Persons Age 65+ w/ Cognitive/Mental Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

Persons Age 65+ w/ Any Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

42



Alabama 89 15% 3 491 17% 2Alaska 6 14% 4 61 14% 10Arizona 86 11% 20 407 11% 27Arkansas 54 14% 4 297 17% 2California 480 12% 13 2,193 10% 34Colorado 43 9% 34 310 10% 34Connecticut 38 9% 34 204 9% 46Delaware 9 8% 44 59 11% 27District of Columbia 8 11% 20 41 10% 34Florida 312 10% 27 1,183 11% 27Georgia 123 14% 4 676 11% 27Hawaii 21 12% 13 78 10% 34Idaho 17 10% 27 104 12% 20Illinois 140 10% 27 732 9% 46Indiana 73 10% 27 483 12% 20Iowa 29 7% 49 205 11% 27Kansas 29 9% 34 184 11% 27Kentucky 81 16% 2 462 17% 2Louisiana 70 14% 4 384 15% 8Maine 16 9% 34 135 16% 6Maryland 61 10% 27 341 10% 34Massachusetts 71 9% 34 421 10% 34Michigan 132 11% 20 807 13% 11Minnesota 41 7% 49 309 9% 46Mississippi 60 18% 1 301 17% 2Missouri 86 12% 13 489 13% 11Montana 14 11% 20 71 12% 20Nebraska 18 8% 44 106 10% 34Nevada 26 9% 34 159 10% 34New Hampshire 13 9% 34 86 10% 34New Jersey 98 9% 34 455 8% 51New Mexico 31 13% 8 158 13% 11New York 268 11% 20 1,265 10% 34North Carolina 135 13% 8 752 13% 11North Dakota 6 7% 49 37 9% 46Ohio 149 10% 27 903 13% 11Oklahoma 54 12% 13 341 16% 6Oregon 58 12% 13 301 13% 11Pennsylvania 163 9% 34 931 12% 20Rhode Island 12 9% 34 81 12% 20South Carolina 69 12% 13 365 13% 11South Dakota 8 8% 44 56 12% 20Tennessee 100 13% 8 582 15% 8Texas 302 13% 8 1,621 11% 27Utah 25 11% 20 150 9% 46Vermont 6 8% 44 49 12% 20Virginia 95 11% 20 485 10% 34Washington 84 12% 13 525 13% 11West Virginia 36 13% 8 222 20% 1Wisconsin 55 8% 44 359 10% 34Wyoming 6 10% 27 42 13% 11united States 4,010 11% 21,460 11%

Persons Age 65+ w/ Cognitive/Mental + Any Other Disability, 2007

Value Percent of (Thousands) Age 65+ Rank

Persons Age 18-64 w/ Any Disability, 2007 Value Percent of (Thousands) Age 65+ Rank

43



Alabama 147 5.2% 5 91 14% 13Alaska 14 3.1% 28 5 9% 50Arizona 122 3.2% 25 97 11% 46Arkansas 91 5.3% 4 60 15% 3California 611 2.7% 35 480 11% 46Colorado 84 2.7% 35 72 14% 13Connecticut 52 2.4% 43 70 14% 13Delaware 13 2.5% 39 14 11% 46District of Columbia 8 2.1% 51 9 15% 3Florida 329 3.0% 31 450 13% 31Georgia 194 3.2% 25 120 12% 39Hawaii 20 2.4% 43 27 14% 13Idaho 30 3.3% 21 26 14% 13Illinois 193 2.4% 43 210 13% 31Indiana 126 3.2% 25 120 15% 3Iowa 57 3.1% 28 69 15% 3Kansas 49 2.9% 32 53 14% 13Kentucky 144 5.4% 3 80 14% 13Louisiana 109 4.2% 9 83 14% 13Maine 38 4.6% 6 25 12% 39Maryland 87 2.4% 43 86 12% 39Massachusetts 116 2.8% 33 120 13% 31Michigan 240 3.8% 11 180 13% 31Minnesota 76 2.3% 49 94 14% 13Mississippi 97 5.5% 2 53 14% 13Missouri 136 3.8% 11 110 13% 31Montana 21 3.5% 19 21 14% 13Nebraska 27 2.5% 39 37 15% 3Nevada 38 2.4% 43 29 9% 50New Hampshire 21 2.5% 39 22 12% 39New Jersey 126 2.3% 49 150 12% 39New Mexico 43 3.6% 16 31 11% 46New York 340 2.8% 33 320 12% 39North Carolina 202 3.6% 16 170 15% 3North Dakota 11 2.6% 37 18 19% 1Ohio 262 3.7% 14 230 14% 13Oklahoma 99 4.5% 8 74 15% 3Oregon 86 3.6% 16 76 15% 3Pennsylvania 262 3.4% 20 280 14% 13Rhode Island 22 3.3% 21 24 15% 3South Carolina 110 4.0% 10 80 13% 31South Dakota 18 3.8% 11 19 17% 2Tennessee 178 4.6% 6 120 14% 13Texas 447 3.1% 28 340 13% 31Utah 39 2.4% 43 32 14% 13Vermont 13 3.3% 21 11 12% 39Virginia 123 2.5% 39 130 13% 31Washington 153 3.7% 14 110 14% 13West Virginia 75 6.7% 1 44 15% 3Wisconsin 91 2.6% 37 110 14% 13Wyoming 11 3.3% 21 10 14% 13united States 6,002 3.2% 5,300 13%

Persons Age 18-64 w/ Cognitive/Mental + Any Other Disability, 2007


Persons Age 65+ w/ Alzheimer’s Disease, 2010


44


Alabama 570 $5,200 $8.49 48 4.2 18Alaska 74 $1,050 $13.10 1 3.1 34Arizona 610 $6,900 $10.50 20 5.6 9Arkansas 360 $3,500 $8.80 46 3.5 29California 4,000 $48,000 $11.05 13 5.0 11Colorado 540 $6,500 $11.04 14 5.8 5Connecticut 370 $4,900 $12.37 2 2.2 48Delaware 105 $1,280 $11.31 9 4.4 15District of Columbia 57 $670 $10.82 16 1.8 50Florida 1,800 $19,200 $9.89 29 4.6 13Georgia 1,330 $13,000 $9.07 44 8.7 3Hawaii 113 $1,450 $11.92 4 3.9 22Idaho 162 $1,600 $9.13 43 4.3 16Illinois 1,490 $17,100 $10.60 19 5.7 6Indiana 720 $7,800 $9.91 28 4.7 12Iowa 300 $3,400 $10.25 25 2.9 42Kansas 270 $2,700 $9.24 40 3.1 34Kentucky 530 $5,400 $9.51 37 4.2 18Louisiana 560 $4,900 $8.13 51 3.7 26Maine 153 $1,840 $11.18 10 2.8 43Maryland 600 $6,600 $10.12 26 3.8 24Massachusetts 690 $8,800 $11.86 5 3.0 37Michigan 1,280 $14,400 $10.41 22 6.3 4Minnesota 590 $7,100 $11.11 12 2.6 44Mississippi 460 $4,000 $8.18 50 3.7 26Missouri 590 $6,300 $9.84 31 4.0 20Montana 111 $1,140 $9.53 36 3.9 22Nebraska 177 $2,000 $10.48 21 3.2 33Nevada 280 $3,300 $10.81 17 10.2 1New Hampshire 147 $1,830 $11.55 6 3.5 29New Jersey 980 $11,800 $11.16 11 3.4 31New Mexico 210 $2,100 $9.36 39 3.0 37New York 2,200 $25,000 $10.61 18 1.4 51North Carolina 1,110 $11,600 $9.63 35 4.0 20North Dakota 56 $580 $9.74 33 1.9 49Ohio 1,320 $14,200 $9.92 27 3.0 37Oklahoma 380 $3,700 $9.15 42 3.4 31Oregon 410 $4,800 $10.91 15 4.5 14Pennsylvania 1,390 $15,600 $10.39 23 2.5 46Rhode Island 114 $1,470 $11.94 3 2.6 44South Carolina 580 $5,700 $8.99 45 5.7 6South Dakota 87 $920 $9.87 30 3.6 28Tennessee 780 $7,800 $9.23 41 3.8 24Texas 2,800 $26,000 $8.76 47 5.3 10Utah 340 $3,500 $9.68 34 9.8 2Vermont 55 $680 $11.45 7 2.3 47Virginia 910 $9,200 $9.38 38 5.7 6Washington 640 $7,900 $11.43 8 4.3 16West Virginia 280 $2,500 $8.23 49 3.0 37Wisconsin 590 $6,600 $10.32 24 3.1 34Wyoming 55 $580 $9.84 31 3.0 37united States 34,000 $375,000 $10.10 3.7

Number of Family Caregivers 2007

(Thousands)

Economic Value of Family Caregiving, 2007

Value (Millions) Per Hour Rank

Ratio of Economic Value of Family Caregiving to Medicaid Long-Term

Care Spending, 2007 Value Rank


45

long-term Care FinanCing

Alabama $4,122 26 9% 44 $953 $206 23Alaska $954 47 51% 4 $255 $373 4Arizona $6,596 15 40% 7 $654 $103 49Arkansas $3,159 29 21% 27 $683 $241 18California $31,045 2 51% 4 $7,477 $205 24Colorado $2,959 30 22% 25 $661 $136 44Connecticut $4,348 24 9% 44 $1,355 $387 3Delaware $991 46 10% 43 $180 $208 22District of Columbia $1,354 40 34% 12 $261 $443 2Florida $13,742 5 14% 35 $2,767 $152 40Georgia $7,170 12 18% 30 $1,003 $105 48Hawaii $1,116 43 17% 33 $261 $203 25Idaho $1,100 44 39% 9 $237 $158 38Illinois $12,651 7 23% 24 $1,757 $137 43Indiana $5,141 19 5% 48 $840 $132 45Iowa $2,649 32 14% 35 $523 $175 37Kansas $2,147 35 34% 12 $526 $189 32Kentucky $4,588 23 8% 46 $825 $194 29Louisiana $4,840 22 24% 22 $670 $156 39Maine $2,116 36 26% 19 $322 $245 16Maryland $5,540 18 11% 39 $1,077 $192 30Massachusetts $10,230 8 24% 22 $2,117 $328 6Michigan $9,215 10 18% 30 $1,807 $179 35Minnesota $6,195 16 44% 6 $1,485 $286 9Mississippi $3,286 28 11% 39 $785 $269 14Missouri $6,598 14 31% 15 $1,098 $187 33Montana $733 48 26% 19 $200 $209 21Nebraska $1,535 38 18% 30 $401 $226 19Nevada $1,239 41 34% 12 $236 $92 50New Hampshire $1,193 42 13% 38 $364 $277 12New Jersey $8,879 11 20% 28 $2,226 $256 15New Mexico $2,609 33 61% 1 $441 $224 20New York $41,397 1 29% 16 $9,480 $491 1North Carolina $9,744 9 39% 9 $1,839 $203 25North Dakota $515 50 5% 48 $178 $279 10Ohio $13,007 6 17% 33 $3,188 $278 11Oklahoma $3,361 27 27% 18 $691 $191 31Oregon $2,907 31 56% 2 $671 $179 35Pennsylvania $15,856 4 11% 39 $4,322 $348 5Rhode Island $1,755 37 11% 39 $338 $320 7South Carolina $4,164 25 22% 25 $626 $142 42South Dakota $620 49 7% 47 $146 $184 34Tennessee $7,107 13 1% 51 $1,199 $195 28Texas $20,615 3 40% 7 $3,160 $132 45Utah $1,405 39 5% 48 $172 $65 51Vermont $1,041 45 35% 11 $171 $276 13Virginia $4,968 21 26% 19 $979 $127 47Washington $5,700 17 55% 3 $1,312 $203 25West Virginia $2,176 34 19% 29 $521 $288 8Wisconsin $5,037 20 28% 17 $1,373 $245 16Wyoming $433 51 14% 35 $79 $151 41united States $311,848 27% $64,168 $213

Total Medicaid Expenditures, 2007


Medicaid HCBS for Older People and Adults w/ Physical

Disabilites, % of LTC, 2007 Value Rank

Medicaid LTC Expenditures for Older People and Adults w/ Physical Disabilites, 2007

Value Per Person (Millions) in State Rank


46



Alabama $871 $188 15 $82 $18 45Alaska $126 $184 18 $129 $188 1Arizona $392 $62 49 $262 $41 24Arkansas $541 $191 14 $142 $50 22California $3,657 $100 41 $3,820 $105 7Colorado $517 $106 39 $144 $30 38Connecticut $1,233 $352 1 $122 $35 30Delaware $163 $188 15 $18 $20 42District of Columbia $173 $294 4 $88 $149 2Florida $2,393 $131 31 $374 $20 42Georgia $821 $86 46 $183 $19 44Hawaii $215 $167 25 $46 $36 28Idaho $146 $97 42 $91 $61 15Illinois $1,355 $105 40 $402 $31 34Indiana $794 $125 35 $46 $7 49Iowa $448 $150 28 $75 $25 39Kansas $349 $126 34 $177 $64 13Kentucky $759 $179 20 $66 $16 46Louisiana $509 $119 37 $160 $37 26Maine $240 $182 19 $82 $62 14Maryland $955 $170 23 $123 $22 40Massachusetts $1,613 $250 7 $504 $78 11Michigan $1,483 $147 29 $324 $32 33Minnesota $835 $161 26 $650 $125 5Mississippi $695 $238 9 $90 $31 34Missouri $760 $129 33 $338 $58 16Montana $149 $155 27 $52 $54 18Nebraska $328 $185 17 $72 $41 24Nevada $155 $60 51 $81 $31 34New Hampshire $318 $242 8 $46 $35 30New Jersey $1,780 $205 12 $445 $51 20New Mexico $174 $88 45 $268 $136 4New York $6,750 $350 2 $2,729 $141 3North Carolina $1,126 $124 36 $713 $79 10North Dakota $168 $263 6 $10 $15 47Ohio $2,643 $230 11 $545 $48 23Oklahoma $506 $140 30 $186 $51 20Oregon $292 $78 48 $379 $101 8Pennsylvania $3,868 $311 3 $454 $37 26Rhode Island $300 $284 5 $38 $36 28South Carolina $490 $111 38 $136 $31 34South Dakota $136 $170 23 $11 $13 48Tennessee $1,183 $192 13 $16 $3 50Texas $1,887 $79 47 $1,273 $53 19Utah $163 $62 49 $9 $3 50Vermont $111 $179 20 $60 $97 9Virginia $720 $93 43 $258 $34 32Washington $595 $92 44 $717 $111 6West Virginia $421 $232 10 $101 $55 17Wisconsin $989 $176 22 $385 $69 12Wyoming $68 $130 32 $11 $21 41united States $46,980 $156 $17,188 $57

Medicaid Nursing Facility Expenditures, 2007


Medicaid HCBS Expenditures for Older People and Adults w/ Physical Disabilites, 2007


47



Alabama NA NA $82 $18 33Alaska $75 $110 2 $53 $78 1Arizona $262 $41 10 NA NAArkansas $68 $24 19 $69 $24 29California $3,711 $102 4 $110 $3 47Colorado NA NA $132 $27 25Connecticut NA NA $122 $35 14Delaware NA NA $18 $20 31District of Columbia $56 $95 5 $32 $54 7Florida $27 $1 33 $321 $18 33Georgia $12 $1 33 $171 $18 33Hawaii NA NA $46 $36 12Idaho $25 $17 24 $66 $44 10Illinois NA NA $402 $31 18Indiana NA NA $46 $7 43Iowa NA NA $75 $25 28Kansas $18 $6 27 $159 $57 6Kentucky NA NA $66 $16 37Louisiana $113 $26 17 $48 $11 41Maine $47 $36 14 $35 $27 25Maryland $32 $6 27 $91 $16 37Massachusetts $476 $74 6 $28 $4 45Michigan $236 $23 20 $88 $9 42Minnesota $314 $60 7 $335 $65 4Mississippi $4 $1 33 $86 $29 21Missouri $241 $41 10 $97 $17 36Montana $26 $27 16 $25 $26 27Nebraska $14 $8 26 $59 $33 16Nevada $67 $26 17 $13 $5 44New Hampshire $6 $5 29 $40 $30 20New Jersey $319 $37 13 $126 $15 39New Mexico $206 $105 3 $61 $31 18New York $2,690 $139 1 $39 $2 50North Carolina $449 $50 8 $264 $29 21North Dakota $7 $11 25 $3 $4 45Ohio NA NA $545 $48 8Oklahoma $11 $3 30 $175 $48 8Oregon $81 $22 22 $275 $73 2Pennsylvania NA NA $454 $37 11Rhode Island NA NA $38 $36 12South Carolina $7 $2 31 $129 $29 21South Dakota $1 $2 31 $9 $12 40Tennessee NA NA $16 $3 47Texas $447 $19 23 $482 $20 31Utah $1 $1 33 $8 $3 47Vermont $17 $28 15 $43 $69 3Virginia NA NA $258 $34 15Washington $318 $49 9 $399 $62 5West Virginia $42 $23 20 $59 $32 17Wisconsin $226 $40 12 $158 $28 24Wyoming NA NA $11 $21 30united States $10,396 $34 $6,340 $21

Medicaid Personal Care Services Expenditures, 2007


Medicaid Aged/Disabled Waiver Services Expenditures, 2007


48



Alabama $1,211 $262 37 $903 $195 23Alaska $337 $492 6 $126 $185 25Arizona $1,226 $193 48 $416 $66 51Arkansas $936 $330 22 $688 $243 12California $9,551 $261 38 $4,434 $121 42Colorado $986 $203 46 $541 $111 44Connecticut $2,084 $595 3 $1,473 $421 3Delaware $285 $329 23 $189 $219 18District of Columbia $378 $642 2 $258 $439 2Florida $3,993 $219 44 $2,722 $149 36Georgia $1,410 $148 49 $918 $96 47Hawaii $371 $289 32 $224 $174 31Idaho $362 $242 40 $208 $139 40Illinois $2,957 $230 41 $2,061 $160 34Indiana $1,574 $248 39 $1,110 $175 29Iowa $1,079 $361 20 $724 $242 14Kansas $873 $314 25 $413 $149 36Kentucky $1,192 $281 35 $909 $214 19Louisiana $1,312 $306 27 $854 $199 21Maine $644 $489 7 $315 $239 15Maryland $1,666 $297 30 $1,015 $181 26Massachusetts $2,895 $449 11 $1,819 $282 9Michigan $2,268 $225 42 $1,528 $152 35Minnesota $2,648 $509 5 $1,011 $194 24Mississippi $1,077 $369 16 $950 $326 6Missouri $1,574 $268 36 $870 $148 38Montana $280 $292 31 $159 $166 33Nebraska $612 $345 21 $395 $223 17Nevada $319 $125 51 $176 $69 50New Hampshire $523 $398 14 $320 $243 12New Jersey $3,393 $391 15 $2,409 $277 10New Mexico $717 $364 19 $195 $99 46New York $16,340 $847 1 $9,466 $491 1North Carolina $2,769 $306 27 $1,595 $176 28North Dakota $311 $486 9 $233 $363 4Ohio $4,625 $403 13 $3,338 $291 7Oklahoma $1,082 $299 29 $633 $175 29Oregon $1,070 $286 33 $292 $78 49Pennsylvania $6,065 $488 8 $4,426 $356 5Rhode Island $560 $530 4 $308 $291 7South Carolina $981 $223 43 $647 $147 39South Dakota $249 $313 26 $156 $196 22Tennessee $2,021 $328 24 $1,416 $230 16Texas $4,709 $197 47 $2,836 $119 43Utah $350 $132 50 $221 $84 48Vermont $293 $471 10 $112 $181 26Virginia $1,602 $208 45 $971 $126 41Washington $1,828 $283 34 $709 $110 45West Virginia $788 $435 12 $478 $264 11Wisconsin $2,058 $367 17 $1,139 $203 20Wyoming $192 $367 17 $88 $168 32united States $97,295 $323 $58,993 $196

Medicaid HCBS Expenditures for All Populations, 2007


Medicaid Institutional LTC Expenditures for All Populations, 2007


49



Alabama $308 $67 46 $308 $67 41Alaska $210 $308 3 $135 $198 7Arizona $810 $128 21 $547 $86 31Arkansas $248 $88 38 $176 $62 44California $5,117 $140 18 $1,406 $38 50Colorado $444 $91 37 $432 $89 30Connecticut $611 $175 11 $611 $175 9Delaware $96 $110 33 $96 $110 24District of Columbia $120 $204 9 $64 $109 26Florida $1,272 $70 44 $1,219 $67 41Georgia $492 $52 49 $480 $50 45Hawaii $148 $115 30 $148 $115 19Idaho $154 $103 35 $129 $86 31Illinois $896 $70 44 $896 $70 40Indiana $464 $73 42 $464 $73 39Iowa $355 $119 27 $355 $119 18Kansas $460 $166 15 $442 $159 11Kentucky $282 $67 46 $282 $67 41Louisiana $458 $107 34 $346 $81 34Maine $329 $249 6 $282 $214 5Maryland $651 $116 29 $619 $110 24Massachusetts $1,076 $167 14 $600 $93 29Michigan $740 $73 42 $504 $50 45Minnesota $1,637 $315 2 $1,323 $254 2Mississippi $126 $43 51 $123 $42 49Missouri $703 $120 26 $462 $79 36Montana $120 $126 22 $94 $98 27Nebraska $217 $122 25 $203 $114 21Nevada $143 $56 48 $76 $30 51New Hampshire $203 $154 17 $196 $149 12New Jersey $985 $113 31 $666 $77 37New Mexico $522 $265 5 $316 $160 10New York $6,874 $356 1 $4,185 $217 4North Carolina $1,175 $130 20 $725 $80 35North Dakota $79 $123 24 $72 $112 22Ohio $1,286 $112 32 $1,286 $112 22Oklahoma $449 $124 23 $439 $121 17Oregon $778 $208 8 $674 $180 8Pennsylvania $1,639 $132 19 $1,639 $132 14Rhode Island $252 $239 7 $252 $239 3South Carolina $334 $76 41 $327 $74 38South Dakota $93 $117 28 $92 $115 19Tennessee $605 $98 36 $605 $98 27Texas $1,873 $78 40 $1,081 $45 48Utah $129 $49 50 $127 $48 47Vermont $181 $291 4 $163 $263 1Virginia $631 $82 39 $631 $82 33Washington $1,119 $173 12 $801 $124 15West Virginia $310 $171 13 $269 $148 13Wisconsin $919 $164 16 $693 $124 15Wyoming $104 $199 10 $104 $199 6united States $38,303 $127 $27,455 $91

Medicaid HCBS Expenditures for All Populations, 2007


Medicaid HCBS Waiver Expenditures for All Populations, 2007


50


Alabama $49 $11 14 $29,278 13 $7,870 27Alaska $1 $1 43 $63,932 1 $16,551 4Arizona NA NA $38,023 NA $15,024 NAArkansas $48 $17 6 $15,856 50 $4,600 46California $160 $4 33 $25,833 29 $9,001 22Colorado $133 $27 4 $27,718 16 $6,336 36Connecticut $200 $57 2 $26,973 20 $8,617 23Delaware $8 $9 19 $43,231 3 $10,429 16District of Columbia $5 $9 19 $35,399 5 $5,143 44Florida $158 $9 19 $23,856 34 $7,183 32Georgia $76 $8 26 $20,618 42 $6,153 38Hawaii $1 $1 43 $35,393 6 $17,602 2Idaho $7 $5 28 $26,547 25 $7,711 28Illinois $48 $4 33 $20,062 46 $6,625 34Indiana $89 $14 9 $20,374 44 $8,404 25Iowa $83 $28 3 $20,546 43 $6,215 37Kansas $13 $5 28 $19,675 48 $9,333 18Kentucky $111 $26 5 $25,519 30 $4,795 45Louisiana $26 $6 27 $20,643 41 $10,436 15Maine $5 $4 33 $26,369 26 $7,480 31Maryland $57 $10 18 $32,977 7 $11,456 11Massachusetts $73 $11 14 $30,792 11 $12,602 7Michigan $24 $2 40 $27,005 19 $4,395 48Minnesota $79 $15 7 $23,724 35 $12,242 8Mississippi $12 $4 33 $28,059 15 $6,616 35Missouri $5 $1 43 $20,102 45 $4,483 47Montana $10 $11 14 $26,720 22 $9,131 20Nebraska $22 $12 12 $24,669 31 $9,464 17Nevada $3 $1 43 $26,632 24 $6,818 33New Hampshire $7 $5 28 $26,678 23 $8,525 24New Jersey $27 $3 39 $36,112 4 $12,118 10New Mexico $1 $0 48 $27,170 18 $16,632 3New York $1,640 $85 1 $32,134 9 $19,551 1North Carolina $126 $14 9 $25,887 28 $8,205 26North Dakota $1 $2 40 $31,253 10 $5,341 43Ohio $150 $13 11 $26,836 21 $11,332 12Oklahoma $18 $5 28 $19,911 47 $5,943 39Oregon $0 $0 48 $23,713 36 $7,572 30Pennsylvania $109 $9 19 $29,431 12 $13,468 6Rhode Island $5 $5 28 $46,247 2 $7,648 29South Carolina $10 $2 40 $28,117 14 $5,813 40South Dakota $7 $9 19 $21,627 40 $3,883 49Tennessee $0 $0 48 $27,582 17 $5,599 42Texas $227 $9 19 $19,471 49 $9,070 21Utah $11 $4 33 $24,376 32 $2,357 50Vermont $7 $11 14 $26,066 27 $10,525 14Virginia $5 $1 43 $24,222 33 $12,172 9Washington $27 $4 33 $22,970 38 $10,624 13West Virginia $28 $15 7 $32,513 8 $9,241 19Wisconsin $53 $9 19 $23,169 37 $14,089 5Wyoming $6 $12 12 $22,187 39 $5,755 41united States $3,966 $13 $26,096 $9,459


Medicaid HCBS Expenditures for Older People and Adults w/

Physical Disabilities per Person Served, 2005

Value Rank

Medicaid Nursing Facility Expenditures per Person

Served, 2005 Value Rank

Medicaid Home Health Expenditures, 2007


51

Long-Term Care FinanCing

Alabama NA $7,870 28 $18,964 30Alaska $15,227 6 $18,097 3 $31,865 9Arizona $15,024 NA NA $25,990 NAArkansas $3,956 25 $5,736 43 $10,373 48California $9,103 11 $6,870 32 $17,008 33Colorado NA $6,336 36 $14,015 41Connecticut NA $8,617 25 $28,655 14Delaware NA $10,429 17 $26,630 18District of Columbia $4,642 21 $7,405 31 $9,799 49Florida $2,390 27 $9,783 20 $15,235 38Georgia NA $6,153 38 $13,217 43Hawaii NA $17,602 5 $27,226 15Idaho $7,581 12 $7,771 29 $11,715 45Illinois NA $6,625 33 $11,002 47Indiana NA $8,404 27 $30,537 11Iowa NA $6,215 37 $15,293 36Kansas NA $9,333 22 $15,087 39Kentucky NA $4,795 46 $15,069 40Louisiana NA $10,436 16 $29,634 12Maine $5,907 17 $15,781 7 $55,642 2Maryland $4,436 22 $20,233 2 $34,067 6Massachusetts $17,087 4 $3,866 48 $33,860 7Michigan $4,302 23 $4,958 45 $22,322 24Minnesota $18,169 3 $10,130 18 $26,868 17Mississippi NA $6,616 34 $8,383 50Missouri $4,840 19 $3,743 49 $11,714 46Montana $7,490 13 $11,896 13 $20,015 28Nebraska $6,317 14 $10,481 15 $21,240 26Nevada $10,319 10 $4,002 47 $11,911 44New Hampshire $20,438 2 $8,410 26 $31,951 8New Jersey $12,894 7 $9,775 21 $26,068 19New Mexico $15,657 5 $20,472 1 $45,135 3New York $24,268 1 $1,326 50 $45,129 4North Carolina $5,641 18 $17,696 4 $25,472 20North Dakota $3,902 26 $9,286 23 $17,997 32Ohio NA $11,332 14 $18,108 31Oklahoma $4,702 20 $6,484 35 $15,287 37Oregon $1,110 29 $8,736 24 $15,561 35Pennsylvania NA $13,468 10 $29,201 13Rhode Island NA $7,648 30 $43,032 5South Carolina NA $5,813 40 $13,295 42South Dakota $1,484 28 $6,061 39 $20,591 27Tennessee NA $5,599 44 $57,822 1Texas $5,908 16 $15,382 9 $19,381 29Utah $617 30 $5,805 41 $23,912 22Vermont $4,300 24 $15,998 6 $31,726 10Virginia NA $12,172 11 $21,797 25Washington $11,649 8 $10,016 19 $15,765 34West Virginia $6,286 15 $11,953 12 $27,174 16Wisconsin $11,511 9 $15,443 8 $22,623 23Wyoming NA $5,755 42 $24,465 21United States $9,666 $9,176 $21,681

Medicaid PCS Expenditures per Person Served, 2005

Value Rank

Medicaid Aged/Disabled Waiver Expenditures per Person Served,

2005 Value Rank

Medicaid HCBS Waiver Expenditures for all Populations

per Person Served, 2005 Value Rank


52


Alabama 68.5% 12 $30 46 $0.0 48Alaska 51.1% 38 $75 3 $4.6 36Arizona 66.5% 14 $93 1 $16.2 15Arkansas 73.4% 2 $40 35 $7.7 24California 50.0% 40 $49 28 $13.3 19Colorado 50.0% 40 $50 16 $7.0 26Connecticut 50.0% 40 $63 6 $42.9 8Delaware 50.0% 40 $44 33 $1.5 44District of Columbia 70.0% 7 $70 4 $16.8 14Florida 58.2% 29 $35 43 $67.2 5Georgia 62.0% 21 $50 16 $16.0 16Hawaii 57.6% 31 $50 16 $7.0 26Idaho 70.4% 5 $40 35 $1.3 45Illinois 50.0% 40 $30 46 $155.2 3Indiana 62.6% 20 $52 15 $48.8 6Iowa 62.0% 21 $50 16 $12.7 20Kansas 60.3% 26 $60 7 $6.8 28Kentucky 69.6% 9 $40 35 $29.8 11Louisiana 69.7% 8 $38 42 $6.0 30Maine 63.3% 18 $40 35 $9.5 23Maryland 50.0% 40 $66 5 $4.9 34Massachusetts 50.0% 40 $60 7 $171.5 2Michigan 56.4% 33 $60 7 $31.1 10Minnesota 50.0% 40 $82 2 $48.2 7Mississippi 75.9% 1 $44 33 $0.0 48Missouri 61.6% 23 $30 46 $12.2 21Montana 69.1% 11 $50 16 $0.0 48Nebraska 57.9% 30 $50 16 $3.6 39Nevada 53.9% 35 $35 43 $1.9 42New Hampshire 50.0% 40 $56 13 $0.4 47New Jersey 50.0% 40 $35 43 $20.8 13New Mexico 71.9% 4 $58 12 $24.0 12New York 50.0% 40 $50 16 $95.3 4North Carolina 64.5% 16 $30 46 $34.2 9North Dakota 64.7% 15 $50 16 $7.3 25Ohio 59.7% 27 $40 35 $14.7 17Oklahoma 68.1% 13 $50 16 $3.3 40Oregon 61.1% 24 $30 46 $6.0 30Pennsylvania 54.4% 34 $45 30 $182.2 1Rhode Island 52.4% 37 $50 16 $3.8 38South Carolina 69.5% 10 $30 46 $1.2 46South Dakota 62.9% 19 $60 7 $6.7 29Tennessee 63.7% 17 $40 35 $5.1 32Texas 60.8% 25 $60 7 $4.8 35Utah 70.1% 6 $45 30 $4.0 37Vermont 58.9% 28 $47.66 29 $5.0 33Virginia 50.0% 40 $40 35 $10.6 22Washington 50.1% 39 $55.45 14 $14.4 18West Virginia 72.8% 3 $50 16 $1.8 43Wisconsin 57.5% 32 $45 30 $0.0 48Wyoming 52.9% 36 $50 16 $3.2 41united States $50 $1,192.4

Federal Medical Assistance Percentage (FMAP), 2007

Value Rank

Medicaid Personal Needs Allowance (per Month), 2007

Value Rank

State-Funded HCBS for Older People, 2007



53


Alabama 8.6% 14 36 9 13,572 3.0 44Alaska 4.2% 49 22 40 6,307 9.4 7Arizona 4.8% 46 21 45 32,348 5.4 28Arkansas 6.7% 33 38 8 27,583 10.0 5California 7.3% 27 32 14 394,373 11.0 3Colorado 7.2% 29 26 27 25,575 5.5 26Connecticut 10.1% 7 34 12 18,272 5.2 30Delaware 7.2% 29 23 39 2,642 3.1 43District of Columbia 7.9% 19 22 40 3,306 5.7 23Florida 11.7% 3 50 5 73,131 4.1 37Georgia 7.3% 27 30 18 24,686 2.7 45Hawaii 2.7% 51 18 50 4,363 3.4 41Idaho 6.6% 34 29 21 13,215 9.3 8Illinois 9.1% 12 27 24 68,953 5.4 28Indiana 6.1% 37 31 16 13,484 2.2 49Iowa 4.8% 46 25 30 18,060 6.1 22Kansas 5.3% 40 26 27 23,348 8.5 12Kentucky 7.9% 19 31 16 14,922 3.6 40Louisiana 12.7% 2 57 1 9,414 2.1 50Maine 8.2% 17 25 30 11,922 9.1 9Maryland 6.9% 32 21 45 19,109 3.4 41Massachusetts 11.3% 4 34 12 32,793 5.1 32Michigan 10.2% 6 27 24 72,607 7.2 20Minnesota 5.0% 42 22 40 54,096 10.6 4Mississippi 9.8% 8 40 7 14,540 5.0 33Missouri 7.7% 22 25 30 81,505 14.1 1Montana 4.9% 43 22 40 7,121 7.6 18Nebraska 5.2% 41 22 40 9,732 5.5 26Nevada 7.7% 22 30 18 5,878 2.4 48New Hampshire 8.5% 16 30 18 4,924 3.8 38New Jersey 7.7% 22 24 35 38,243 4.4 36New Mexico 6.6% 34 32 14 15,630 8.2 15New York 8.2% 17 35 11 162,387 8.4 13North Carolina 7.7% 22 24 35 72,221 8.3 14North Dakota 4.9% 43 19 48 4,990 7.8 16Ohio 7.8% 21 28 22 52,110 4.5 35Oklahoma 10.7% 5 55 2 27,621 7.8 16Oregon 6.2% 36 18 50 42,377 11.7 2Pennsylvania 9.4% 11 24 35 46,247 3.7 39Rhode Island 9.5% 10 25 30 5,568 5.2 30South Carolina 7.0% 31 26 27 20,341 4.8 34South Dakota 3.7% 50 20 47 4,426 5.7 23Tennessee 9.1% 12 41 6 6,485 1.1 51Texas 12.8% 1 55 2 130,871 5.7 23Utah 8.6% 14 52 4 6,782 2.7 45Vermont 9.6% 9 36 9 5,343 8.6 11Virginia 7.7% 22 27 24 19,436 2.6 47Washington 5.5% 39 19 48 59,762 9.5 6West Virginia 5.9% 38 24 35 13,126 7.3 19Wisconsin 4.9% 43 25 30 48,208 8.7 10Wyoming 4.6% 48 28 22 3,391 6.7 21united States 8.4% 35 1,854,998 6.3

Medicare Beneficiaries Receiving Home Health

Services (%), 2006 Value Rank

Medicare Home Health Visits per User, 2006

Value Rank

Medicaid HCBS Participants, 2005 Per 1,000 Value Population Rank


54



Alabama NA NA 13,572 3.0 35Alaska 2,742 4.1 9 3,565 5.3 15Arizona 15,352 2.6 14 16,996 2.9 37Arkansas 15,452 5.6 5 12,131 4.4 24California 313,893 8.7 1 80,480 2.2 43Colorado NA NA 25,575 5.5 12Connecticut NA NA 18,272 5.2 16Delaware NA NA 2,642 3.1 32District of Columbia 2,352 4.0 10 954 1.6 49Florida 13,980 0.8 27 59,151 3.3 31Georgia NA NA 24,686 2.7 38Hawaii NA NA 4,363 3.4 30Idaho 3,601 2.5 15 9,614 6.7 4Illinois NA NA 68,953 5.4 14Indiana NA NA 13,484 2.2 43Iowa NA NA 18,060 6.1 8Kansas NA NA 23,348 8.5 3Kentucky NA NA 14,922 3.6 29Louisiana NA NA 9,414 2.1 45Maine 7,861 6.0 3 4,061 3.1 32Maryland 4,643 0.8 27 14,466 2.6 39Massachusetts 13,767 2.1 19 19,026 3.0 35Michigan 55,158 5.5 6 17,449 1.7 48Minnesota 9,940 1.9 23 44,156 8.6 2Mississippi NA NA 14,540 5.0 18Missouri 49,481 8.5 2 32,024 5.5 12Montana 3,124 3.3 12 3,997 4.3 25Nebraska 1,549 0.9 26 8,183 4.7 21Nevada 2,038 0.8 27 3,840 1.6 49New Hampshire 25 0.0 31 4,899 3.8 27New Jersey 20,884 2.4 18 17,359 2.0 46New Mexico 9,614 5.0 7 6,016 3.1 32New York 84,270 4.4 8 78,117 4.1 26North Carolina 50,818 5.9 4 21,403 2.5 41North Dakota 1,362 2.1 19 3,628 5.7 11Ohio NA NA 52,110 4.5 22Oklahoma 7,000 2.0 21 20,621 5.8 10Oregon 5,086 1.4 24 37,291 10.3 1Pennsylvania NA NA 46,247 3.7 28Rhode Island NA NA 5,568 5.2 16South Carolina NA NA 20,341 4.8 19South Dakota 901 1.2 25 3,525 4.5 22Tennessee NA NA 6,485 1.1 51Texas 77,725 3.4 11 53,146 2.3 42Utah 1,755 0.7 30 5,027 2.0 46Vermont 1,534 2.5 15 3,809 6.1 8Virginia NA NA 19,436 2.6 39Washington 18,429 2.9 13 41,333 6.6 7West Virginia 4,535 2.5 15 8,591 4.8 19Wisconsin 11,123 2.0 21 37,085 6.7 4Wyoming NA NA 3,391 6.7 4united States 794,642 2.7 1,060,356 3.6

Medicaid Personal Care Services Participants, 2005 Per 1,000 Value Population Rank

Medicaid HCBS Waiver Participants, 2005 Per 1,000 Value Population Rank

55


Medicaid Aged/Disabled Waiver Participants per 100 Beneficiaries Using

Nursing Facilities, 2005 Value Rank

Medicaid Aged/Disabled Waiver Participants, 2005 Per 1,000 Value Population Rank


Alabama 8,373 1.8 26 32 28Alaska 2,347 3.5 11 221 2Arizona NA NA NA Arkansas 8,749 3.2 15 32 28California 14,985 0.4 48 13 43Colorado 15,219 3.3 12 94 5Connecticut 11,675 3.3 12 28 33Delaware 1,312 1.6 30 36 24District of Columbia 521 0.9 41 11 46Florida 25,773 1.5 34 27 34Georgia 15,418 1.7 27 32 28Hawaii 2,195 1.7 27 41 21Idaho 7,733 5.4 3 153 3Illinois 51,831 4.1 7 67 10Indiana 3,836 0.6 47 7 49Iowa 6,268 2.1 23 31 32Kansas 14,193 5.2 4 87 6Kentucky 12,165 2.9 17 43 18Louisiana 4,009 0.9 41 13 43Maine 1,489 1.1 37 16 39Maryland 3,714 0.7 46 14 42Massachusetts 7,068 1.1 37 12 45Michigan 9,144 0.9 41 17 37Minnesota 27,893 5.5 2 83 7Mississippi 11,884 4.1 7 55 13Missouri 23,817 4.1 7 60 11Montana 1,853 2.0 24 36 24Nebraska 4,792 2.7 20 43 18Nevada 2,534 1.1 37 44 16New Hampshire 2,590 2.0 24 34 26New Jersey 6,915 0.8 44 15 40New Mexico 2,442 1.3 35 34 26New York 21,809 1.1 37 11 46North Carolina 13,729 1.6 30 32 28North Dakota 497 0.8 44 9 48Ohio 38,013 3.3 12 38 22Oklahoma 16,048 4.5 6 72 9Oregon 28,222 7.8 1 279 1Pennsylvania 20,131 1.6 30 21 36Rhode Island 2,788 2.6 22 25 35South Carolina 13,672 3.2 15 81 8South Dakota 992 1.3 35 17 37Tennessee 964 0.2 50 3 50Texas 38,943 1.7 27 37 23Utah 886 0.4 48 15 40Vermont 1,745 2.8 19 44 16Virginia 12,424 1.6 30 45 15Washington 31,139 5.0 5 138 4West Virginia 4,942 2.7 20 42 20Wisconsin 21,173 3.8 10 58 12Wyoming 1,488 2.9 17 53 14united States 582,342 2.0 34

56



Alabama 0 0.00 40 6,757 1.5 25Alaska 730 1.07 9 304 0.5 47Arizona 4,034 0.64 16 NA NAArkansas 211 0.07 36 6,788 2.4 17California 205 0.01 39 87,027 2.4 17Colorado 3,800 0.78 14 8,687 1.9 24Connecticut 439 0.13 33 21,753 6.2 4Delaware 217 0.25 24 989 1.2 30District of Columbia 0 0.00 40 2,124 3.6 11Florida 11,389 0.62 18 21,192 1.2 30Georgia 2,300 0.24 26 14,014 1.5 25Hawaii 1,400 1.09 8 1,300 1.0 35Idaho 2,231 1.49 6 3,326 2.3 19Illinois 4,681 0.36 21 74,236 5.8 6Indiana 0 0.00 40 8,879 1.4 28Iowa 497 0.17 30 24,558 8.3 1Kansas 0 0.00 40 5,865 2.1 22Kentucky 0 0.00 40 22,415 5.4 9Louisiana 0 0.00 40 12,187 2.7 15Maine 4,571 3.47 1 2,875 2.2 20Maryland 2,326 0.41 19 4,393 0.8 39Massachusetts 0 0.00 40 17,875 2.8 14Michigan 10,300 1.02 10 6,573 0.7 43Minnesota 3,486 0.67 15 5,229 1.0 35Mississippi 200 0.07 36 8,834 3.0 13Missouri 6,000 1.02 10 7,739 1.3 29Montana 614 0.64 16 437 0.5 47Nebraska 1,693 0.95 13 6,292 3.6 11Nevada 380 0.15 32 1,551 0.6 44New Hampshire 243 0.18 29 2,841 2.2 20New Jersey 2,966 0.34 22 10,219 1.2 30New Mexico 254 0.13 33 431 0.2 50New York 3,335 0.17 30 109,244 5.7 8North Carolina 20,442 2.26 3 38,668 4.5 10North Dakota 0 0.00 40 521 0.8 39Ohio 235 0.02 38 84,374 7.4 3Oklahoma 0 0.00 40 5,129 1.5 25Oregon 5,983 1.60 4 2,245 0.6 44Pennsylvania 0 0.00 40 9,359 0.8 39Rhode Island 411 0.39 20 1,000 0.9 38South Carolina 829 0.19 28 11,100 2.6 16South Dakota 1,098 1.38 7 4,729 6.1 5Tennessee 0 0.00 40 12,539 2.1 22Texas 2,393 0.10 35 187,099 8.2 2Utah 548 0.21 27 2,121 0.8 39Vermont 1,484 2.39 2 3,611 5.8 6Virginia NA NA 3,299 0.4 49Washington 6,193 0.96 12 3,597 0.6 44West Virginia 475 0.26 23 1,749 1.0 35Wisconsin 8,542 1.52 5 5,903 1.1 33Wyoming 130 0.25 24 565 1.1 33united States 117,265 0.39 924,259 3.1

Persons in Assisted Living / Residential Care Covered by Medicaid or State Funding, 2007

Per 1,000 Value Population Rank

Medicaid Home Health Participants, 2005 Per 1,000 Value Population Rank

57


Alabama 23,588 24 3.8 28 8.1 28 49,922 22Alaska 628 51 1.3 51 3.4 49 1,335 51Arizona 12,574 33 1.5 50 3.1 51 40,229 26Arkansas 18,746 28 4.7 15 9.9 15 33,370 31California 104,779 2 2.6 41 5.4 42 254,793 1Colorado 16,820 30 3.4 35 7.4 34 37,557 27Connecticut 27,257 19 5.8 3 11.2 3 61,463 20Delaware 4,015 46 3.4 35 7.2 36 8,942 46District of Columbia 2,804 49 4.0 24 8.3 24 5,755 49Florida 72,447 7 2.3 46 4.5 46 203,903 3Georgia 35,682 14 3.8 28 8.5 23 65,045 18Hawaii 3,965 47 2.2 47 4.1 47 8,231 47Idaho 4,533 45 2.6 41 5.5 41 12,558 41Illinois 77,779 6 5.0 12 10.2 11 166,511 7Indiana 40,322 11 5.1 10 10.4 9 85,348 12Iowa 27,042 20 6.2 2 11.7 1 49,441 23Kansas 20,170 26 5.6 6 10.8 6 35,465 30Kentucky 23,657 23 4.3 20 9.3 17 49,438 24Louisiana 26,460 21 5.1 10 10.8 6 43,012 25Maine 6,546 39 3.4 35 6.8 38 18,043 36Maryland 25,555 22 3.9 27 8.2 25 64,388 19Massachusetts 45,172 9 5.3 9 10.2 11 101,292 9Michigan 41,833 10 3.3 38 6.7 39 97,667 10Minnesota 32,052 17 5.0 12 10.0 14 69,791 16Mississippi 16,762 31 4.6 16 9.8 16 28,018 32Missouri 38,791 12 4.9 14 10.1 13 77,243 13Montana 5,281 43 4.0 24 8.1 28 11,762 43Nebraska 13,484 32 5.7 5 11.0 4 26,663 34Nevada 4,724 44 1.7 48 3.9 48 11,908 42New Hampshire 7,063 37 4.3 20 8.8 21 15,215 39New Jersey 45,860 8 4.0 24 8.1 28 114,190 8New Mexico 5,981 40 2.4 44 5.0 44 13,198 40New York 111,313 1 4.4 18 8.8 21 224,233 2North Carolina 38,282 13 3.5 34 7.5 33 85,873 11North Dakota 5,926 41 6.4 1 11.7 1 10,710 45Ohio 82,702 4 5.4 8 10.8 6 185,482 4Oklahoma 21,113 25 4.4 18 9.2 18 37,458 28Oregon 8,208 35 1.7 48 3.4 49 26,786 33Pennsylvania 80,792 5 4.3 20 8.1 28 178,338 6Rhode Island 8,207 36 5.6 6 10.4 9 16,826 38South Carolina 16,856 29 2.9 40 6.4 40 36,282 29South Dakota 6,553 38 5.8 3 10.9 5 11,586 44Tennessee 33,059 16 4.2 23 9.1 19 70,818 15Texas 91,980 3 3.8 28 8.2 25 180,123 5Utah 5,544 42 2.4 44 5.0 44 17,591 37Vermont 3,127 48 3.7 32 7.7 32 6,800 48Virginia 28,778 18 3.2 39 6.9 37 68,224 17Washington 19,641 27 2.6 41 5.4 42 57,490 21West Virginia 9,977 34 3.6 33 7.4 34 21,659 35Wisconsin 33,483 15 4.5 17 9.0 20 73,192 14Wyoming 2,445 50 3.8 28 8.2 25 4,952 50united States 1,440,358 3.8 7.8 3,176,119

Total Nursing Facility Residents, 2007 Per 100 Per 100 Value Rank Age 65+ Rank Age 75+ Rank


Total Nursing Facility Stays, 2006

Value Rank

58


Alabama 69% 10 14% 18 18% 39 51% 10Alaska 73% 5 12% 33 15% 45 52% 6Arizona 61% 32 13% 27 26% 13 42% 40Arkansas 70% 8 11% 37 19% 35 40% 48California 65% 19 13% 27 22% 28 39% 49Colorado 58% 40 12% 33 30% 8 46% 25Connecticut 66% 14 16% 7 18% 39 47% 20Delaware 58% 40 15% 14 27% 11 47% 20District of Columbia 80% 1 10% 43 10% 50 49% 16Florida 58% 40 20% 1 23% 23 45% 30Georgia 74% 3 11% 37 15% 45 49% 16Hawaii 70% 8 9% 46 21% 31 53% 5Idaho 59% 38 16% 7 26% 13 41% 46Illinois 63% 26 14% 18 24% 21 42% 40Indiana 62% 30 15% 14 23% 23 45% 30Iowa 48% 51 7% 50 45% 1 46% 25Kansas 53% 49 9% 46 38% 2 46% 25Kentucky 67% 11 15% 14 18% 39 48% 18Louisiana 74% 3 11% 37 15% 45 43% 37Maine 66% 14 16% 7 18% 39 59% 1Maryland 61% 32 16% 7 23% 23 43% 37Massachusetts 65% 19 14% 18 22% 28 51% 10Michigan 64% 24 17% 3 19% 35 56% 2Minnesota 57% 45 10% 43 33% 6 41% 46Mississippi 77% 2 14% 18 10% 50 52% 6Missouri 61% 32 13% 27 26% 13 44% 36Montana 58% 40 11% 37 32% 7 42% 40Nebraska 54% 48 10% 43 36% 4 42% 40Nevada 58% 40 14% 18 28% 10 38% 50New Hampshire 65% 19 15% 14 20% 33 55% 4New Jersey 63% 26 17% 3 20% 33 42% 40New Mexico 64% 24 11% 37 25% 18 45% 30New York 72% 6 13% 27 15% 45 46% 25North Carolina 67% 11 16% 7 17% 44 46% 25North Dakota 55% 47 8% 49 37% 3 52% 6Ohio 63% 26 14% 18 23% 23 48% 18Oklahoma 66% 14 12% 33 23% 23 42% 40Oregon 61% 32 13% 27 26% 13 45% 30Pennsylvania 63% 26 12% 33 25% 18 47% 20Rhode Island 66% 14 9% 46 26% 13 47% 20South Carolina 65% 19 16% 7 19% 35 56% 2South Dakota 57% 45 7% 50 36% 4 50% 13Tennessee 66% 14 16% 7 18% 39 50% 13Texas 65% 19 14% 18 21% 31 43% 37Utah 53% 49 20% 1 27% 11 38% 50Vermont 67% 11 14% 18 19% 35 52% 6Virginia 60% 36 17% 3 22% 28 45% 30Washington 60% 36 17% 3 24% 21 50% 13West Virginia 72% 6 14% 18 14% 49 51% 10Wisconsin 62% 30 13% 27 25% 18 47% 20Wyoming 59% 38 11% 37 30% 8 45% 30united States 64% 14% 22% 46%

Nursing Facility Residents w/ Medicaid as Primary

Payer, 2007 Value Rank

Nursing Facility Residents w/ Medicare as Primary


Nursing Facility Residents w/ “Other” as Primary



Nursing Facility Residents w/ Dementia, 2007

Value Rank

59


Alabama $158 22 $263 47 $158 39 $2,440 43Alaska $384 1 $466 1 $515 1 $4,567 2Arizona $145 31 $312 24 $203 21 $2,617 36Arkansas $132 38 $248 51 $137 48 $1,981 51California $150 27 $372 2 $238 10 $3,098 19Colorado $164 20 $335 13 $202 22 $3,249 12Connecticut $211 3 $325 20 $345 2 $3,928 6Delaware $208 5 $306 28 $210 18 $3,774 7District of Columbia $234 2 $327 18 $216 15 $4,027 5Florida $173 13 $319 22 $213 16 $2,642 35Georgia $122 42 $276 39 $158 39 $2,340 45Hawaii $205 6 $339 10 $295 5 $3,443 9Idaho $169 18 $306 28 $185 26 $2,749 30Illinois $104 49 $304 30 $178 30 $3,732 8Indiana $137 35 $283 36 $190 25 $2,732 31Iowa $114 45 $352 5 $137 48 $2,614 37Kansas $129 40 $330 15 $133 50 $2,468 41Kentucky $152 24 $269 44 $177 31 $2,793 28Louisiana $114 45 $251 50 $125 51 $2,528 39Maine $173 13 $333 14 $233 11 $4,103 4Maryland $193 8 $317 23 $221 13 $3,144 16Massachusetts $187 9 $329 16 $296 4 $4,187 3Michigan $148 28 $303 31 $209 19 $2,825 26Minnesota $147 29 $337 12 $156 44 $3,204 13Mississippi NA $273 40 $174 33 $2,277 47Missouri $112 47 $269 44 $162 35 $2,806 27Montana $146 30 $312 24 $163 34 $2,826 25Nebraska $131 39 $328 17 $156 44 $2,335 46Nevada $169 18 $349 7 $211 17 $2,504 40New Hampshire $176 12 $347 8 $259 7 $3,426 10New Jersey $187 9 $370 3 $276 6 $4,682 1New Mexico $152 24 $279 38 $162 35 $2,981 22New York $210 4 $307 26 $319 3 $3,295 11North Carolina $135 37 $273 40 $184 28 $2,730 32North Dakota $160 21 $294 34 $139 47 $2,236 48Ohio $201 7 $296 33 $191 24 $2,932 23Oklahoma $117 44 $262 48 $141 46 $2,138 50Oregon $173 13 $360 4 $207 20 $3,114 18Pennsylvania $185 11 $287 35 $247 9 $3,186 14Rhode Island $173 13 $327 18 $248 8 $3,136 17South Carolina $136 36 $270 43 $158 39 $2,669 34South Dakota $120 43 $352 5 $157 42 $2,191 49Tennessee $142 33 $261 49 $162 35 $2,857 24Texas $106 48 $273 40 $160 38 $2,764 29Utah $139 34 $307 26 $157 42 $2,433 44Vermont $152 24 $339 10 $232 12 $2,569 38Virginia $145 31 $282 37 $180 29 $3,013 21Washington $155 23 $341 9 $220 14 $3,033 20West Virginia $170 17 $267 46 $185 26 $2,717 33Wisconsin $129 40 $325 20 $198 23 $3,170 15Wyoming NA $298 32 $176 32 $2,449 42united States $158 $305 $209 $3,008

Medicaid Payment per Day for Nursing Facility Care,

2007 Value Rank

Medicare Payment per Day for Nursing Facility Care,

2006 Value Rank

Average Private Pay Rate per Day in Nursing Facility,

2008 Value Rank


Average Private Pay Rate per Month in Assisted

Living, 2008 Value Rank

60


Alabama $130 38 $15 48 $76 1 $32 49Alaska $191 2 $24 1 $74 2 $99 1Arizona $159 12 $19 21 $37 22 $46 41Arkansas $109 48 $16 46 $26 43 $43 44California $162 9 $21 7 $51 10 $77 4Colorado $142 24 $20 12 $34 24 $56 24Connecticut $124 41 $21 7 $28 36 $70 9Delaware $147 16 $20 12 $43 14 $67 11District of Columbia $165 6 $19 21 $22 47 $62 17Florida $106 50 $18 33 $22 47 $52 31Georgia $145 20 $17 37 $66 6 $49 37Hawaii $198 1 $20 12 $45 13 $59 20Idaho $132 35 $17 37 $33 25 $66 13Illinois $170 5 $20 12 $39 19 $56 24Indiana $129 39 $19 21 $24 46 $51 34Iowa $116 46 $20 12 $36 23 $66 13Kansas $135 30 $17 37 $27 40 $72 7Kentucky $133 33 $16 46 $62 7 $56 24Louisiana $118 45 $14 49 $69 4 $52 31Maine $138 27 $21 7 $54 8 $44 43Maryland $164 7 $19 21 $29 33 $69 10Massachusetts $133 33 $23 3 $32 26 $56 24Michigan $162 9 $19 21 $32 26 $50 35Minnesota $147 16 $23 3 $28 36 $58 22Mississippi $132 35 $14 49 $74 2 $43 44Missouri $140 26 $18 33 $31 30 $60 18Montana $146 18 $20 12 $27 40 $67 11Nebraska $144 22 $19 21 $26 43 $55 28Nevada $163 8 $20 12 $53 9 $73 5New Hampshire $136 29 $24 1 $39 19 $58 22New Jersey $154 13 $19 21 $32 26 $81 3New Mexico $135 30 $18 33 $28 36 $23 50New York $120 44 $19 21 $30 31 $72 7North Carolina $153 14 $17 37 $39 19 $45 42North Dakota $124 41 $19 21 $29 33 $73 5Ohio $131 37 $18 33 $18 51 $47 40Oklahoma $109 48 $17 37 $41 16 $48 38Oregon $179 4 $20 12 $46 12 $83 2Pennsylvania $143 23 $19 21 $28 36 $63 16Rhode Island $145 20 $22 5 $22 47 $64 15South Carolina $162 9 $17 37 $41 16 $50 35South Dakota $149 15 $19 21 $21 50 $15 51Tennessee $134 32 $17 37 $42 15 $48 38Texas $128 40 $17 37 $40 18 $39 47Utah $101 51 $21 7 $27 40 $37 48Vermont $115 47 $22 5 $26 43 $59 20Virginia $141 25 $17 37 $32 26 $52 31Washington $189 3 $21 7 $68 5 $55 28West Virginia $146 18 $14 49 $49 11 $42 46Wisconsin $137 28 $20 12 $30 31 $53 30Wyoming $121 43 $19 21 $29 33 $60 18united States $134 $19 $38 $59

Medicare Reimbursement per Home Health Visit,

2006 Value Rank

Average Private Pay Hourly Rate for Home Health Aide,

2008 Value Rank

Average Private Pay Hourly Rate for

Medicare-Certified Home Health Aide, 2008

Value Rank


Average Private Pay Daily Rate for Adult Day Care,

2008 Value Rank

61

long-term Care resourCes


Alabama 145 0.23 23 40 0.06 36Alaska 16 0.33 9 11 0.23 4Arizona 80 0.10 45 22 0.03 45Arkansas 174 0.44 2 33 0.08 28California 621 0.16 33 467 0.12 17Colorado 128 0.26 17 42 0.09 25Connecticut 79 0.17 31 68 0.14 12Delaware 16 0.14 40 15 0.13 15District of Columbia 21 0.30 11 9 0.13 15Florida 735 0.24 22 165 0.05 38Georgia 97 0.10 45 62 0.07 29Hawaii 13 0.07 49 27 0.15 9Idaho 50 0.29 12 4 0.02 48Illinois 422 0.27 14 88 0.06 36Indiana 172 0.22 24 68 0.09 25Iowa 172 0.39 6 71 0.16 8Kansas 133 0.37 7 19 0.05 38Kentucky 101 0.18 30 119 0.22 5Louisiana 217 0.42 4 12 0.02 48Maine 28 0.14 40 42 0.22 5Maryland 50 0.08 47 81 0.12 17Massachusetts 119 0.14 40 133 0.15 9Michigan 327 0.26 17 85 0.07 29Minnesota 196 0.31 10 66 0.10 22Mississippi 56 0.15 35 12 0.03 45Missouri 165 0.21 27 59 0.07 29Montana 36 0.27 14 56 0.42 1Nebraska 65 0.27 14 21 0.09 25Nevada 63 0.22 24 6 0.02 48New Hampshire 35 0.21 27 23 0.14 12New Jersey 50 0.04 51 114 0.10 22New Mexico 66 0.26 17 18 0.07 29New York 178 0.07 49 175 0.07 29North Carolina 165 0.15 35 107 0.10 22North Dakota 26 0.28 13 22 0.24 2Ohio 409 0.26 17 106 0.07 29Oklahoma 210 0.44 2 25 0.05 38Oregon 61 0.12 43 20 0.04 43Pennsylvania 275 0.15 35 208 0.11 21Rhode Island 22 0.15 35 18 0.12 17South Carolina 67 0.12 43 83 0.14 12South Dakota 39 0.34 8 6 0.05 38Tennessee 136 0.17 31 28 0.04 43Texas 1,700 0.71 1 297 0.12 17Utah 59 0.25 21 8 0.03 45Vermont 13 0.15 35 20 0.24 2Virginia 174 0.19 29 47 0.05 38Washington 59 0.08 47 50 0.07 29West Virginia 63 0.22 24 6 0.02 48Wisconsin 117 0.16 33 111 0.15 9Wyoming 27 0.42 4 12 0.19 7united States 8,448 0.22 3,407 0.09

Medicare-Certified Home Health Agencies, 2006

Value Per 1,000 Age 65+ Rank

Adult Day Facilities, 2001/2002


62



Alabama 307 0.5 36 9,509 15 38Alaska 229 4.8 1 1,912 40 6Arizona 1,951 2.4 5 27,000 33 15Arkansas 119 0.3 44 5,018 13 43California 7,471 1.9 9 161,586 40 6Colorado 495 1.0 19 14,237 29 22Connecticut 263 0.6 30 2,808 6 49Delaware 32 0.3 44 1,804 15 38District of Columbia 22 0.3 44 509 7 48Florida 2,400 0.8 23 75,450 24 28Georgia 1,860 2.0 8 26,500 28 23Hawaii 490 2.7 4 4,284 23 30Idaho 278 1.6 11 6,819 39 8Illinois 346 0.2 48 16,800 11 46Indiana 461 0.6 30 33,313 42 5Iowa 248 0.6 30 13,072 30 19Kansas 239 0.7 28 10,726 30 19Kentucky 289 0.5 36 6,802 12 45Louisiana 123 0.2 48 5,357 10 47Maine 681 3.5 3 8,703 45 1Maryland 1,366 2.1 7 20,093 30 19Massachusetts 285 0.3 44 14,869 17 36Michigan 4,706 3.7 2 46,095 36 12Minnesota 1,239 1.9 9 NA NAMississippi 185 0.5 36 5,133 14 41Missouri 616 0.8 23 21,166 27 26Montana 184 1.4 12 4,351 33 15Nebraska 276 1.2 15 10,063 43 3Nevada 258 0.9 20 3,941 14 41New Hampshire 142 0.9 20 4,283 26 27New Jersey 222 0.2 48 17,761 16 37New Mexico 284 1.1 18 NA NANew York 500 0.2 48 39,170 15 38North Carolina 1,307 1.2 15 41,642 38 9North Dakota 111 1.2 15 3,472 37 11Ohio 1,205 0.8 23 44,005 28 23Oklahoma 206 0.4 40 9,302 19 34Oregon 429 0.9 20 22,130 45 1Pennsylvania 1,550 0.8 23 71,831 38 9Rhode Island 63 0.4 40 3,574 24 28South Carolina 480 0.8 23 16,279 28 23South Dakota 157 1.4 12 3,578 32 17Tennessee 328 0.4 40 16,289 21 33Texas 1,433 0.6 30 45,853 19 34Utah 151 0.6 30 5,256 22 31Vermont 118 1.4 12 2,610 31 18Virginia 577 0.6 30 31,964 35 13Washington 551 0.7 28 26,829 35 13West Virginia 120 0.4 40 3,510 13 43Wisconsin 1,617 2.2 6 31,782 43 3Wyoming 35 0.5 36 1,436 22 31united States 39,005 1.0 1,000,476 26

Assisted Living and Residential Care Facilities, 2007


Assisted Living and Residential Care Units, 2007


63


Median Hourly Wage, Personal and Home Care Aides, 2007

Value Rank

Personal and Home Care Aides, 2007 Value Per 1,000 Age 65+ Rank


Alabama 2,580 4 47 $7.47 46Alaska 3,980 83 1 $12.91 1Arizona 13,780 17 17 $10.06 12Arkansas 5,480 14 22 $7.57 45California 39,770 10 35 $9.87 17Colorado 10,850 22 7 $8.97 31Connecticut 6,660 14 22 $9.89 15Delaware 520 4 47 $10.83 5District of Columbia 970 14 22 $9.89 15Florida 9,820 3 49 $8.98 29Georgia 8,710 9 39 $9.01 28Hawaii 3,410 19 15 $9.09 27Idaho 2,050 12 30 $8.49 40Illinois 19,490 13 26 $8.36 41Indiana 11,280 14 22 $9.41 21Iowa 5,620 13 26 $9.50 19Kansas 9,270 26 5 $8.72 34Kentucky 3,730 7 43 $8.19 42Louisiana 10,290 20 12 $7.16 48Maine 5,110 26 5 $8.98 29Maryland 4,570 7 43 $10.28 10Massachusetts 13,030 15 20 $11.24 2Michigan 12,400 10 35 $9.45 20Minnesota 28,290 44 3 $10.95 3Mississippi 1,980 5 46 $6.87 49Missouri 15,940 20 12 $8.51 39Montana 3,000 22 7 $8.86 32Nebraska 1,320 6 45 $9.21 25Nevada 2,850 10 35 $10.16 11New Hampshire 2,470 15 20 $10.36 9New Jersey 9,380 8 41 $10.89 4New Mexico 10,140 41 4 $8.86 32New York 54,160 21 11 $10.39 8North Carolina 17,170 16 19 $8.64 37North Dakota 1,690 18 16 $9.24 23Ohio 13,780 9 39 $9.15 26Oklahoma 9,610 20 12 $8.10 43Oregon 6,130 13 26 $9.96 14Pennsylvania 20,650 11 32 $9.37 22Rhode Island 1,600 11 32 $10.68 6South Carolina 4,380 8 41 $8.71 36South Dakota 1,470 13 26 $8.72 34Tennessee 8,900 11 32 $8.63 38Texas 123,910 52 2 $6.63 50Utah NA NA $9.22 24Vermont NA NA NAVirginia 9,100 10 35 $7.77 44Washington 16,740 22 7 $10.61 7West Virginia 4,770 17 17 $7.26 47Wisconsin 16,310 22 7 $9.57 18Wyoming 770 12 30 $10.02 13united States 595,350 16 $8.89

64



Alabama 10,070 16 31 $8.05 48 1,985 9Alaska 1,500 31 4 $13.35 1 0 22Arizona 15,400 19 20 $9.97 23 0 22Arkansas 5,430 14 37 $8.27 47 0 22California 48,820 12 44 $9.56 29 1,942 10Colorado 7,910 16 31 $10.68 10 0 22Connecticut 12,180 26 9 $12.76 2 71 19Delaware 1,920 16 31 $11.50 6 0 22District of Columbia 1,210 17 26 $10.43 15 0 22Florida 29,720 10 46 $9.54 30 7,410 4Georgia 10,010 11 45 $8.61 46 763 12Hawaii 1,630 9 47 $11.79 5 100 18Idaho 3,820 22 15 $8.85 41 0 22Illinois 24,040 16 31 $9.85 24 0 22Indiana 11,910 15 36 $9.59 28 1,299 11Iowa 10,140 23 13 $10.14 19 0 22Kansas 8,300 23 13 $9.04 38 0 22Kentucky 3,710 7 50 $10.10 20 0 22Louisiana 9,040 17 26 $7.61 50 9,209 3Maine 4,860 25 10 $10.52 13 107 17Maryland 11,280 17 26 $10.49 14 7,200 5Massachusetts 18,190 21 17 $11.89 4 0 22Michigan 32,210 25 10 $9.26 35 3,404 7Minnesota 28,200 44 3 $10.75 9 0 22Mississippi 3,240 9 47 $8.80 42 0 22Missouri 11,290 14 37 $8.76 45 39 21Montana 2,390 18 22 $9.31 33 600 13Nebraska 4,040 17 26 $10.64 11 0 22Nevada 3,600 13 41 $10.54 12 488 14New Hampshire 2,780 17 26 $10.97 7 0 22New Jersey 20,020 18 22 $10.91 8 0 22New Mexico 6,650 27 6 $9.03 39 0 22New York 145,490 57 2 $10.04 22 0 22North Carolina 73,770 67 1 $9.18 36 0 22North Dakota 1,890 20 18 $9.74 26 0 22Ohio 48,350 31 4 $9.39 32 2,107 8Oklahoma 7,850 16 31 $8.78 43 0 22Oregon 9,770 20 18 $9.51 31 0 22Pennsylvania 50,690 27 6 $9.60 27 0 22Rhode Island NA NA $11.90 3 111 16South Carolina 10,340 18 22 $8.78 43 4,642 6South Dakota 870 8 49 $9.85 24 0 22Tennessee 10,720 14 37 $9.00 40 0 22Texas 52,200 22 15 $7.76 49 36,412 1Utah 4,350 19 20 $9.30 34 62 20Vermont 2,300 27 6 $10.42 16 0 22Virginia 12,250 13 41 $9.11 37 0 22Washington 9,640 13 41 $10.23 18 0 22West Virginia 5,130 18 22 $7.35 51 0 22Wisconsin 17,680 24 12 $10.05 21 11,777 2Wyoming 900 14 37 $10.25 17 210 15united States 834,580 22 $9.62 89,938

Medicaid Aged/Disabled Waiver Waiting List, 2007

Value Rank

Median Hourly Wage, Home Health Aides, 2007

Value Rank

Home Health Aides, 2007


65



Alabama 232 0.37 35 26,696 43 29Alaska 15 0.31 41 725 15 51Arizona 137 0.17 50 16,218 20 49Arkansas 253 0.64 10 26,166 66 5California 1,283 0.32 39 123,228 31 43Colorado 214 0.43 28 20,093 41 32Connecticut 244 0.52 21 29,612 63 10Delaware 45 0.38 33 4,714 40 33District of Columbia 20 0.29 44 2,982 43 29Florida 684 0.22 49 81,966 26 46Georgia 362 0.38 33 40,159 43 29Hawaii 48 0.26 47 4,185 23 48Idaho 79 0.45 27 6,090 35 39Illinois 810 0.52 21 98,594 64 9Indiana 523 0.66 9 49,709 62 11Iowa 466 1.06 1 33,693 77 1Kansas 363 1.01 2 23,849 66 5Kentucky 295 0.54 19 26,186 48 21Louisiana 289 0.55 17 35,821 69 2Maine 112 0.57 15 7,196 37 38Maryland 235 0.36 36 29,250 44 28Massachusetts 457 0.53 20 50,037 58 14Michigan 438 0.34 37 48,078 38 37Minnesota 397 0.62 12 34,892 55 16Mississippi 206 0.56 16 18,652 51 20Missouri 534 0.68 8 52,404 66 5Montana 96 0.72 7 7,299 55 16Nebraska 228 0.96 4 16,297 69 2Nevada 48 0.17 50 5,643 20 49New Hampshire 83 0.50 23 7,877 48 21New Jersey 367 0.32 39 51,401 45 27New Mexico 72 0.29 44 6,808 27 45New York 654 0.26 47 120,629 47 24North Carolina 425 0.39 31 43,580 39 36North Dakota 83 0.89 5 6,430 69 2Ohio 983 0.64 10 94,459 61 12Oklahoma 356 0.74 6 31,740 66 5Oregon 140 0.29 44 12,625 26 46Pennsylvania 728 0.39 31 88,736 47 24Rhode Island 88 0.60 14 8,877 60 13South Carolina 177 0.31 41 18,059 32 42South Dakota 110 0.97 3 6,553 58 14Tennessee 330 0.42 29 37,576 47 24Texas 1,197 0.50 23 125,753 53 18Utah 95 0.41 30 8,000 34 41Vermont 41 0.49 25 3,389 40 33Virginia 282 0.31 41 31,485 35 39Washington 247 0.33 38 22,688 30 44West Virginia 133 0.47 26 11,093 40 33Wisconsin 402 0.55 17 38,250 52 19Wyoming 39 0.61 13 3,052 48 21united States 16,145 0.43 1,699,494 45

Total Nursing Facilities, 2007


Total Nursing Facility Beds, 2007


66


Alabama 88% 20 4.1 7 14% 33Alaska 87% 27 5.5 1 7% 47Arizona 78% 41 3.5 42 15% 28Arkansas 72% 46 4.0 9 15% 28California 85% 31 3.8 19 12% 36Colorado 84% 34 3.7 26 43% 2Connecticut 92% 4 3.7 26 41% 3Delaware 85% 31 4.0 9 39% 4District of Columbia 94% 2 4.2 5 44% 1Florida 88% 20 4.6 2 8% 44Georgia 89% 18 3.4 46 16% 22Hawaii 95% 1 3.8 19 7% 47Idaho 74% 42 4.5 3 34% 6Illinois 79% 40 3.3 49 25% 11Indiana 81% 37 3.6 34 35% 5Iowa 80% 38 3.3 49 14% 33Kansas 85% 31 3.6 34 28% 9Kentucky 90% 13 4.0 9 7% 47Louisiana 74% 42 3.4 46 12% 36Maine 91% 10 4.3 4 7% 47Maryland 87% 27 3.8 19 16% 22Massachusetts 90% 13 3.8 19 17% 20Michigan 87% 27 3.7 26 30% 8Minnesota 92% 4 3.6 34 15% 28Mississippi 90% 13 3.9 14 12% 36Missouri 74% 42 3.6 34 16% 22Montana 72% 46 4.0 9 19% 18Nebraska 83% 36 3.7 26 25% 11Nevada 84% 34 3.5 42 15% 28New Hampshire 90% 13 3.9 14 11% 39New Jersey 89% 18 3.6 34 16% 22New Mexico 88% 20 3.4 46 27% 10New York 92% 4 3.6 34 18% 19North Carolina 88% 20 3.7 26 10% 42North Dakota 92% 4 4.2 5 11% 39Ohio 88% 20 3.8 19 15% 28Oklahoma 67% 49 3.6 34 20% 16Oregon 65% 50 3.9 14 16% 22Pennsylvania 91% 10 3.9 14 11% 39Rhode Island 92% 4 3.5 42 4% 51South Carolina 93% 3 3.9 14 9% 43South Dakota NA 3.3 49 24% 14Tennessee 88% 20 3.6 34 16% 22Texas 73% 45 3.5 42 14% 33Utah 69% 48 4.1 7 8% 44Vermont 92% 4 3.8 19 8% 44Virginia 91% 10 3.7 26 17% 20Washington 87% 27 3.8 19 25% 11West Virginia 90% 13 3.7 26 20% 16Wisconsin 88% 20 3.7 26 31% 7Wyoming 80% 38 4.0 9 24% 14united States 85% 3.7 18%

Nursing Facilities w/ Deficiency for Actual Harm or Jeopardy of

Residents (%), 2007 Value Rank

Direct Care Nursing Hours per Patient Day, 2007

Value Rank

Nursing Facility Occupancy Rate, 2007

Value Rank


67


Alabama 3% 34 1,849 27 100% 1Alaska 5% 18 859 49 80% 34Arizona 5% 18 2,743 19 99% 20Arkansas 12% 1 2,637 20 100% 1California 11% 2 1,472 33 88% 30Colorado 7% 7 1,219 40 100% 1Connecticut 5% 18 6,407 4 100% 1Delaware 5% 18 1,181 41 100% 1District of Columbia 2% 44 879 47 0% 51Florida 7% 7 7,319 2 26% 49Georgia 6% 13 1,373 36 98% 21Hawaii 4% 28 2,849 17 96% 23Idaho 4% 28 1,175 42 100% 1Illinois 4% 28 1,503 31 91% 29Indiana 5% 18 4,751 6 100% 1Iowa 2% 44 9,781 1 19% 50Kansas 3% 34 3,193 13 100% 1Kentucky 6% 13 914 45 94% 25Louisiana 11% 2 1,554 29 100% 1Maine 3% 34 2,083 26 100% 1Maryland 4% 28 1,124 44 95% 24Massachusetts 5% 18 1,505 30 100% 1Michigan 5% 18 4,592 7 69% 40Minnesota 3% 34 5,885 5 60% 42Mississippi 9% 6 1,356 37 100% 1Missouri 6% 13 4,306 9 72% 37Montana 2% 44 795 50 100% 1Nebraska 2% 44 4,512 8 45% 46Nevada 10% 5 863 48 63% 41New Hampshire 2% 44 2,419 24 92% 28New Jersey 5% 18 3,881 11 94% 25New Mexico 6% 13 1,489 32 100% 1New York 5% 18 3,077 15 33% 48North Carolina 7% 7 2,935 16 100% 1North Dakota 2% 44 2,104 25 80% 34Ohio 6% 13 1,718 28 51% 44Oklahoma 11% 2 1,472 33 100% 1Oregon 4% 28 6,958 3 72% 37Pennsylvania 4% 28 2,446 23 94% 25Rhode Island 3% 34 1,153 43 56% 43South Carolina 7% 7 1,258 39 100% 1South Dakota 3% 34 3,942 10 98% 21Tennessee 7% 7 3,466 12 81% 33Texas 5% 18 2,774 18 100% 1Utah 7% 7 1,421 35 82% 32Vermont 2% 44 754 51 49% 45Virginia 3% 34 2,465 22 71% 39Washington 3% 34 2,483 21 78% 36West Virginia 3% 34 1,335 38 87% 31Wisconsin 2% 44 3,136 14 42% 47Wyoming 3% 34 893 46 100% 1united States 6% 2,192 79%

Nursing Facilities Visited by Ombudsman at Least Quarterly,

2006 Value Rank

Long-Term Care Facility Beds per FTE Ombudsman, 2006

Value Rank

Nursing Facility Residents w/ Physical Restraints (%), 2007

Value Rank


68

trends

Alabama 6,205 8,373 +35% 30 6,205 8,373 +35% 24Alaska 2,879 5,089 +77% 17 1,423 2,347 +65% 14Arizona 8,407 15,352 +83% 13 NA NA NA Arkansas 26,534 24,201 -9% 49 8,818 8,749 -1% 44California 223,042 328,878 +47% 26 11,423 14,985 +31% 26Colorado 13,006 15,219 +17% 39 13,006 15,219 +17% 37Connecticut 9,740 11,675 +20% 36 9,740 11,675 +20% 32Delaware 805 1,312 +63% 22 805 1,312 +63% 16District of Columbia 1,704 2,873 +69% 20 79 521 +559% 2Florida 27,404 39,753 +45% 27 17,941 25,773 +44% 22Georgia 12,636 15,418 +22% 34 12,636 15,418 +22% 29Hawaii 991 2,195 +121% 12 991 2,195 +121% 7Idaho 4,910 11,334 +131% 11 2,989 7,733 +159% 6Illinois 33,831 51,831 +53% 24 33,831 51,831 +53% 19Indiana 2,345 3,836 +64% 21 2,345 3,836 +64% 15Iowa 4,691 6,268 +34% 31 4,691 6,268 +34% 25Kansas 11,746 14,193 +21% 35 11,746 14,193 +21% 30Kentucky 14,399 12,165 -16% 51 14,399 12,165 -16% 48Louisiana 902 4,009 +344% 3 902 4,009 +344% 3Maine 3,266 9,350 +186% 7 1,977 1,489 -25% 50Maryland 4,834 8,357 +73% 19 157 3,714 +2266% 1Massachusetts 11,718 20,835 +78% 16 6,052 7,068 +17% 37Michigan 57,650 64,302 +12% 43 11,341 9,144 -19% 49Minnesota 21,539 37,833 +76% 18 14,222 27,893 +96% 9Mississippi 4,124 11,884 +188% 5 4,124 11,884 +188% 5Missouri 63,005 73,298 +16% 40 23,802 23,817 +0% 43Montana 4,420 4,977 +13% 42 1,626 1,853 +14% 39Nebraska 3,466 6,341 +83% 13 2,357 4,792 +103% 8Nevada 1,928 4,572 +137% 9 1,479 2,534 +71% 13New Hampshire 1,753 2,615 +49% 25 1,629 2,590 +59% 17New Jersey 26,410 27,799 +5% 46 5,818 6,915 +19% 34New Mexico 2,234 12,056 +440% 1 1,351 2,442 +81% 10New York 109,071 106,079 -3% 47 20,283 21,809 +8% 40North Carolina 22,663 64,547 +185% 8 11,427 13,729 +20% 32North Dakota 380 1,859 +389% 2 380 497 +31% 26Ohio 29,225 38,013 +30% 33 29,225 38,013 +30% 28Oklahoma 16,515 23,048 +40% 28 9,042 16,048 +77% 12Oregon 31,275 33,308 +7% 45 29,205 28,222 -3% 45Pennsylvania 6,740 20,131 +199% 4 6,740 20,131 +199% 4Rhode Island 2,358 2,788 +18% 37 2,358 2,788 +18% 35South Carolina 14,522 13,672 -6% 48 14,522 13,672 -6% 47South Dakota 1,713 1,893 +11% 44 719 992 +38% 23Tennessee 535 964 +80% 15 535 964 +80% 11Texas 102,428 116,668 +14% 41 32,144 38,943 +21% 30Utah 1,126 2,641 +135% 10 847 886 +5% 42Vermont 1,140 3,279 +188% 5 1,140 1,745 +53% 19Virginia 10,498 12,424 +18% 37 10,498 12,424 +18% 35Washington 35,692 49,568 +39% 29 29,178 31,139 +7% 41West Virginia 11,031 9,477 -14% 50 5,182 4,942 -5% 46Wisconsin 24,392 32,296 +32% 32 13,884 21,173 +52% 21Wyoming 953 1,488 +56% 23 953 1,488 +56% 18united States 1,026,374 1,376,984 +34% 448,167 582,342 +30%

Medicaid HCBS Participants, Older People and Adults w/ Physical Disabilities

2000 2005 % Change Rank


Medicaid Aged/Disabled Waiver Participants


69

trends

Alabama 38 9 36 9 -6% 34Alaska 19 48 22 40 +19% 5Arizona 21 46 21 45 +2% 18Arkansas 35 12 38 8 +9% 9California 26 31 32 14 +21% 4Colorado 27 24 26 27 -2% 24Connecticut 38 9 34 12 -12% 42Delaware 27 24 23 39 -16% 47District of Columbia 26 31 22 40 -15% 45Florida 30 17 50 5 +67% 1Georgia 34 13 30 18 -11% 40Hawaii 19 48 18 50 -5% 33Idaho 23 41 29 21 +24% 3Illinois 25 37 27 24 +8% 11Indiana 28 20 31 16 +10% 8Iowa 25 37 25 30 +2% 18Kansas 27 24 26 27 -3% 27Kentucky 37 11 31 16 -16% 47Louisiana 57 1 57 1 +1% 20Maine 33 14 25 30 -24% 51Maryland 22 44 21 45 -6% 34Massachusetts 39 7 34 12 -13% 44Michigan 28 20 27 24 -4% 29Minnesota 22 44 22 40 +0% 21Mississippi 41 4 40 7 -3% 27Missouri 26 31 25 30 -2% 24Montana 26 31 22 40 -16% 47Nebraska 23 41 22 40 -6% 34Nevada 28 20 30 18 +9% 9New Hampshire 33 14 30 18 -11% 40New Jersey 27 24 24 35 -10% 39New Mexico 27 24 32 14 +18% 6New York 33 14 35 11 +5% 14North Carolina 26 31 24 35 -7% 37North Dakota 23 41 19 48 -19% 50Ohio 27 24 28 22 +6% 12Oklahoma 49 2 55 2 +14% 7Oregon 18 51 18 50 +3% 16Pennsylvania 25 37 24 35 -4% 29Rhode Island 29 18 25 30 -15% 45South Carolina 27 24 26 27 -4% 29South Dakota 21 46 20 47 -2% 24Tennessee 39 7 41 6 +5% 14Texas 41 4 55 2 +33% 2Utah 49 2 52 4 +6% 12Vermont 41 4 36 9 -12% 42Virginia 28 20 27 24 -4% 29Washington 19 48 19 48 +3% 16West Virginia 26 31 24 35 -8% 38Wisconsin 25 37 25 30 +0% 21Wyoming 29 18 28 22 -1% 23united States 31 35 +13%

Medicare Home Health Visits per User

2001 Rank 2006 Rank % Change Rank


70

trends

Alabama 21,189 23,588 +11% 2 23,354 26,696 +14% 2Alaska 628 628 +0% 28 703 725 +3% 21Arizona 13,462 12,574 -7% 46 15,904 16,218 +2% 25Arkansas 17,827 18,746 +5% 12 24,438 26,166 +7% 9California 97,954 104,779 +7% 7 115,516 123,228 +7% 9Colorado 16,543 16,820 +2% 23 20,213 20,093 -1% 32Connecticut 29,343 27,257 -7% 46 31,412 29,612 -6% 44Delaware 3,913 4,015 +3% 18 4,262 4,714 +11% 5District of Columbia 2,834 2,804 -1% 30 3,114 2,982 -4% 37Florida 67,822 72,447 +7% 7 78,810 81,966 +4% 18Georgia 33,620 35,682 +6% 10 36,836 40,159 +9% 7Hawaii 3,881 3,965 +2% 23 4,089 4,185 +2% 25Idaho 4,407 4,533 +3% 18 5,675 6,090 +7% 9Illinois 81,719 77,779 -5% 38 100,344 98,594 -2% 34Indiana 42,166 40,322 -4% 36 53,292 49,709 -7% 45Iowa 30,151 27,042 -10% 49 35,550 33,693 -5% 41Kansas 21,508 20,170 -6% 41 24,862 23,849 -4% 37Kentucky 21,875 23,657 +8% 6 23,857 26,186 +10% 6Louisiana 33,282 26,460 -20% 51 42,323 35,821 -15% 51Maine 6,917 6,546 -5% 38 7,575 7,196 -5% 41Maryland 24,576 25,555 +4% 14 28,261 29,250 +3% 21Massachusetts 46,397 45,172 -3% 34 51,173 50,037 -2% 34Michigan 40,422 41,833 +3% 18 46,320 48,078 +4% 18Minnesota 35,799 32,052 -10% 49 38,385 34,892 -9% 48Mississippi 15,656 16,762 +7% 7 17,854 18,652 +4% 18Missouri 38,391 38,791 +1% 25 51,865 52,404 +1% 28Montana 5,617 5,281 -6% 41 7,230 7,299 +1% 28Nebraska 14,116 13,484 -4% 36 15,972 16,297 +2% 25Nevada 4,297 4,724 +10% 3 5,286 5,643 +7% 9New Hampshire 6,796 7,063 +4% 14 7,485 7,877 +5% 16New Jersey 43,601 45,860 +5% 12 50,062 51,401 +3% 21New Mexico 5,948 5,981 +1% 25 7,051 6,808 -3% 36New York 105,315 111,313 +6% 10 113,116 120,629 +7% 9North Carolina 37,213 38,282 +3% 18 41,299 43,580 +6% 15North Dakota 6,277 5,926 -6% 41 6,681 6,430 -4% 37Ohio 79,273 82,702 +4% 14 92,014 94,459 +3% 21Oklahoma 20,895 21,113 +1% 25 30,099 31,740 +5% 16Oregon 7,910 8,208 +4% 14 11,228 12,625 +12% 4Pennsylvania 80,395 80,792 +0% 28 89,924 88,736 -1% 32Rhode Island 8,704 8,207 -6% 41 9,575 8,877 -7% 45South Carolina 14,290 16,856 +18% 1 15,595 18,059 +16% 1South Dakota 6,750 6,553 -3% 34 7,336 6,553 -11% 49Tennessee 34,981 33,059 -5% 38 38,980 37,576 -4% 37Texas 88,925 91,980 +3% 18 115,495 125,753 +9% 7Utah 5,092 5,544 +9% 4 7,100 8,000 +13% 3Vermont 3,311 3,127 -6% 41 3,679 3,389 -8% 47Virginia 26,508 28,778 +9% 4 29,291 31,485 +7% 9Washington 20,054 19,641 -2% 31 23,784 22,688 -5% 41West Virginia 10,179 9,977 -2% 31 11,057 11,093 +0% 31Wisconsin 36,886 33,483 -9% 48 43,403 38,250 -12% 50Wyoming 2,502 2,445 -2% 31 3,015 3,052 +1% 28united States 1,428,117 1,440,358 +1% 1,671,744 1,699,494 +2%

Nursing Facility Residents



Nursing Facility Beds


71

trends

Alabama 91% 11 88% 20 -2% 30Alaska 89% 22 87% 27 -3% 38Arizona 85% 32 78% 41 -7% 49Arkansas 73% 48 72% 46 -1% 24California 85% 32 85% 31 +0% 17Colorado 82% 39 84% 34 +2% 4Connecticut 93% 3 92% 4 -1% 24Delaware 92% 6 85% 31 -7% 49District of Columbia 91% 11 94% 2 +3% 1Florida 86% 30 88% 20 +2% 4Georgia 91% 11 89% 18 -2% 30Hawaii 95% 1 95% 1 +0% 17Idaho 78% 44 74% 42 -3% 38Illinois 81% 40 79% 40 -3% 38Indiana 79% 42 81% 37 +2% 4Iowa 85% 32 80% 38 -5% 44Kansas 87% 26 85% 31 -2% 30Kentucky 92% 6 90% 13 -1% 24Louisiana 79% 42 74% 42 -5% 44Maine 91% 11 91% 10 +0% 17Maryland 87% 26 87% 27 +0% 17Massachusetts 91% 11 90% 13 +0% 17Michigan 87% 26 87% 27 +0% 17Minnesota 93% 3 92% 4 -1% 24Mississippi 88% 24 90% 13 +2% 4Missouri 74% 47 74% 42 +0% 17Montana 78% 44 72% 46 -5% 44Nebraska 88% 24 83% 36 -6% 48Nevada 81% 40 84% 34 +2% 4New Hampshire 91% 11 90% 13 -1% 24New Jersey 87% 26 89% 18 +2% 4New Mexico 84% 36 88% 20 +3% 1New York 93% 3 92% 4 -1% 24North Carolina 90% 18 88% 20 -2% 30North Dakota 94% 2 92% 4 -2% 30Ohio 86% 30 88% 20 +1% 15Oklahoma 69% 51 67% 49 -3% 38Oregon 70% 50 65% 50 -5% 44Pennsylvania 89% 22 91% 10 +2% 4Rhode Island 91% 11 92% 4 +2% 4South Carolina 92% 6 93% 3 +2% 4South Dakota 92% 6 NA NA Tennessee 90% 18 88% 20 -2% 30Texas 77% 46 73% 45 -4% 43Utah 72% 49 69% 48 -2% 30Vermont 90% 18 92% 4 +2% 4Virginia 90% 18 91% 10 +1% 15Washington 84% 36 87% 27 +2% 4West Virginia 92% 6 90% 13 -2% 30Wisconsin 85% 32 88% 20 +3% 1Wyoming 83% 38 80% 38 -3% 38united States 85% 85% -1%

Nursing Facility Occupancy Rate

2002 Rank 2007 Rank Change Rank


72

trends

Alabama $3,123 $4,122 +32% 23 $746 $953 +28% 22 Alaska $700 $954 +36% 19 $139 $255 +84% 1 Arizona $3,535 $6,596 +87% 1 $434 $654 +51% 6 Arkansas $2,250 $3,159 +40% 15 $595 $683 +15% 33 California $23,523 $31,045 +32% 23 $4,729 $7,477 +58% 4 Colorado $2,326 $2,959 +27% 28 $488 $661 +35% 12 Connecticut $3,577 $4,348 +22% 33 $1,084 $1,355 +25% 27 Delaware $636 $991 +56% 2 $134 $180 +35% 12 District of Columbia $1,035 $1,354 +31% 25 $186 $261 +40% 10 Florida $9,957 $13,742 +38% 17 $2,021 $2,767 +37% 11 Georgia $6,400 $7,170 +12% 45 $942 $1,003 +6% 43 Hawaii $750 $1,116 +49% 9 $196 $261 +33% 16 Idaho $799 $1,100 +38% 17 $184 $237 +29% 19 Illinois $8,947 $12,651 +41% 14 $1,707 $1,757 +3% 45 Indiana $4,415 $5,141 +16% 38 $884 $840 -5% 48 Iowa $2,313 $2,649 +15% 41 $525 $523 +0% 46 Kansas $1,852 $2,147 +16% 38 $471 $526 +12% 35 Kentucky $3,815 $4,588 +20% 36 $695 $825 +19% 31 Louisiana $4,925 $4,840 -2% 51 $607 $670 +10% 38 Maine $1,459 $2,116 +45% 11 $268 $322 +20% 29 Maryland $3,671 $5,540 +51% 6 $810 $1,077 +33% 16 Massachusetts $8,747 $10,230 +17% 37 $1,719 $2,117 +23% 28 Michigan $7,576 $9,215 +22% 33 $2,008 $1,807 -10% 50 Minnesota $4,611 $6,195 +34% 21 $1,147 $1,485 +29% 19 Mississippi $2,905 $3,286 +13% 44 $499 $785 +57% 5 Missouri $5,359 $6,598 +23% 31 $1,008 $1,098 +9% 40 Montana $590 $733 +24% 30 $181 $200 +10% 38 Nebraska $1,377 $1,535 +11% 48 $427 $401 -6% 49 Nevada $824 $1,239 +51% 6 $130 $236 +82% 2 New Hampshire $1,030 $1,193 +16% 38 $259 $364 +41% 9 New Jersey $7,737 $8,879 +15% 41 $1,749 $2,226 +27% 24 New Mexico $1,744 $2,609 +50% 8 $305 $441 +45% 7 New York $36,047 $41,397 +15% 41 $8,883 $9,480 +7% 41 North Carolina $6,803 $9,744 +43% 12 $1,368 $1,839 +34% 15 North Dakota $469 $515 +10% 49 $180 $178 -1% 47 Ohio $9,802 $13,007 +33% 22 $2,842 $3,188 +12% 35 Oklahoma $2,297 $3,361 +46% 10 $547 $691 +26% 26 Oregon $2,590 $2,907 +12% 45 $504 $671 +33% 16 Pennsylvania $12,134 $15,856 +31% 25 $4,067 $4,322 +6% 43 Rhode Island $1,387 $1,755 +27% 28 $286 $338 +18% 32 South Carolina $3,385 $4,164 +23% 31 $487 $626 +28% 22 South Dakota $554 $620 +12% 45 $136 $146 +7% 41 Tennessee $5,804 $7,107 +22% 33 $943 $1,199 +27% 24 Texas $13,389 $20,615 +54% 5 $2,768 $3,160 +14% 34 Utah $1,005 $1,405 +40% 15 $100 $172 +72% 3 Vermont $665 $1,041 +56% 2 $121 $171 +42% 8 Virginia $3,469 $4,968 +43% 12 $816 $979 +20% 29 Washington $5,401 $5,700 +6% 50 $1,173 $1,312 +12% 35 West Virginia $1,598 $2,176 +36% 19 $385 $521 +35% 12 Wisconsin $3,914 $5,037 +29% 27 $1,728 $1,373 -21% 51 Wyoming $277 $433 +56% 2 $61 $79 +29% 19 united States $243,497 $311,848 +28% $54,261 $64,168 +18%

Total Medicaid Spending (Millions)



Medicaid LTC Spending for Older People and Adults w/ Physical Disabilities (Millions)


73

trends

Alabama $53 $82 +55% 34 $693 $871 +26% 13Alaska $51 $129 +150% 10 $87 $126 +45% 3Arizona $143 $262 +83% 25 $290 $392 +35% 5Arkansas $98 $142 +45% 39 $497 $541 +9% 29California $1,851 $3,820 +106% 16 $2,878 $3,657 +27% 11Colorado $90 $144 +60% 31 $398 $517 +30% 9Connecticut $57 $122 +113% 14 $1,026 $1,233 +20% 22Delaware $9 $18 +89% 24 $124 $163 +31% 8District of Columbia $5 $88 +1600% 1 $181 $173 -4% 41Florida $146 $374 +157% 7 $1,876 $2,393 +28% 10Georgia $107 $183 +71% 28 $835 $821 -2% 38Hawaii $27 $46 +67% 29 $169 $215 +27% 11Idaho $62 $91 +48% 37 $123 $146 +19% 24Illinois $195 $402 +106% 16 $1,512 $1,355 -10% 45Indiana $21 $46 +117% 13 $863 $794 -8% 44Iowa $30 $75 +149% 11 $495 $448 -10% 45Kansas $132 $177 +34% 47 $340 $349 +3% 33Kentucky $80 $66 -17% 51 $615 $759 +23% 21Louisiana $10 $160 +1480% 2 $597 $509 -15% 48Maine $31 $82 +163% 5 $237 $240 +1% 37Maryland $48 $123 +157% 7 $762 $955 +25% 16Massachusetts $301 $504 +67% 29 $1,418 $1,613 +14% 25Michigan $228 $324 +42% 41 $1,780 $1,483 -17% 50Minnesota $253 $650 +156% 9 $893 $835 -7% 43Mississippi $50 $90 +78% 26 $449 $695 +55% 2Missouri $269 $338 +26% 49 $739 $760 +3% 33Montana $48 $52 +8% 50 $134 $149 +11% 28Nebraska $36 $72 +100% 18 $391 $328 -16% 49Nevada $22 $81 +261% 3 $107 $155 +45% 3New Hampshire $24 $46 +95% 22 $235 $318 +35% 5New Jersey $324 $445 +37% 44 $1,424 $1,780 +25% 16New Mexico $136 $268 +97% 20 $169 $174 +3% 33New York $2,008 $2,729 +36% 46 $6,875 $6,750 -2% 38North Carolina $474 $713 +50% 36 $894 $1,126 +26% 13North Dakota $5 $10 +92% 23 $175 $168 -4% 41Ohio $342 $545 +59% 32 $2,500 $2,643 +6% 30Oklahoma $93 $186 +99% 19 $454 $506 +12% 27Oregon $268 $379 +41% 42 $236 $292 +24% 20Pennsylvania $134 $454 +240% 4 $3,933 $3,868 -2% 38Rhode Island $24 $38 +58% 33 $262 $300 +14% 25South Carolina $97 $136 +41% 42 $390 $490 +25% 16South Dakota $6 $11 +78% 26 $130 $136 +4% 31Tennessee $6 $16 +163% 5 $937 $1,183 +26% 13Texas $957 $1,273 +33% 48 $1,811 $1,887 +4% 31Utah $5 $9 +96% 21 $96 $163 +70% 1Vermont $29 $60 +109% 15 $92 $111 +20% 22Virginia $116 $258 +123% 12 $700 $720 +3% 33Washington $496 $717 +44% 40 $677 $595 -12% 47West Virginia $74 $101 +37% 44 $311 $421 +35% 5Wisconsin $263 $385 +46% 38 $1,465 $989 -33% 51Wyoming $7 $11 +54% 35 $54 $68 +25% 16united States $10,204 $17,188 +68% $44,057 $46,980 +7%

Medicaid HCBS Spending for Older People and Adults w/ Physical Disabilities (Millions)



Medicaid Nursing Facility Spending (Millions)

2002 2007 %Change Rank

74

trends

Alabama 7% 38 9% 44 +2% 42Alaska 37% 5 51% 4 +13% 7Arizona 33% 9 40% 7 +7% 17Arkansas 16% 23 21% 27 +4% 29California 39% 4 51% 4 +12% 9Colorado 18% 19 22% 25 +3% 35Connecticut 5% 43 9% 44 +4% 29Delaware 7% 38 10% 43 +3% 35District of Columbia 3% 46 34% 12 +31% 1Florida 7% 38 14% 35 +6% 21Georgia 11% 30 18% 30 +7% 17Hawaii 14% 25 17% 33 +4% 29Idaho 34% 8 39% 9 +5% 26Illinois 11% 30 23% 24 +11% 12Indiana 2% 49 5% 48 +3% 35Iowa 6% 41 14% 35 +9% 16Kansas 28% 10 34% 12 +6% 21Kentucky 11% 30 8% 46 -3% 51Louisiana 2% 49 24% 22 +22% 2Maine 12% 27 26% 19 +14% 6Maryland 6% 41 11% 39 +5% 26Massachusetts 18% 19 24% 22 +6% 21Michigan 11% 30 18% 30 +7% 17Minnesota 22% 15 44% 6 +22% 2Mississippi 10% 34 11% 39 +1% 45Missouri 27% 11 31% 15 +4% 29Montana 26% 12 26% 19 -1% 50Nebraska 8% 36 18% 30 +10% 14Nevada 17% 21 34% 12 +17% 4New Hampshire 9% 35 13% 38 +4% 29New Jersey 19% 17 20% 28 +1% 45New Mexico 45% 2 61% 1 +16% 5New York 23% 14 29% 16 +6% 21North Carolina 35% 6 39% 9 +4% 29North Dakota 3% 46 5% 48 +3% 35Ohio 12% 27 17% 33 +5% 26Oklahoma 17% 21 27% 18 +10% 14Oregon 53% 1 56% 2 +3% 35Pennsylvania 3% 46 11% 39 +7% 17Rhode Island 8% 36 11% 39 +3% 35South Carolina 20% 16 22% 25 +2% 42South Dakota 4% 45 7% 47 +3% 35Tennessee 1% 51 1% 51 +1% 45Texas 35% 6 40% 7 +6% 21Utah 5% 43 5% 48 +1% 45Vermont 24% 13 35% 11 +11% 12Virginia 14% 25 26% 19 +12% 9Washington 42% 3 55% 3 +12% 9West Virginia 19% 17 19% 29 +0% 49Wisconsin 15% 24 28% 17 +13% 7Wyoming 12% 27 14% 35 +2% 42united States 19% 27% +8%

Percentage of Medicaid LTC Spending for Older People and Adults w/ Physical Disabilities Going to HCBS

2002 Rank 2007 Rank Change Rank


ACROSS THE STATES - AARP...funded home and community-based services has increased over the past five years. 9: Long-term care spending is not the primary cause of Medicaid spending

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