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

Abstract

As states make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use and spending. Because state Medicaid programs differ in the types of services they offer and in how they report these services, analyzing HCBS at the national level is challenging. Describe the HCBS taxonomy and present findings on HCBS waiver expenditures and users. This brief analyzed fee-for-service claims from 28 approved states in 2010 Medicaid Analytic eXtract (MAX) files. We summed all expenditures and counted the unique number of users across each HCBS taxonomy service and category. The taxonomy was developed jointly by Truven Health (at that time Thomson Reuters) and Mathematica Policy Research, with stakeholder input, and reviewed using procedure codes. Today, the taxonomy is organized by 18 categories and over 60 specific services. For calendar year 2010, 28 states spent almost $23.6 billion on HCBS, with 80 percent of expenditures categorized as round-the-clock, home-based, and day services. Other services, such as case management, or equipment, modifications, and technology were widely used, but are not particularly costly and do not account for a large proportion of expenditures in every state. By providing a common language, the taxonomy presents detailed information on services and makes it easier to assess and identify state-level variation for HCBS.