Home and community-based services (HCBS) accounted for a majority of Medicaid long-term services and supports (LTSS) expenditures for the first time in Federal Fiscal Year (FY) 2013. Total federal and state LTSS spending was $146 billion, including $75 billion for HCBS and $71 billion for institutional LTSS. The percentage of total LTSS spent on home and community-based services (HCBS) increased from 49.3 percent in FY 2012 to 51.3 percent in FY 2013. The shifting balance was attributable to both an increase in HCBS spending of 7.6 percent and a 0.7 decrease in spending for institutional services. FY 2013 marked the third consecutive year in which HCBS spending increased and institutional spending decreased. Total Medicaid LTSS increased 3.4 percent in FY 2013 from $141 billion in FY 2012. Average annual growth in the three-year period including FY 2011 through FY 2013 was 1.6 percent, which is slower than historical averages. From FY 1996 through FY 2010, expenditures increased by more than 5 percent per year….