Abstract
This study compares health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Costs for those initiating extended nursing facility care were, on average, $2919 higher adjusted total health care expenditures per month compared to those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community.