Data from the U.S. Census Bureau shows the number of people who are elderly is growing at a faster pace than the rest of the population. Officials project that people age 65 and older will outnumber children by 2034, a first in the nation’s history. In Louisiana, 16.4% of residents were age 65 or older in the 2020 census, a percentage projected to reach 19.7% a decade later. The Public Affairs Research Council authored a report to show the aging population will place new demands on the long-term care system. Care for older adults is expected to consume a larger portion of the Medicaid budget in Louisiana and other states. The Medicaid program is financed by federal and state funds on a cost-share basis tied to poverty rates. The total budget for Louisiana Medicaid in the current year is $18 billion, and most of that, $13.3 billion, comes from federal sources. Spending on nursing homes and home- and community-based services for adults accounts for $1.7 billion of that total. Nursing homes account for the largest percentage of institutional care spending, with regular rate increases known as rebasing built into the program and driving up taxpayer financed costs for the facilities. Medicaid spending on nursing homes has grown over the last decade from $904 million in the 2013-14 budget year to an estimated $1.3 billion this year, according to Medicaid data from the Louisiana Department of Health. Meanwhile, the number of people served at nursing homes with Medicaid funding has fluctuated from 17,000 to nearly 28,000 over the same period. As of August, 17,549 people were in the facilities, according to department of health enrollment data. Medicaid spends anywhere from $45,000 to $52,500 per year for each nursing home resident. While nursing home care is a federal mandate for Medicaid programs, Louisiana also includes optional home- and community-based services in its Medicaid program, allowing people to stay out of institutional care with assistance that is not strictly medical in nature. Compared to other states, Louisiana spends a smaller percentage of its long-term care dollars on home and community-based services for adults and children. The programs that offer these services such as Long Term-Personal Care Services and Program of All Inclusive Care for the Elderly serve about 17,000 to 20,000 people annually and are budgeted for $446 million this fiscal year. Medicaid spends anywhere from $23,000 to $38,000 for each person in these programs annually. PAR argues that in addition to federal Medicaid requirements that prioritize nursing home services over waiver programs, Louisiana law creates difficulties for efforts to shift money away from nursing homes. The state constitution limits reductions to certain health providers, such as nursing homes and hospitals, leaving other programs that provide long-term care more vulnerable to cuts if Medicaid faces cost constraints.