For the first time ever, Medicaid is spending more on community-based services than on institutional care.

A new report finds that more than half of Medicaid spending on long-term services and supports went toward home and community-based services during fiscal year 2013, which spanned from October 2012 through September 2013.

During that time, state and federal Medicaid programs allocated $146 billion toward long-term care services, 51 percent of which went to community-based options. That’s up from 49 percent the year before, according to the report produced for the Centers for Medicare and Medicaid Services.

For the third year in a row, spending on home and community-based services grew while funding for institutional care declined.

The figures account for Medicaid services provided to people with developmental disabilities, older people and those with physical disabilities as well as individuals with serious mental illness or emotional disturbance. Medicaid pays for more long-term services and supports than any other provider in the nation.

There was an uptick in home and community-based services spending for all of the populations served, the report found, though people with developmental disabilities were by far the most likely to be served in this manner.

Despite the national trend toward community-based offerings, however, the situation varies by state. In about half of states, the majority of Medicaid dollars were still directed to institutional care, the report found.

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