This week, our In Focus section reviews key takeaways from the Centers for Medicare & Medicaid Services (CMS) report published recently on Medicaid long term supports and services (LTSS) expenditures in fiscal year 2013. The report, Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2013, is published annually by CMS and provides a detailed overview of Medicaid LTSS spending across the states. For the first time, in FY 2013, home and community based LTSS (HCBS) surpassed institutional LTSS in terms of a share of total Medicaid LTSS spending. In total, Medicaid spending for LTSS topped $146 billion in FY 2013, or 34 percent of all state and federal spending on Medicaid.