Unlike Maryland, national costs for institutionalization as opposed to HCBS do not differ by an order of magnitude.
The thing that concerns me the most is the institutionalization of some of these policies.
institutionalize in·sti·tu·tion·a·lize (ĭn'stĭ-tōō'shə-nə-līz', -tyōō'-)
v. in·sti·tu·tion·al·ized, in·sti·tu·tion·al·iz·ing, in·sti·tu·tion·al·iz·es
To place a person in the care of an institution, especially one providing care for the disabled or mentally ill.