Study Profiles HCBS Trends Among the Intellectually and Developmentally Disabled
December 13, 2013 04:35 PM
In 2013, The University of Minnesota’s National Residential Information Systems Project (RISP) released a study titled Residential Services for Persons with Intellectual or Developmental Disabilities: Status and Trends Through 2011 (the Study). The Study’s major findings as they apply to home and community-based services (HCBS) and rebalancing are below.
HCBS Waivers: The number of people with intellectual and developmental disabilities (IDD) that are recipients of HCBS waivers increased dramatically, from 1,381 in 1982, to 62,429 in 1992, to 373,946 in 2002, and to 616,491 in 2011. Total IDD HCBS waiver expenditures increased from $10.9 billion in 2001 to $26.3 billion in 2010 to $27.9 billion in 2011. From 2001 to 2011, the degree of expenditure increase varied significantly across states, with Illinois, Mississippi, New York and Ohio experiencing increases above 500%, while California, Michigan, New Hampshire, Oklahoma, and Rhode Island seeing increases from 25% to 73%. HCBS waiver recipients accounted for 69.0% of the national IDD population in 2010.
Rebalancing: The Study provided several statistics demonstrating the success of rebalancing of the IDD population. The average daily population living in either psychiatric or large state-operated IDD facilities decreased from 187,305 nationally in 1965 to 103,629 in 1985 and to 29,809 in 2011. Relative to the general population, the institutionalized IDD population declined as well. The proportion of those with IDD living in either psychiatric or large state-operated IDD facilities as compared to the general population fell from 115.8 per 100,000 nationally in 1965 to 49.3 per 100,000 in 1985 and to 9.6 per 100,000 in 2011.
Further evidence of rebalancing is demonstrated when comparing the proportion of IDD population residing in Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IDs) (27.2 out of 100,000), versus those receiving HCBS (197.9 out of 100,000) in 2011. The utilization levels of HCBS relative to the population varied significantly among states. Eight states had over 350 out of 100,000 receiving HCBS (Arizona, Iowa, Minnesota, New York, North Dakota, South Dakota, Vermont, and Wyoming), while five state had fewer than 100 per 100,000 receiving HCBS (Delaware, Michigan, Mississippi, Nevada, and Texas).
Cost-Effectiveness of Rebalancing: The Study confirmed the cost-effectiveness of HCBS compared to institutional care. In 2011, annual Medicaid expenditures per person in ICF-IDs was $148,146, versus only $45,294 per person for IDD HCBS.
For the full Study, click here.
The Study’s findings echo those of a recent AARP Solutions Forum on HCBS of the relative success in rebalancing of the IDD population. The Council supports greater HCBS utilization and rebalancing as prudent win-win solutions for states for both economic and beneficiary rights reasons. The Council supports rebalancing in favor of home care and supports HCBS waivers so long as they do not reduce existing benefits. For details, see pages 16 and 22 of the Council’s Blueprint for action, here.
The National Council on Medicaid Home Care – a NAHC affiliate - encourages providers to continue advocating for mechanisms to improve access to HCBS services through their state associations, as well as through state and federal governments. Home care providers are encouraged to keep abreast of HCBS developments in their states, and nationally, and to contact the Council with any questions or concerns.