A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015

2017 ◽  
Vol 55 (5) ◽  
pp. 281-302 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
National Level ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Day Habilitation ◽  
Services And Supports ◽  
National Analysis ◽  
Regulation Changes ◽  
Community Based Services

Abstract Medicaid Home and Community Based Services (HCBS) 1915(c) waivers are the largest source of funding for the long term services and supports of people with intellectual and developmental disabilities (IDD). National-level analyses of HCBS IDD waivers are crucial because of the large variance across states, the recent CMS rule and regulation changes (CMS 2249-F/2296-F), and the ever changing economic and political landscape. Therefore, the aim of this study was to examine state waiver priorities for people with IDD. In FY 2015, 111 waivers projected spending $25.6 billion for approximately 630,000 people with IDD. The services with the most funding were residential habilitation, supports to live in one's own home, and day habilitation. However, our analysis revealed large discrepancies across states and services.

Day Habilitation Services for People With Intellectual and Developmental Disabilities in Medicaid Home and Community-Based Services Waivers

2016 ◽  
Vol 41 (4) ◽  
pp. 244-255 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
Service Utilization ◽  
Fiscal Year ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Total Spending ◽  
Day Habilitation ◽  
Services And Supports ◽  
Community Based Services

Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are one of the largest providers of long-term services and supports for people with intellectual and developmental disabilities (IDD). HCBS waivers also play a prominent role in providing day habilitation services for people with IDD. The purpose of this study was to examine how HCBS waivers allocate day habilitation services for people with IDD. HCBS waivers providing day habilitation services for people with IDD were analyzed to determine service utilization and projected expenditures. In fiscal year 2014, HCBS waivers projected US$5.62 billion of funding for day habilitation services; however, there was wide variance across services in terms of projected total spending, spending per participant, and reimbursement rates.

Self-Advocacy Services for People With Intellectual and Developmental Disabilities: A National Analysis

2017 ◽  
Vol 55 (6) ◽  
pp. 370-376 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Developmental Disabilities ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Self Advocacy ◽  
Participant Direction ◽  
National Analysis ◽  
Community Based Services

Abstract Self-advocacy plays an important role in facilitating the empowerment of people with intellectual and developmental disabilities (IDD), and helps people with IDD develop the skills necessary for the participant direction of services. The purpose of this study was to examine Medicaid Home and Community Based Services (HCBS) 1915(c) waivers across the nation to determine how states were utilizing self-advocacy services for people with IDD. Findings revealed approximately half of waivers provided self-advocacy services; however, less than .01% of waiver spending was projected for stand-alone self-advocacy services. States need to expand the provision of self-advocacy services for people with IDD in order to strengthen their ability to direct their waiver services and exercise their rights.

The State of Transportation for People With Intellectual and Developmental Disabilities in Medicaid Home and Community-Based Services 1915(c) Waivers

2016 ◽  
Vol 27 (3) ◽  
pp. 168-177 ◽  
Author(s):  
Carli Friedman ◽  
Mary C. Rizzolo
Keyword(s):  
Developmental Disabilities ◽  
Public Transportation ◽  
Independent Living ◽  
People With Disabilities ◽  
Transportation Systems ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Transportation Services ◽  
Services And Supports ◽  
Community Based Services

Transportation is the most frequently reported problem for people with disabilities. While some people with disabilities have difficulty with limited or no public transportation systems, others have trouble with inaccessible infrastructures and systems. In addition, people with intellectual and developmental disabilities (IDD) often have trouble with many of the skills that navigating transportation requires. Although accessible transportation is crucial for independent living, Medicaid only requires states cover nonemergency medical transportation and does not require transportation related to other aspects necessary for community living such as accessing work, errands, or recreational activities. The purpose of this article is to examine Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers, the largest provider of long-term services and supports for people with IDD, to see how transportation is provided for people with IDD. Our examination of 99 waivers for FY 2013 revealed 58 waivers provided transportation-specific services and 71 waivers provided transportation within another service. The majority of waivers provided transportation for people with IDD through these two means; however, this transportation was often limited to very specific purposes. From our findings, it appears transportation services for people with IDD in waivers need to be expanded to support community access and integration.

System and Individual Outcomes and Their Predictors in Services and Support for People with IDD

2013 ◽  
Vol 51 (5) ◽  
pp. 298-315 ◽  
Author(s):  
Renáta Tichá ◽  
Amy Hewitt ◽  
Derek Nord ◽  
Sherri Larson
Keyword(s):  
Developmental Disabilities ◽  
Future Research ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Employment Services ◽  
Individual Outcomes ◽  
Research Questions ◽  
National Significance ◽  
Community Based Services

Abstract The growth and advancement of community-based services for people with intellectual and developmental disabilities (IDD) have resulted in vast changes in the long-term services and support landscape as well as in expected outcomes of service systems for service recipients. Investments in IDD research have been made to provide a deeper understanding of these outcomes and to explain them. This article summarizes outcomes and their predictors through systems and individual lenses by examining the research and findings of the Administration on Intellectual and Developmental Disabilities' Data Projects of National Significance that address residential services, employment services, costs of services, and individual outcomes. The article also discusses challenges and debates associated with outcome-related research and poses future research questions.

Community-Based Services for People With Brain Injury: A National Analysis

2018 ◽  
Vol 32 (2) ◽  
pp. 123-138 ◽  
Author(s):  
Carli Friedman ◽  
Laura VanPuymbrouck
Keyword(s):  
Brain Injury ◽  
Underserved Populations ◽  
Fiscal Year ◽  
Community Based ◽  
Institutional Settings ◽  
Services And Supports ◽  
National Analysis ◽  
Community Based Services

Purpose:Where and how rehabilitation and long-term services and supports (LTSS) occur for individuals with brain injury (BI) has shifted dramatically over the last few decades. Medicaid Home and Community Based Services (HCBS) 1915(c) waivers allow states to offer LTSS that is tailored to the needs of underserved populations in the community rather than institutional settings.Method:This study examined how states utilized waivers to provide for people with BI.Results:Findings revealed only 15 states had waivers for people with BI in fiscal year 2016.Conclusions:Of those waivers for people with BI, there were vast differences across states and services.

Outdated Language: Use of “Mental Retardation” in Medicaid HCBS Waivers Post-Rosa's Law

2016 ◽  
Vol 54 (5) ◽  
pp. 342-353 ◽  
Author(s):  
Carli Friedman
Keyword(s):  
Mental Retardation ◽  
Federal Government ◽  
Language Use ◽  
Community Services ◽  
Intellectual And Developmental Disabilities ◽  
Federal Programs ◽  
Community Based ◽  
Services And Supports ◽  
Community Based Services

Abstract Rosa's Law, which changed references of “mental retardation” to “intellectual disability” within federal legislation, marked recognition by the federal government that the term “mental retardation” is outdated and pejorative. However, Rosa's Law did not apply to many notable federal programs related to disability, such as Medicaid. This article explores if and how the term “mental retardation” was used within Medicaid Home and Community Based Services 1915(c) waivers, as they are the most prevalent provider of long-term services and supports for people with intellectual and developmental disabilities. Waivers provide some of the most advanced community services and the language used in them should reflect this. Although an overwhelming majority of waivers used “mental retardation,” we found that the term was used less for later benchmark dates.

Home- and Community-Based Speech, Language, and Hearing Services for People with Intellectual and Developmental Disabilities

2018 ◽  
Vol 43 (2) ◽  
pp. 111-125
Author(s):  
Carli Friedman ◽  
Ellyn McNamara
Keyword(s):  
Developmental Disabilities ◽  
Community Participation ◽  
Fiscal Year ◽  
Intellectual And Developmental Disabilities ◽  
Hearing Disorders ◽  
Community Based ◽  
Increased Risk ◽  
Alternative Settings ◽  
Community Based Services

Speech language and hearing (SLH) services can improve people with intellectual and developmental disabilities’ (IDD) health, autonomy, and community participation. The aim of this study was to explore how SLH services are offered to people with IDD across the nation, particularly in fiscal year 2015 Medicaid Home and Community Based Services (HCBS) 1915(c) waivers ( N = 111 waivers). Findings revealed, unlike Medicaid state plans, HCBS waivers were often utilized to offer SLH services in alternative settings, like participants’ homes, and provide long-term habilitative care rather than immediate acute care. Given increased risk for and under identification of communication and hearing disorders in people with IDD, adequate access to sufficient SLH services is essential to ensure the rights of people with IDD.

Aging in Place: A National Analysis of Home- and Community-Based Medicaid Services for Older Adults

2018 ◽  
Vol 29 (4) ◽  
pp. 245-256 ◽  
Author(s):  
Carli Friedman ◽  
Joe Caldwell ◽  
Angela Rapp Kennedy ◽  
Mary C. Rizzolo
Keyword(s):  
Older Adults ◽  
Aging In Place ◽  
Nursing Facilities ◽  
Community Based ◽  
Age In Place ◽  
Services And Supports ◽  
Aging Adults ◽  
National Analysis ◽  
Community Based Services

The number of Americans needing long-term services and supports (LTSS) is projected to more than double in the coming decades largely due to an aging baby boomer population, meaning paying for LTSS will become an even greater challenge for American families and the country. Despite the benefits of aging in place, there remains a long-standing institutional bias within the Medicaid program, where services in nursing facilities are mandatory while home- and community-based services (HCBS) are mostly optional for states to cover. This study examined HCBS 1915(c) waivers ( n = 61 waivers) for older adults to categorize and compare service priorities. Findings revealed waivers for older adults were primarily focused on supporting individuals in their own homes to age in place. However, findings also revealed HCBS waivers are an underutilized mechanism for funding the LTSS of older adults. As states continue to deal with an increasing population of aging adults, with and without disabilities, the HCBS waiver option will continue to be an important component of a state’s service system.

Families of Individuals With Intellectual and Developmental Disabilities: Policy, Funding, Services, and Experiences

2013 ◽  
Vol 51 (5) ◽  
pp. 349-359 ◽  
Author(s):  
Amy Hewitt ◽  
John Agosta ◽  
Tamar Heller ◽  
Ann Cameron Williams ◽  
Jennifer Reinke
Keyword(s):  
Developmental Disabilities ◽  
Research Priorities ◽  
Future Research ◽  
Intellectual And Developmental Disabilities ◽  
Policy Makers ◽  
Home Support ◽  
The Status ◽  
Services And Supports ◽  
At Home

Abstract Families are critical in the provision of lifelong support to individuals with intellectual and developmental disabilities (IDD). Today, more people with IDD receive long-term services and supports while living with their families. Thus, it is important that researchers, practitioners, and policy makers understand how to best support families who provide at-home support to children and adults with IDD. This article summarizes (a) the status of research regarding the support of families who provide support at home to individuals with IDD, (b) present points of concern regarding supports for these families, and (c) associated future research priorities related to supporting families.

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