Home and Community Based Services (HCBS) Waivers: A Nationwide Study of the States

2013 ◽  
Vol 51 (1) ◽  
pp. 1-21 ◽  
Author(s):  
Mary C. Rizzolo ◽  
Carli Friedman ◽  
Amie Lulinski-Norris ◽  
David Braddock
Keyword(s):  
United States ◽  
Developmental Disabilities ◽  
Real Time ◽  
The United States ◽  
Fiscal Year ◽  
Intellectual And Developmental Disabilities ◽  
Medicaid Program ◽  
Community Based ◽  
Waiver Program ◽  
Community Based Services

Abstract In fiscal year (FY) 2009, the Medicaid program funded over 75% of all publicly funded long-term supports and services (LTSS) for individuals with intellectual and developmental disabilities (IDD) in the United States (Braddock et al., 2011). The majority of spending was attributed to the Home and Community Based Services (HCBS) Waiver program. In FY 2009, federal–state spending for the HCBS Waiver program reached over $25.1 billion and constituted almost half of total funding across the nation that year (Braddock et al., 2011). Considerable effort has been spent investigating Medicaid program expenditures, however, due in part to the unique and state-specific nature of HCBS programs, national-level analysis on the types of services offered to individuals with IDD has not been available. A full understanding of the supports available through the Medicaid program is critical as the United States considers strategies for economic recovery among competing state and federal budget priorities. This article presents the results of an analysis of 88 Medicaid HCBS Section 1915(c) waiver applications for individuals with intellectual and developmental disabilities in 41 states and the District of Columbia. It analyzes IDD data and trends close to the real time intent of states and empowers advocates in presenting timely solutions to real-time issues.

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.

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.

Participatory, art-based appreciative inquiry with artists labelled/with intellectual and developmental disabilities

2021 ◽  
Vol 00 (00) ◽  
pp. 1-17
Author(s):  
Sara Miller
Keyword(s):  
Developmental Disabilities ◽  
Appreciative Inquiry ◽  
The United States ◽  
Intellectual And Developmental Disabilities ◽  
Community Based ◽  
Participatory Art ◽  
The Future ◽  
Online Methods ◽  
And Control ◽  
Community Access

People labelled/with intellectual and developmental disabilities (IDD) participate in community-based studio programming across the United States, yet their experiences and preferences for studio programming are not well known. The goal of this research was to learn what artists in a community-based studio think is important about their studio and what they want to change in the future. Using art-based appreciative inquiry and online methods, the artists were prompted to talk and create artwork about ‘what is most important’ in the studio and ‘what we want for the future’. The artists reported that the most important aspects of the studio are the staff and their friends at the studio and the opportunity to make art that is motivated by their interests. The wishes expressed by the artists included increased opportunities to be social, to make more money, to have more community access and more choice and control in the studio.

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.

Employment: Renewed Investments

Inclusion ◽  
2013 ◽  
Vol 1 (1) ◽  
pp. 7-16 ◽  
Author(s):  
David M. Mank ◽  
Teresa A. Grossi
Keyword(s):  
United States ◽  
Developmental Disabilities ◽  
Supported Employment ◽  
The United States ◽  
Intellectual And Developmental Disabilities ◽  
Integrated Employment ◽  
Fair Pay

Abstract Supported employment for people with intellectual and developmental disabilities emerged in the 1980s, clearly showing the untapped potential of people to work productively in integrated jobs. Expanding across the United States and other countries, supported employment was shown to be an effective approach to employment across communities and cultures. While supported employment has expanded little in the last decade, there is a renewed investment nationwide and in some other countries. The renewed developments include improvements in supported employment methods, interest in funding based on outcomes rather than services, concern about the persistence of segregated workshops, the need for qualified supported employment personnel, investment in Employment First policies in states, the emergence of litigation promoting integrated employment over segregation, renewed investment in transition, investments in other countries, and the increasingly clear voice of self-advocates with intellectual and developmental disabilities calling for community jobs and fair pay. While there is renewed interest in supported employment, threats remain to further improvement and expansion that must also be addressed.

Economic Impact of Missouri’s Partnership for Hope Home and Community-Based Medicaid Waiver for Individuals With Intellectual and Developmental Disabilities

2016 ◽  
Vol 27 (3) ◽  
pp. 138-147 ◽  
Author(s):  
Kelli N. Barton ◽  
George S. Gotto
Keyword(s):  
Developmental Disabilities ◽  
Economic Impact ◽  
The State ◽  
Federal State ◽  
Intellectual And Developmental Disabilities ◽  
Administrative Authority ◽  
Community Based ◽  
Federal Funds ◽  
Dollar Amount ◽  
Community Based Services

Missouri’s Partnership for Hope (PfH) is a home and community-based services (HCBS) Medicaid waiver that targets services to the needs of individuals with intellectual and developmental disabilities (IDD). PfH is predicated on a unique federal–state–county partnership, where counties may vote to participate in PfH by leveraging funds for services. The aim of this study was to explore the economic impact of PfH. The economic contribution and impact of PfH (October 2010–September 2013) were explored using IMPLAN software and data. Results indicate that a county and state investment of US$3.5 million each leveraged US$11.7 million in federal funds, contributed almost US$22.2 million to Missouri’s gross state product (GSP), and was responsible for more than 435 jobs for Missourians. An estimated 13.8 million of those dollars were “new” to the state’s economy. Economic impact analyses showed that PfH spending facilitated economic growth. The unique structure of PfH grants counties greater administrative authority and allows the state and counties to split the state Medicaid match dollar amount. Furthermore, results indicate that encouraging participants to self-direct services, and providing support for them to do so, is beneficial to a state’s economy, particularly job creation.

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.

Sign in / Sign up

Export Citation Format

Share Document