The University of Minnesota’s National Residential Information Systems Project (RISP) recently 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,
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.