Date Presented 03/22/24
This study analyzed fiscal year 2021 Medicaid Home and Community-Based Service (HCBS) 1915(c) waivers from across the United States, serving people with any type of intellectual and developmental disabilities, to identify how environmental modification services were used. The findings identify major opportunities for the role of OT.
Primary Author and Speaker: Laura Vanpuymbrouck
Contributing Authors: Carli Friedman
PURPOSE: Medicaid Home and Community Based Services (HCBS) are service programs for people with IDD that help them live in their own homes and communities (Friedman, 2020). However, little is known about environmental modification services (EMS) in HCBS programs for people with IDD. This study examined states’ projections of EMS in HCBS waivers for people with IDD.
DESIGN: This study used a mixed methods approach to analyze Fiscal Year 2021 (FY21) Medicaid HCBS 1915(c) waivers from across the US, serving people with any type of IDD, to identify how EMS were provided.
METHOD: Content analysis (Patton, 2002) was used to analyze states’ definitions of EMS. Then cost-neutrality demonstrations data were analyzed to identify features of spending and service provision. Descriptive statistics were then used to examine EMS allocation.
RESULTS: In FY21, 75 waivers (70.09%) from 35 states (77.78%) provided 127 EMS to people with IDD. EMS for the home occurred most often (53.54%), 29.92% for vehicles, 14.96% for both home and vehicles, and 1.57% for work settings. The most common purpose for EMS was to promote the health, welfare, and safety of people with IDD (82.68%), and promote the independence of people with IDD (69.29%). However, there were vast differences across states.
CONCLUSION: In FY21, not all HCBS programs for people with IDD provide EMS, and only 1.5% of people with IDD receiving HCBS were projected to receive EMS. This is troubling given the lack of accessible housing, people with IDD’s preferences for community-living, and growing preference for aging in place (Chidambaram, 2022). Additionally, the average projected cost per person for EMS in this study ($6,297) was a fraction of the average cost of institutional living for people with IDD ($140,210 in 2019; Larson et al., 2022).
IMPACT STATEMENT: This study’s findings can provide foundational data for advocacy and research on the role of occupational therapy within HCBS environmental modifications.
References
Chidambaram, P. (2022). Over 200,000 residents and staff in long-term care facilities have died from COVID-19 Kaiser Family Foundation. https://www.kff.org/policy-watch/over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-19/
Friedman, C. (2020). There’s no place like home: A national study of how people with intellectual and/or developmental disabilities and their families choose where to live. The Arc of the United States, & CQL | The Council on Quality and Leadership.
Larson, S. A., van der Salm, B., Pettingell, S., Sowers, M., & Anderson, L. L. (2022). In-home and residential long-term supports and services for persons with intellectual or developmental disabilities: Status and trends 2019. University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration.
Patton, M. Q. (2002). Qualitative evaluation and research methods (3rd ed.). Sage Publications,
