Mental/Behavioral Health Services: Medicaid Home and Community-Based Services 1915(c) Waiver Allocation for People With Intellectual and Developmental Disabilities

Intellectual and Developmental Disabilities

Rizzolo

2016

Self Cite

The United States long-term services and supports system is built on largely unpaid (informal) labor. There are a number of benefits to allowing family caregivers to serve as paid personal care providers including better health and satisfaction outcomes, expanded workforces, and cost effectiveness. The purpose of this study was to examine how Medicaid HCBS Section 1915(c) waivers for people with intellectual and developmental disabilities allocate personal care services to pay family caregivers. Our analysis revealed about two thirds of waivers in fiscal year (FY) 2014 allowed for family caregivers to potentially be paid for personal care services. This amounted to up to $2.71 billion of projected spending, which is slightly more than half of all personal care service expenditures in FY 2014.

Section: Discussionmentioning

confidence: 81%

Un/Paid Labor: Medicaid Home and Community Based Services Waivers That Pay Family as Personal Care Providers

Intellectual and Developmental Disabilities

Rizzolo

2016

Self Cite

“…Although all HCBS waivers specify general safeguards, our examination of electronic monitoring services showed particular attention to navigating ethical dilemmas; from our examination of other types of waiver services (e.g. dental services (Friedman et al, ), mental/behavioral health services (Friedman et al, ), transportation services (Friedman & Rizzolo, ) this appears fairly unique to electronic monitoring services. In addition to the requirement of informed consent as mentioned above, it was not uncommon for those waivers providing electronic monitoring services to specify other ethical requirements.…”

Section: Discussionmentioning

confidence: 95%

Electronic Video Monitoring in Medicaid Home and Community‐Based Services Waivers for People With Intellectual and Developmental Disabilities

Policy Practice Intel Disabi

Rizzolo

2017

Self Cite

While the number of available caregivers for people with intellectual and developmental disabilities (I/DD) is reducing, the number of people who need care and support is steadily increasing, effectively creating a vacuum of care. In response to this increasing problem, and as a result of advances in technology, telecare, and remote monitoring in the long‐term support of people who are aging or have I/DD are becoming more prominent. Despite noted benefits, telecare and other forms of technological surveillance are relatively new for caregivers in service to people with I/DD. Medicaid Home and Community Based Services (HCBS) Section 1915(c) waivers are a critical funding stream for people with I/DDs and long‐term support needs in the United States. In order to examine the implementation of electronic monitoring technology for people with I/DD, we examined which HCBS waivers were providing electronic monitoring services and how they were doing so. Ninety‐nine I/DD‐related HCBS 1915(c) waivers (44 states and the District of Columbia) were collected for fiscal year (FY) 2013 from the U. S. CMS Medicaid.gov website. We then examined this data to determine, if applicable, the electronic monitoring services provided, the projected number of users, and the average cost of each unit of service. We also examined the electronic monitoring service definitions to determine themes across services. We found seven out of the 99 HCBS FY 2013 waivers (7.1%) provided electronic monitoring services through nine different services. Moreover, very little funding was allocated for these services. Our findings highlight that electronic monitoring services are largely not being utilized for the more than 600,000 people with I/DD on Medicaid HCBS waivers. As HCBS waivers look to reduce costs and continue to support people with I/DD we believe more states will consider these technologies.

“…While the variation across HCBS day habilitation services may appear extreme, it is relatively common among HCBS waiver services for people with IDD. Examination of other HCBS 1915(c) waiver services for people with IDD, such as dental, mental/behavioral health, or transportation, have revealed similar trends (Friedman et al, 2015; Friedman & Rizzolo, 2016; Friedman, Rizzolo, & Schindler, 2014). The flexibility granted to states by CMS allows states much leeway in terms of how they provide services.…”

Section: Discussionmentioning

confidence: 96%

“…Because of the prevalent role HCBS waivers play both in providing day habilitation services and long-term services and supports for people with IDD, and the new changes set forth by the final rule requirements and Employment First initiatives, the purpose of this study was to examine how Medicaid HCBS 1915(c) waivers across the nation allocate day habilitation services for people with IDD. Such comparisons across HCBS waivers are necessary because of the large variation across state waiver programs (Friedman, Lulinski, & Rizzolo, 2015; Peebles & Bohl, 2014). FY 2014 Medicaid HCBS waivers providing day habilitation services for people with IDD were analyzed to determine service utilization and projected expenditures.…”

mentioning

confidence: 99%

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

Research and Practice for Persons with Severe Disabilities

2016

Self Cite

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.