Occupational Therapy in Medicaid Home and Community-Based Services Waivers

Abstract

OBJECTIVE. Medicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015. METHOD. Medicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization. RESULTS. In FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates. CONCLUSION. Comparisons across states strengthen the profession’s ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs.

Sustainable Community Health

“…Occupational therapy is a discipline that uses a variety of procedures and evidence-based devices to help people with injuries, illnesses, and disabilities to strengthen fine and gross motor skills to help them function in daily life. Occupational therapists often target skills such as feeding, leisure activities, dressing, and daily living routines (Friedman & VanPuymbrouck, 2018;Umeda et al, 2017). They also can help teach individuals with IDD how to communicate via assistive devices such as tablet devices in conjunction with speech therapists and behavior analysts (Wilkinson, 2011).…”

Occupational Therapy Practice with Adults with Intellectual Disability: What More Can We Do?

“…As a result, adults with ID have transitioned from living and working in institutional settings to community-based settings (Dean et al, 2015). However, provision of community-based services, including occupational therapy, do not meet current demand (Friedman & VanPuymbrouck, 2018). In order to adequately support adults with ID to live and work inclusively in their communities, occupational therapists must advocate to expand their role beyond traditional service delivery in congregate day and residential settings to that of community-based consultant, program developer, and evaluator (Umeda et al, 2017).…”

“…Occupational therapists can support adults with ID to hire (and terminate) their own staff and provide training to manage their self-directed services budgets. Friedman and VanPuymbrouck (2018) found that many Medicaid waivers did not provide occupational therapy services to adults with ID during the 2015 fiscal year, despite expanded coverage under the PPACA. It is imperative that occupational therapists are aware of the language used to describe habilitation services in their states and that they advocate, with their state-level occupational therapy associations, for a more comprehensive and inclusive definition to increase insurance coverage of habilitative occupational therapy services for adults with ID (Brown, 2014).…”

“…Occupational therapists can address the occupational concerns of adults with ID through basic activities and instrumental activities of daily living (IADLs) training, community reentry programs, vocational training and employment coaching, and health management skills intervention (Bathje et al, 2017;Friedman & VanPuymbrouck, 2018). However, there remain ongoing funding barriers to occupational therapy intervention for community-based ID services (Friedman & VanPuymbrouck, 2018). Traditional health care reimbursement mechanisms reward interventions that "fix" impairment, leading the occupational therapy profession to limit its involvement with particular disability communities, such as adults with ID (Brown, 2014).…”