The 2005 State of the States in Developmental Disabilities study has been completed (Braddock et al., 2005). In this paper we summarize selected trends in public spending for services to persons with intellectual and developmental disabilities (ID/DD) in the United States during 2002–2004. Total public United States spending for ID/DD services from consolidated federal, state, and local sources grew from $34.48 billion in Fiscal Year (FY) 2002 to $38.55 billion in FY 2004. The 2004 spending figure included three components: (a) $30.80 billion for residential services provided in settings for 15 or fewer persons and for related community services, such as day programs, family support, supported living, and supported employment; (b) $6.03 billion for state-operated institutions for 16+ persons; and (c) $1.72 billion for privately operated 16+ person institutional facilities.
Total public spending grew 5.7% during FYs 2002–2004, adjusted for inflation (U.S. Department of Commerce, 2005). This was the slowest growth rate in total nationwide ID/DD spending for any 2-year period since 1977–1979, the first period for which we collected data. Spending for community residential and related services (hereafter “community services”) advanced 8.5% during the 2002– 2004 period. In contrast, public/private institutional spending for persons in 16+ settings declined 4.3% during the same period, continuing a multiyear trend.
Inflation-adjusted double-digit percentage increases in public spending for community services were common in the 1980s, as were single-digit increases in spending for public/private institutions for 16+ persons. In the 1990s, community services spending also grew rapidly, at between 5% and 10% per annum in adjusted terms; however, spending for public/private 16+ institutional settings declined consistently from 1992 through 2004. The only exception to annual reductions in public/private institutional spending since 1992 was in FY 2001, when such spending increased by one tenth of a percent in adjusted terms (see Figure 1).
When we began the 2002–2004 study, we hypothesized that approximately 15 states would reduce overall public spending, adjusted for inflation, for ID/DD services in 2002–2003. That number of states, on average, had done so during a similar 1981–1983 nationwide period of budgetary retrenchment. Twelve states, in fact, did reduce overall financial commitments to ID/DD services during 2002–2003. New York, Michigan, Washington, South Carolina, Arkansas, Illinois, West Virginia, Oklahoma, and Oregon reduced spending by 1% to 8% during 2002–2003. Virginia, Utah, and North Dakota also reduced spending, but only by less than one half percent. Seven of the 12 states (Illinois, Michigan, Oklahoma, Oregon, South Carolina, Washington, and West Virginia) also reduced adjusted total ID/DD spending over the 2-year period from 2002–2004 (see Table 1).
In contrast, during 2002–2004, Florida, Wyoming, New Mexico, Louisiana, Indiana, and Hawaii, respectively, allocated an additional 18% to 42% of inflation-adjusted spending for ID/DD services. California, North Dakota, Kentucky, Wisconsin, Nevada, Nebraska, Connecticut, Arizona, Maryland, Montana, and Idaho increased adjusted spending by 10% to 14% during the 2-year period. Growth in the Medicaid Home and Community Based Services Waiver accounted for the vast majority of growth of ID/DD spending in the states.
During 2002–2004, as previously noted, community services spending advanced 8.5% on a nationwide basis. Hawaii and Indiana increased spending by 43% and, at the other end of the spectrum, Oklahoma reduced spending by 8%. Other state leaders in increasing community services spending during the 2-year period included Louisiana (35%); Florida (24%); and Alabama, Connecticut, and New Mexico (20%). Six states in addition to Oklahoma reduced community services spending during 2002–2004. These states were Alaska (6%); South Carolina (5%); New Jersey (3%); and Colorado, Michigan, and Texas (2%).
Budgetary constraints have been problematic for most state governments since 2001. Moreover, powerful demographic and legal forces continue to stimulate growing demand for ID/DD residential and community services nationally. Stimulative forces include aging family caregivers (Braddock, 1999; Fujiura, 1998), increased longevity of persons with ID/DD (Janicki, 1996), and Olmstead/waiting list cases (Olmstead v. L.C., 1999; Smith, 2005). The growing broad-based demand for ID/DD residential and community services in the United States is a strong and continuing trend, even notwithstanding the recent modest slow-down in the rate of growth of public spending for such services.
Preparation of this manuscript was supported in part by funding from the Administration on Developmental Disabilities, U.S. Department of Health and Human Services, and by the Coleman Institute and the Department of Psychiatry, University of Colorado School of Medicine.