Between June 30, 2004, and June 30, 2005 (Fiscal Year [FY] 2005), the number of persons with intellectual and developmental disabilities (ID/DD) receiving Medicaid Home and Community Based Services (HCBS) increased by 21,848 (5.2%), from 421,760 to 443,608. As the number of HCBS recipients continued to increase between June 2004 and June 2005, the number of Intermediate Care Facility (ICF/MR) recipients decreased for the 12th straight year, from 104,526 to 101,821 persons (2.6%). Between June 1993 and June 2005, ICF/ MR recipients decreased by nearly 46,000 persons (31.1%), from the 1993 all time high of 147,729. During this same period, residents of ICFs/MR with 16 or more residents decreased by 37,889 persons (38.2%). In contrast, between June 1993 and June 2005, HCBS recipients increased by a total of 357,004 (412.2%). Figure 1 shows the changes in HCBS and ICF/MR recipients between June 30, 1993, and June 30, 2005.
Between FY 2004 and FY 2005, Medicaid HCBS expenditures for persons with ID/DD increased by 7.8%, from $15.49 billion to $16.70 billion. This increase of $1.21 billion dollars was equal to the average annual increase between FY 1993 and FY 2005 ($1.21 billion). Table 1 shows changes in state HCBS programs for persons with ID/DD between 1993 and 2005. Nationally, in addition to the growth in total recipients and expenditures, the average expenditure for HCBS per end of year HCBS recipient increased from $25,176 to $37,637 (49.5%). Adjusting for the inflation of the Consumer Price Index between 1993 and 2005, the “real dollar” increase in per person expenditures was 10.6% (from $34,022 to $37,637). Because of the rapid growth in state HCBS programs, between 1993 and 2005, the average expenditures for HCBS per state resident increased from $8.52 to $56.33 (or from $11.51 to $56.33 in “constant” 2005 dollars). Very large differences were evident among states in average HCBS expenditures per state resident, ranging in 2005 from more than $120 per state resident in 7 states to less than $30 in 7 other states. (Source: Prouty, R., Smith, G., & Lakin, K. C. (Eds.). (2006). Residential services for persons with developmental disabilities: Status and trends through 2005. Minneapolis: University of Minnesota, Research and Training Center on Community Living.