Edited by K. Charlie Lakin, David Braddock, and Gary Smith
During the decade between 1996 and 2006, there was a steady increase in the number of persons with intellectual and developmental disabilities (ID/DD) receiving Medicaid at Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) and Home and Community-Based Services (HCBS). On June 30, 1996, there were a total of 319,679 recipients of Medicaid ICF/MR for persons with ID/ DD: 129,449 residents of ICFs/MR, and 190,230 receiving HCBS. By June 30, 2006, the total number of recipients of ICF/MR and HCBS for persons with ID/DD had increased to 577,607 persons: 98,411 living in ICFs/MR and 479,196 receiving HCBS. The growth in the total number of HCBS recipients during the decade was notable in both total number (288,966) and in proportional increase (152%). The growth in long-term services and supports recipients with ID/DD was accompanied by steady increases in Medicaid expenditures for ICF/MR and HCBS recipients with ID/DD. These expenditures increased from $14.45 billion dollars in fiscal year (FY) 1996 (32.6% of which was for HCBS) to $30.88 billion in FY 2006 (59.5% of which was for HCBS).
Figure 1 shows changes between FY 1996 and FY 2006 in the total amounts proportions of Medicaid institutional (nursing facility and ICF/MR) and HCBS expenditures for persons with and without ID/DD. In 1996, ICF/MR expenditures for persons with ID/DD ($9.7 billion) made up 23.9% of all Medicaid institutional expenditures ($40.7 billion). By 2006, although ICF/MR expenditures had increased to $12.5 billion, they made up only 20.8% of all Medicaid institutional and HCBS expenditures. In 1996, HCBS expenditures for persons with ID/DD made up 76.5% of all HCBS expenditures. Between FY 1996 and FY 2006, HCBS expenditures tripled (from $4.7 billion to $18.4 billion) but had decreased to 72.6% of all HCBS expenditures. As a proportion of all Medicaid institutional and HCBS expenditures, Medicaid ICF/ MR and HCBS expenditures for persons with ID/ DD increased from 30.8% in FY 1996 to 36.0% in FY 2006.
Table 1 shows levels of expenditures for various categories of Medicaid institutional, HCBS, all long-term services (institutional, HCBS, personal care, and home health), and all Medicaid expenditures by state and for the United States as a whole. It shows that nationally in FY 2006, 31.2% of all Medicaid long-term services expenditures ($99.14 billion) and 10.3% of all Medicaid expenditures ($298.74 billion) went to ICF/MR and HCBS for persons with ID/DD. Patterns of expenditures among states tended to fall around the national averages, but with some variations. States varied in their proportions of all Medicaid long-term services expenditures that went to HCBS and ICF/MR for persons with ID/DD, with 34 states falling between 20.0% and 36.0%, less than 20% in 2 states, and more than 36% in 14 states. In all but 7 states, most HCBS expenditures went to support persons with ID/DD, with 27 states falling between 60% and 90% and with more than 90% in 7 states. In 41 states, the total amount of Medicaid spending allocated to HCBS and ICF/MR for persons with ID/DD fell between 6.0% and 13.9%, with the national average being 10.3%. In 3 states (Louisiana, North Dakota, and Wyoming) expenditures for HCBS and ICF/MR for persons with ID/DD were more than 20% of all Medicaid expenditures.
(Sources: B. Burwell, K. Sredl, & S. Eiken (2007, August). Medicaid long-term care expenditures in FY 2006. Cambridge, MA: MEDSTAT; and R. Prouty, G. Smith, & K. C. Lakin (2007, July). Residential services for persons with developmental disabilities: Status and trends through 2006. Minneapolis: University of Minnesota, Research and Training Center on Community Living/ICI.