States’ Extraordinary Community-Based Services Dichotomy: DD vs. A/PD. Information Bulletin # 247 (12/11)
The 2010 Medicaid expenditure data demonstrates that States know how to serve some people with disabilities in the community, but it depends primarily on your disability.
We previously reviewed 2010 Medicaid expenditures for people with disabilities. [See Information Bulletin #245]. However, we reviewed only people whom CMS categories as “A/PD” – aged and physical disabilities. A number of people asked questions about people who have a “DD” – developmental disability - diagnosis, of whom intellectual disabilities make up the bulk. Unfortunately, MA funding provides for these two silos.
When we compared the two groups, A/PD with DD, the differences were extremely stark and profound.
Here are some comparisons:
Only one State (NM) spent more than 62.1% of its MA 2010 long-term care expenditures on services and supports [this includes both institutional and community-based] in the community for people who have an A/PD diagnosis/label.
Drum roll, please: 40 States spent more than 62.1% of their MA long-term expenditures on services and supports in the community for people who have a DD diagnosis/label. Yes – 1:40!!!
Only 11 States (OH, ID, ND, NC, IA, AR, NJ, LA, IL, TX and MS) spent less than that 62.1% in the community for people with a DD diagnosis, and except for MS, which is a far outlier, 10 of them spent more than 40% in the community for people with a DD label but less than 62.1%.
Every State except NM spent less than 62.1% in the community for people with A/PD.
10 States (MI, VT, OR, AK, NH, AZ, CO, MD, NM, HI,) of the top 40 actually spent more than 90% of their MA long-term expenditures on services and supports in the community for people with DD. Congratulations!!!!
Some States actually do a flip between community expenditures between the two groups A/PD compared to DD:
For example, MD spent 20.5% in the community for persons in A/PD but 100% in the community for DD; AL spent 16.3% in the community for A/PD but 88.8% in the community for DD; AK spent 25.2% for A/PD and 49.9% for DD; OH spent 26.2 % and 59% on DD in the community.
Obviously, States know how to allocate their MA long-term care expenditures for services and supports to the community. Why is it that when more than 90% of Americans want to receive services in the community are States still not allocated the A/PD funds in the community, the same as these States allocate their DD funds?
Steve Gold, The Disability Odyssey continues
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Special thanks, again, to Thompson Reuters and CMS for compiling and
making this data available.