Comparing States on Access to Community-Based Services

Comparing States on Access to Community-Based Services. Information Bulletin #354 (3/2012).

There are various criteria one can use to evaluate a State’s commitment to provide services to persons with disabilities in the community instead of in an institution. The Kaiser Commission used four criteria together and ranked states. See “State Options That Expand Access to Medicaid Home and Community-Based Services,” [HCBS] [10/11], http://www.kff.org/medicaid/8241.cfm

The four criteria used are:

1. Participants receiving HCBS Per 1,000 Population in the State. Using this criterion eliminates differences among States with regards to size, wealth, and per capita. It says for every 1,000 persons (with and without a disability) in a State, how many people with disabilities receive HCBS.

2. Expenditures Per Capita. This criterion divides the total number of people in a State (with and without a disability) by the total HCBS expenditures for people with disabilities. The “per capita” is what each person in a State pays for HCBS. This eliminates State differences regarding wealthy states, big/small, etc.

3. % of HCBS to Total Medicaid Long-Term Care Participants. This looks at the total Medicaid number of people with disabilities in both the community and institutions, and shows the percentage of the total number of people with disabilities (in both the community and institutions) who receive Medicaid services in the community.

4. % of HCBS to Total Medicaid Long-Term Care Expenditures. Whereas #3 compares % of people with disabilities who receive services in the community, this criterion looks at the total Medicaid expenditures – the money – for people with disabilities in both the community and institutions, and shows the % of the total expenditures (again in both the community and institutions) spent in the community.

Here are the worst States using each criterion.

#1 Criterion - National average per 1,000 is 9.34. Best in country is 15.36. Worst:
HI 5.15
DE 5.03
NV 4.62
AL 4.61
MD 4.48
IN 3.86
UT 3.56
TN 3.42
VA 3.30
GA 3.22

#2 Criterion - National average per capita expenditure is $166. Best in country is $487. Worst:

AL $93
MI $84
FL $81
GA $76
IL $71
UT $64
MS $61
NV $59

# 3 Criterion - % of HCBS to total participants. National average is 62%. Best in country is 86%. Worst:

FL 46%
OH 45%
LA 45%
AL 45%
MS 44%
RI 44%
GA 43%
TN 37%
IN 34%

#4 Criterion - % of HCBS Expenditures to total expenditures. National average is 45%. Best is 83%. Worst:

AR 34%
KY 33%
IN 33%
AL 31%
NJ 31%
ND 30%
IL 30%
MS 30%

Caveats – A. this data includes both people with intellectual disabilities and people with physical and all other disabilities. Using these four criteria but focused on only ID or only A/PD would show different results; B. this data is a few years old.

Nevertheless, the data shows which States were far below the national average and overwhelmingly below the best States, and which States were not committed to implementing the ADA or complying with the Olmstead decision.

Disability Advocates - the ball is on your side of the court. Only you can change your States. Don’t expect CMS to do it. Don’t assume DOJ (or any other agency) will ride in to fix up your problem. Don’t think your Governor will see the light. If your State is among the worst, the responsibility is yours.

Power Concedes Nothing Without A Struggle. F. Douglas

Steve Gold, The Disability Odyssey continues

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