University of Colorado Advisory Committee National National Youth Conference of Leadership Sibling State Legislatures Network Leadership Network
Current AIDD Grant Period (2012-2017) Two data collection cycles: FYs 2012 and 2013 — Completed FYs 2014 and 2015 (Start fall of 2015) Review state budget and program document review; Develop and implement 51 tailored state spreadsheets; collection with territories began in 2013 Obtain, interpret, and verify financial and programmatic data with state officials; and Disseminate and provide technical assistance.
BUDGET CATERORIES/VARIABLES FOR FOR STATE SPENDING/DATA COLLECTION State Local Federal States report State Plan COMMUNITY SERVICES FUNDS (15 or Fewer Persons) Medicaid (Personal Care, Rehab, Clinic, TCM); General Funds Local Funds Public ICF/ID Medicaid Match Local Medicaid Private ICF/ID managed care (e.g. VT, Other State Funds Match HCBS Waiver Rehab Services WI); 1915(b/c) Waivers Clinic Services Targeted Case Mgt. (e.g. MI) and Section 1115 Personal Care Admin. Other Research and Other Federal Demonstration Waivers Title XX/SSGB (e.g. AZ) SSI/ADC for HCBS Waiver STATE INSTITUTIONAL SERVICES FUNDS (16 OR MORE PERSONS) General Funds Local Funds Federal ICF/ID Medicaid Match Local Medicaid Other Federal Other State Funds Match PRIVATE INSTITUTIONAL SERVICES FUNDS (16 OR MORE PERSONS) General Funds Local Funds Federal ICF/ID Medicaid Match Local Medicaid Other Federal Other State Funds Match
Overview of IDD Financial and Programmatic Trends through FY 2013 Just published by AAIDD
The Impact of the Great Recession
$70 2011: $57.6 $61.6 $60 $57.8 $54.4 Billions of 2013 Dollars $50 $45.8 $40 $31.3 $30 $20 $15.2 $10 $0 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 13 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 10 12 Fiscal Year Source: Braddock, Hemp, Rizzolo, Tanis, & Haffer. State of the States in Developmental Disabilities, 2015
UNITED STATES 12.0% 10.3% 10.0% 8.0% 7.1% 7.0% Percent Real Change 6.0% 6.0% 4.2% 4.0% 3.3% 2.4% 2.4% 2.0% 1.6% 1.5% 2.0% 0.0% -0.6% -2.0% 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 10 12 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 13 Fiscal Year Source: Braddock, Hemp, Rizzolo, Tanis, & Haffer. State of the States in Developmental Disabilities, 2015
% % Change Change % Change State State Kentucky 40.3% Iowa 12.2% Illinois 3.9% Mississippi 38.8% New Jersey 11.8% Oklahoma 3.5% Louisiana 35.3% District of Columbia 11.4% Wyoming 2.3% Virginia 35.1% Nebraska 10.8% Nevada 1.6% Missouri 34.8% Texas 10.8% South Dakota 1.4% Alaska 30.1% Indiana 9.2% Washington 1.3% Pennsylvania 25.7% Utah 8.7% Minnesota 0.7% West Virginia 23.4% Tennessee 8.1% Kansas 0.3% Montana 20.6% New Hampshire 8.0% New Mexico -0.2% Georgia 19.9% North Carolina 8.0% Idaho -0.7% Delaware 15.7% Michigan 6.3% Arizona -1.4% Connecticut 14.4% Alabama 5.8% Colorado -1.6% Maryland 13.2% Wisconsin 5.2% Arkansas -2.7% South Carolina 13.0% New York 4.6% Rhode Island -5.2% Maine 12.7% Ohio 4.2% Vermont -7.2% North Dakota 12.5% California 4.2% Florida -9.4% Massachusetts 12.4% Oregon 4.0% Hawaii -11.4% United States 8.5% Source: Braddock, Hemp, Rizzolo, Tanis, & Haffer. State of the States in Developmental Disabilities, 2015
1978 - 7 1990 - 3 2002 - 4 1979 - 6 1991 - 6 2003 - 16 1980 - 16 1992 - 11 2004 - 17 1981 - 14 1993 - 18 2005 - 24 1982 - 14 1994 - 8 2006 - 15 1983 - 16 1995 - 11 2007 - 15 1984 - 8 1996 - 11 2008 - 17 1985 - 5 1997 - 10 2009 - 23 1986 - 5 1998 - 4 2010 - 22 1987 - 7 1999 - 10 2011 - 31 1988 - 7 2000 - 6 2012 - 13 1989 - 6 2001 - 10 2013 - 14
ICF/ID (6 or fewer) 7-15 Person Settings 5%3% Public Institutions (16+) 10% 6 Person or Fewer 58% Residential & Private Institutions (16+) 3% Related Community Services 7% Supported Employment (1.4%) 13% Family Support Supported Living/ Personal Assistance $61.46 Billion Source: Braddock, Hemp, Rizzolo, Tanis, & Haffer. State of the States in Developmental Disabilities, 2015
Fiscal Effort is a measure of how much a state spends on I/DD LTSS per $1,000 of statewide personal income. …in other words, how much does your state IL Total Fiscal Effort: $2.70 spend after you control Ranks 43rd US $4.40 for state wealth – this allows you to compare your IL Community Fiscal Effort: $2.01 Ranks 47 th state to any other state US $3.81 regardless of state wealth. Source: Braddock, Hemp, Rizzolo, Tanis, & Haffer. State of the States in Developmental Disabilities, 2015
…It made up 78% of total I/DD spending in 2013 Home and Community Based Services (HCBS) Waiver: • Authorized in 1981 as a way Other of keeping people out of Intermediate Medicaid (5%) institutions while lowering Care Facilities Other for Persons with costs State Funds (12%) I/DD (21%) • Supported almost 686,000 people with DD in FY 2013 Other Federal Funds (10%) • Reimburses states for a Home and variety of community-based Community services and supports Based Services (HCBS) Waiver • (51%) Allows states to determine how many people they will serve and what services they Total I/DD Spending: $61.48 Billion will offer
1 New York $277 18 Maryland $128 35 Virginia $78 2 Maine $241 19 South Dakota $125 36 Oklahoma $76 3 Vermont $240 20 Nebraska $124 37 Hawaii $74 4 District of Columbia $232 21 Oregon $122 38 Georgia $66 5 Minnesota $231 22 Massachusetts $118 39 Colorado $63 6 Connecticut $212 23 Indiana $117 40 Alabama $62 7 Alaska $211 24 Ohio $117 41 North Carolina $61 8 Rhode Island $198 25 Kansas $113 42 Arkansas $61 9 North Dakota $193 26 Kentucky $107 43 California $60 10 Wyoming $182 27 Delaware $106 44 South Carolina $59 11 West Virginia $181 28 Missouri $104 45 Utah $57 12 New Hampshire $161 29 Arizona $98 46 Illinois $49 13 Louisiana $157 30 Michigan $97 47 Florida $44 14 Wisconsin $152 31 Tennessee $96 48 Texas $42 15 Pennsylvania $140 32 Montana $91 49 Idaho $40 16 New Mexico $137 33 New Jersey $88 50 Mississippi $30 17 Iowa $130 34 Washington $87 51 Nevada $27 UNITED STATES $100 Source: Braddock, Hemp, Rizzolo, Tanis, & Haffer. State of the States in Developmental Disabilities, 2015
Northeast $218 New England $167 Mid-Atlantic $124 Great Plains $115 Great Lakes $112 n o i Northwest $98 g e R Rocky Mountain $83 Southwest $65 Pacific $64 Southeast $58 U.S. $100 $0 $50 $100 $150 $200 $250 Federal-State Waiver Spending per Capita (General Population) 2. Northeast (NJ, NY, PR, VI) 10. Northwest (AK, ID, OR, WA) 1. New England (CT, ME, MA, NH, RI, VT) 8. Rocky Mountain (CO, MT, ND, SD, UT & WY) 3. Mid-Atlantic (DE, DC, MD, PA, VA, WV) 6. Southwest (AR, LA, NM, OK, TX) 7. Great Plains (IA, KS, MO, NE) 9. Pacific (AS, AZ, CA, CNMI, GUAM, HI, NV) 5. Great Lakes (IL, IN, MI, MN, OH, & WI) 4. Southeast (AL, FL, GA, KY, MS, NC, SC, TN)
88 HCBS Waiver Applications for 2010: types of services ▪ definitions of services (n=1,329) # of “users” average units per user average cost per unit 93 HCBS Waiver Amendments Rizzolo, M. C., Friedman, C., Lulinski-Norris, A., & Braddock, D. (in press – Feb/2013). Home and Community Based Services reasons for filing amendments (HCBS) Waivers: A nationwide study of the states. Intellectual and Developmental Disabilities.
Jargon Gobbledygook Over 1,300 definitions Companion/ Residential Adult Day Homemaker/ Habilitation Health Chore/PA/SL Community Financial Assistive and Day Care Transition Support Medical Habilitation Coordination Supports Services Technologies Health and Prevocational Supported Transportation Professional Respite Services Employment Services Individual Family Training Self-Advocacy Recreation and Goods and Education and Counseling Training Leisure Services
- Prevocational Services (3%) Supported - Family Training and Counseling (2%) Employment - Transportation (2%) 3% Remainder - Care Coordination (2%) 15% - Health and Professional Services (2%) - Respite (1%) Day - Assistive and Medical Technologies (1%) Habilitation o AT and Environmental Mods (0.5%) 19% o Med Equip and PERS (0.7%) Residential - Community Transition Supports (<1%) Habilitation - Financial Support Services (<1%) 53% - Adult Day Health (<1%) - Individual Goods and Services (<1%) Homemaker/ - Self Advocacy Training (<1%) Chore/PA/SL - Education (<1%) 11% - Recreation and Leisure (<1%)
United States 2013 Supervised Residential Setting 634,509 13% Alone or with Roommate 71% 16% 786,156 With Family Caregiver 3,557,246 TOTAL: 4,977,911 PERSONS Source: Braddock, D., et al., State of the States in Developmental Disabilities, 2015, based on Fujiura (1998, 2013) and Larson et al. (2001).
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