Available online 26 November 2022, 101419

Author links open overlay panelAbstractBackground

In recognition of the important role housing plays in people’s health and quality of life, Medicaid Home- and Community-Based Services (HCBS) programs are more frequently working to promote the housing security of Medicaid beneficiaries. One mechanism states use to promote housing security of people with intellectual and developmental disabilities (IDD) is to offer community transition services in their HCBS programs. Community transition services help with transition by assisting with securing housing and leases, obtaining basic furnishings, paying for utility setup, funding moving expenses, and making accessibility adaptations.

Objective

The aim of this study was to examine if and how states provided community transition services in their HCBS waiver programs for people with IDD.

Methods

We analyzed 107 fiscal year (FY) 2021 HCBS 1915(c) waivers for people with IDD from across the United States. We analyzed the service expenditures and utilization data for community transition services, including projected spending, projected number of users served, reimbursement rates, projected spending per participant, and annual service provision per participant.

Results

In FY2021, 49 waivers (45.8%) from 28 states provided community transition services to people with IDD. A total of $7.16 million of spending was projected for community transition services for 2,321 people with IDD, with an average spending per person of $2,329.

Conclusions

While community transition services can help promote the housing insecurity of people with IDD, there was wide variance in how these services were allocated to people with IDD in FY2021.

Section snippetsMethods

For this study, we obtained Medicaid HCBS 1915(c) waivers from the CMS Medicaid.gov website between December 2021 and January 2022. When doing so, we excluded HCBS waivers that were not 1915(c), did not exclusively serve people with IDD (developmental disability, intellectual disability, and/or autism), and did not include 2021 – while most states used the state FY (July 1, 2020 to June 30, 2021), others used the federal fiscal year (October 1, 2020 to September 30, 2021) or the calendar year

Results

Our analysis of 107 HCBS IDD waivers revealed 49 waivers (45.8%) from 28 states provided 63 different community transition services.

Discussion

Transitioning from an institutional setting to a community-based setting, or from a congregate community-based setting to an individual community-based setting is a time of critical importance in people with IDD’s lives. Not only does it represent a time of disruption and uncertainty in people with IDD’s lives, how the household is established lays the foundation for people with IDD’s long-term stability and security to ensure they are able to stay in that home. For these reasons, community

Conclusion

Housing security is crucial for people with IDD’s health and quality of life.4,5,21,22 Including community transition services in Medicaid HCBS can help promote the housing security of people with IDD. However, we found less than half of HCBS waivers offered community transition services to people with IDD in FY2021. Furthermore, among the waiver programs that did provide community transition services, there was wide variance in how the services were allocated. A suitable environment that is

Conflict of Interest Statement

The author reports no conflicts of interest.

Acknowledgements

Thank you to Mary Kay Rizzolo for reviewing this manuscript and providing feedback.

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