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The 4^th Annual Case For Inclusion Report

An Analysis of Medicaid for Americans with
Intellectual and Developmental Disabilities

The Case for Inclusion 2009 ranks all 50 States and the District of Columbia on how well they are providing community-based supports to Americans with intellectual and developmental disabilities being served by Medicaid. The report uses existing methodology first implemented in 2007.

Unfortunately, the findings compared to previous years (2007 - 2008) are mixed:

• Positively, there are 1,536 fewer Americans living in large state institutions (more than 16 beds). This is a bigger drop than seen last year. However, there remain 169 large institutions (4 fewer) housing 36,175 Americans;
• Negatively, only nine states (down from 11) report more than 2,000 residents living in large public or private institutions - California, Florida, Illinois, New Jersey, New York, North Carolina, Ohio, Pennsylvania & Texas;
• Sustaining the 2008 level, 19 states, but up from 16 in 2007, have more than 80 percent of those served living in home-like settings;
• Positively, seven states - Alaska, Arizona, Michigan, New Hampshire, Oregon, Rhode Island, and Vermont- direct more than 95 percent of all related funds to those living in the community rather than in large institutions. Colorado directs a very close 94.6% of funds;
• Positively, five states - Idaho, Louisiana, North Carolina, Ohio and Texas - as well as the District of Columbia experienced at least a five percent increase in people served in the community (HCBS waiver).
• Negatively, Wisconsin reduced number of people served in the community (HCBS waiver) by more than five percent;
• Nationally, 29 states direct more than 80 percent of all related funding to those living in the community;
• Positively, 39 states, up from 33, report having a Medicaid Buy-In program supporting individuals as they go to work and increase their earnings; and
• In terms of rankings, in total, 15 states had a sizable change in rankings over last two years. Pennsylvania (to #16 from #29 in 2007, dropping one place from 2008) and Missouri (to #29 from #41, dropping one place from 2008) improved the most with Wyoming (to #28 from #17) and Maine (to #35 from #24) dropping the most in the rankings.