11/9/2017
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David Braddock, PhDRichard Hemp, MAAmie Lulinski, PhD
Emily Shea Tanis, PhD
17th Annual Coleman Institute Conference on Cognitive Disability and Technology
November 2, 2017Broomfield, CO
Financial and Programmatic Trends Through FY 2015
Published by
Sources: Braddock et. al. (1981-2017)
I. INSTITUTIONAL SERVICES FINANCIAL DATA(16 or more persons)
A. PUBLIC 16+ INSTITUTIONAL SERVICES FUNDS 1. State Funds
a. ICF/ID Medicaid Matchb. General Funds (not including state ICF/MR match)c. Other State Funds (not including state ICF/MR match)d. Local Funds in Excess of Match
2. Federal Fundsa. Federal ICF/IDb. Title XX/Social Services Block Grantc. Other Federal Funds
B. PRIVATE 16+ INSTITUTIONAL SERVICES FUNDS1. State Funds
a. ICF/ID Medicaid Matchb. General Funds (not including state ICF/ID match)c. Other State Funds (not including state ICF/ID match)d. Local Funds in Excess of Match
2. Federal Fundsa. Federal ICF/IDb. Other Federal Funds
II. COMMUNITY SERVICES FINANCIAL DATA (15 or fewer persons)
A. COMMUNITY SERVICES FUNDS FOR 15 OR FEWER PERSONS1. State Funds
a. ICF/ID Medicaid Matchb. General Funds (not including state ICF/ID match)c. Other State Funds (not including state ICF/ID match)d. Local/County Funds in Excess of Matche. SSI State Supplement Funds
2. Federal Fundsa. Public ICF/ID (<16)b. Private ICF/ID (<16)c. HCBS Waiverd. Other Medicaid Services
1. Rehabilitation Services2. Clinic Services3. Targeted Case Management4. Personal Care Services5. Other Medicaid Services
e. Title XX/Social Services Block Grantf. Other Federal Funds g. SSI and Adults Disabled in Childhood (ADC) benefits –
HCBS Waiver participants
I. COMMUNITY RESIDENTIAL SETTINGS (1-6 PERSONS)A. Public ICFs/IDB. Private ICFs/IDC. Supported LivingD. Personal Assistance
E. Other residential settings(Group homes, apartments, foster, host homes)
II. COMMUNITY RESIDENTIAL SETTINGS (7-15 PERSONS)A. Public ICFs/IDB. Private ICFs/IDC. Other residential settings for 7-15 persons
III. DAY/WORK PROGRAM PARTICIPANTSA. Sheltered employment/work activityB. Day habilitation ("day training")C. Supported/competitive employment
IV. HCBS WAIVER PARTICIPANTS
V. PUBLIC & PRIVATE INSTITUTIONAL SETTINGS (16+ PERSONS)A. State-operated institutionsB. Private ICFs/IDC. Other private residential facilitiesD. Nursing faciltiy residents with I/DD
Sources: Braddock (1981, 2002a); Braddock, Hemp, & Fujiura (1987).Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
State survey instruments (primary data sources)
National data sources (secondary data sources)
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Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
Selected examples Review of: ▪ Published budget documents▪ Conversations with state IDD agency personnel
Data collection tool▪ Excel spreadsheets▪ Revenue and expenditure data▪ Number of participants▪ Spending, revenue, and participant data on specific support
categories
▪ Accompanied by an instruction guide and definitions
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
• Continued decline in public/private institutions• Increased HCBS Waiver spending, decline in
public and private facility ICF/ID spending• Largest growth is in “Individual and Family
Support” (Family support, supported living and supported employment)
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
18481853
18581863
18681873
18781883
18881893
18981903
19081913
19181923
19281933
19381943
19481953
19581963
19681973
19781983
19881993
19982003
20082013
20150
50,000
100,000
150,000
200,000
250,000
Dai
ly C
en
sus
10
97,209
194,650
21,103
2015
1938
1967
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15Fiscal Year
$0
$30,000
$60,000
$90,000
$120,000
Infl
atio
n-A
dju
ste
d D
oll
ars
pe
r P
art
icip
an
t p
er
Ye
ar
$6,924$12,402
$15,271 $15,950 $16,518
$73,036
$88,815
$79,849
$78,947
$73,384
Source: Braddock et al., Coleman Institute and Department of Psy chiatry , Univ ersity of Colorado, 2017
7+ Person Residences
Individual and Family Support
-17.4%
+33.2%
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
1. District of Columbia (1991)2. New Hampshire (1991)3. Rhode Island (1994)4. Alaska (1997)5. New Mexico (1997)6. West Virginia (1998)7. Hawaii (1999)8. Maine (1999)9. Minnesota (2000)10. Indiana (2007)11. Michigan (2009)12. Oregon (2009)13. Alabama (2012)
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Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
1969 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020
Year
0
25
50
75
100
125
150
175
200
225
Nu
mb
er o
f C
losu
res
1 2 7 1027
46
77
112
133147
173181
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
77 82 87 92 97 02 07 12 17 22 27 30Year
0
20
40
60
80
100
120
140
160
Th
ou
san
ds
of
Res
iden
ts
150,207
21,103 (2015)
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
1 IDAHO 232 NEVADA 473 DELAWARE 544 MONTANA 555 OKLAHOMA 666 WYOMING 707 NORTH DAKOTA 828 ARIZONA 939 NEBRASKA 116
10 MARYLAND 122Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
7778
7980
8182
8384
8586
8788
8990
9192
9394
9596
9798
9900
0102
0304
0506
0708
0910
1112
1314
15
Fiscal Year
$0
$10
$20
$30
$40
$50
$60
$70
$80
Bill
ion
s o
f 2
015
Do
llars
$15.9
$32.7
$48.0
$56.9
$62.6$65.2
One reduction:-0.8% in 2011
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
13.6%
10.7%
TOTAL IDD SPENDING: $65.21 BILLION
General funds, special tax levies, lotteries, other state
and local funds
SSI/ADC, Title XX/SSBG, other Federal funds
Federal, State, LocalMedicaid*
*TOTAL FEDERAL-STATE MEDICAID: $49.4 BILLION a) HCBS WAIVER (70%)b) PUBLIC & PRIVATE ICFs/ID (22%)c) STATE PLAN MEDICAID (8%)
75.8%
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Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
683,290
793,6153,590,998
TOTAL: 5,067,903 PERSONS
13.5%
15.7%
70.9%
Source: Braddock et al., Coleman Institute and Department of Psychiatry, University of Colorado, 2016, based on Fujiura (2015).
SUPERVISED RESIDENTIAL SETTING
ALONE ORWITH ROOMATE
WITH FAMILYCAREGIVER
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
1980 1990 2000 2010 2015 2020 2030
Fiscal Year
0
200
400
600
800
1,000
Th
ou
san
ds
of
Per
so
ns
259,909321,552
441,101
594,389
680,851737,950
880,2266 or Fewer Person Settings7-15 Person SettingsPublic and Private 16 + Person Settings
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
683,290
793,6153,590,998
TOTAL: 5,067,903 PERSONS
13.5%
15.7%
70.9%
Source: Braddock et al., Coleman Institute and Department of Psychiatry, University of Colorado, 2016, based on Fujiura (2015).
SUPERVISED RESIDENTIAL SETTING
ALONE ORWITH ROOMATE
WITH FAMILYCAREGIVER
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
Total: 3,590,998 Caregivers Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
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Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15
FISCAL YEAR
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
MIL
LIO
NS
OF
CA
RE
GIV
ING
FA
MIL
IES
4% 6% 10% 13% 14% 16% 15% 15% 17%
2.89 2.993.14
3.32 3.38 3.48 3.52 3.57 3.59
Total IDD Caregiving FamiliesFamilies Supported by State IDD Agencies .
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
Fiscal effort: Is a ratio of a state’s spending for IDD
services per $1,000 of the state’s total personal income;▪ Allows for state-to-state comparisons
controlling for state wealth;
▪ Allows us to rank states by the proportion of their aggregate statewide personal income devoted to financing IDD services.
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
1 New York $9.06 18 Connecticut $5.25 35 Michigan $3.712 Maine $8.02 19 New Mexico $5.17 36 Tennessee $3.623 North Dakota $7.92 20 Alaska $5.12 37 California $3.504 West Virginia $7.57 21 Delaware $4.95 38 Maryland $3.355 Louisiana $7.25 22 Oregon $4.88 39 Virginia $3.186 District of Columbia $7.15 23 South Dakota $4.73 40 Kansas $3.157 Kentucky $6.96 24 North Carolina $4.66 41 Washington $3.138 Minnesota $6.95 25 Nebraska $4.51 42 Oklahoma $2.879 Iowa $6.88 26 Montana $4.41 43 Utah $2.75
10 Ohio $6.77 27 Idaho $4.39 44 Illinois $2.7211 Vermont $6.53 28 Missouri $4.27 45 Georgia $2.4712 Massachusetts $5.94 29 Wyoming $4.13 46 Hawaii $2.3113 Wisconsin $5.73 30 New Hampshire $4.12 47 Colorado $2.2914 Indiana $5.60 31 Mississippi $4.02 48 Alabama $2.2015 Rhode Island $5.54 32 South Carolina $3.80 49 Texas $2.1916 Arkansas $5.28 33 Arizona $3.77 50 Florida $1.9917 Pennsylvania $5.26 34 New Jersey $3.73 51 Nevada $1.57
UNITED STATES: $4.30
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
7778
7980
8182
8384
8586
8788
8990
9192
9394
9596
9798
9900
0102
0304
0506
0708
0910
1112
1314
15
Fiscal Year
$0.00
$1.00
$2.00
$3.00
$4.00
$5.00
Sp
en
din
g (
$)
per
$1
,000
Pe
rso
na
l In
co
me
$2.21
$2.57
$3.45
$3.90$4.06
$4.46
$4.32
$4.43$4.30
$0.56
$0.98
$2.15
$3.06$3.31
$3.78
$3.69$3.74$3.81
$1.66
$1.71 $1.59
$1.30
$0.83 $0.75 $0.70
$0.64
$0.58 $0.49
Total Fiscal EffortCommunity ServicesInstitutional Settings (16+)
-30%
-4%
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
7778
7980
8182
8384
8586
8788
8990
9192
9394
9596
9798
9900
0102
0304
0506
0708
0910
1112
1314
15
Fiscal Year
$0
$10
$20
$30
$40
Bill
ion
s o
f 2
015
Do
llars
$12.2
$18.8
$17.5$16.6
$15.6$14.2 $13.6
$11.0
$0.2
$4.2
$19.9
$25.0
$28.7$29.7
$32.4$34.5
HCBS WaiverICF/ID
-23%
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
UNITED STATES $107
1 District of Columbia $278 18 Iowa $154 35 Virginia $872 Vermont $274 19 New Mexico $154 36 Oregon $843 Minnesota $260 20 Indiana $140 37 North Carolina $784 New York $255 21 Nebraska $135 38 Oklahoma $785 North Dakota $240 22 Maryland $129 39 Hawaii $756 Maine $236 23 South Dakota $129 40 Colorado $737 Alaska $229 24 Delaware $125 41 South Carolina $718 Rhode Island $217 25 Ohio $122 42 Arkansas $699 Connecticut $205 26 Missouri $115 43 California $69
10 West Virginia $196 27 Michigan $114 44 Alabama $6611 Kentucky $193 28 Arizona $114 45 Utah $6212 Massachusetts $174 29 Idaho $101 46 Illinois $6013 Wisconsin $168 30 New Jersey $101 47 Georgia $4914 Pennsylvania $165 31 Tennessee $101 48 Florida $4615 Wyoming $164 32 Montana $99 49 Texas $3516 New Hampshire $164 33 Kansas $95 50 Nevada $3317 Louisiana $155 34 Washington $93 51 Mississippi $24
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Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
Medicaid spending is likely to be cutMedicaid cuts may impact Medicaid-
funded institutions, community-based services, and health care
The impact on IDD supports may be 18% or more Likely much higher in health care for poor and
older citizens.
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
21,18212,695
8,5798,2238,088
5,9005,271
5,0234,9664,827
4,5384,2384,1754,0854,0844,037
3,5483,2803,2203,1153,019
2,7762,768
2,5802,4562,2902,2622,174
1,8261,5861,5151,4581,4211,3911,3651,2011,1431,1141,0691,033
857726726563560526501468440359339
0 6,000 12,000 18,000 24,000
New YorkCalifornia
Pennsylv aniaOhio
TexasNorth Carolina
IndianaMichigan
MinnesotaFlorida
LouisianaNew Jersey
IllinoisWisconsinKentucky
MassachusettsTennessee
ArizonaMissouriVirginia
ConnecticutWashington
IowaOregon
MarylandArkansas
South CarolinaGeorgia
West VirginiaOklahoma
MississippiMaine
New MexicoColoradoAlabama
District of ColumbiaKansas
UtahNebraska
IdahoNorth DakotaRhode Island
New HampshireDelawareVermont
AlaskaNev ada
MontanaSouth Dakota
HawaiiWyoming
Source: Estimated from U.S. House of Representatives (2016) by R. Hemp based on State of the States Medicaid data
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
http://www.StateoftheStates.org/
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
www.StateoftheStates.org
1. Total Fiscal Effort for IDD Services2. Community Fiscal Effort for IDD Services3. Institutional (16+) Fiscal Effort for IDD Services4. Community Spending as a Percent of Total IDD Services5. Percent of Total Out-of-Home Placements in Settings for 6 or Fewer Persons6. Percent of Total Statewide I/DD Caregiving Families Supported by State IDD Agencies7. Aging IDD Caregivers as Percent of Total Persons with IDD8. Individual and Family Support Spending per Capita9. Home and Community Based Services (HCBS) Waiver Federal-State Spending per Capita10. Average Annual Cost of Care in State-Operated 16+ Person IDD Institutions11. Average Daily Cost of Care in State-Operated 16+ Person IDD Institutions12. Nursing Facility Residents with IDD, Per 100,000 of the State Population13. Six-or-fewer Person Community Spending as a Percent of Total IDD Spending14. Unmatched State Funds Potentially Available to Match Additional Federal Medicaid Funding15. Medicaid Percent of Total IDD Spending16. Public Spending for Family Support and Supported Living as a % of Total IDD Spending
Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
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Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017
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Financial support was obtained from the U.S. Administration on Intellectual and Developmental Disabilities and the Coleman Institute for Cognitive Disabilities, University of Colorado.