The push to move consumers needing long-term services and supports (LTSS) out of residential placements and into community settings continues. Part of the push is that there are currently 59 lawsuits related to Olmstead open across the country, which require states to find ways to support care individuals in the community (see Olmstead Litigation in the 12 U.S. Circuit Courts of Appeals). And there are the cost issues. The majority of the services—both institutional and community-based—required to support these consumers are covered by Medicaid. Generally, the community-based options are less expensive than residential care options (see For I/DD, The Question Isn’t Managed Care Or Not-It’s Residential Care Or Not). But while there are an estimated 6.2 million people with I/DD who are on the Medicaid roles, only 689,144 (11.2%) are receiving HCBS services. An estimated 200,000 are on state HCBS waiver waiting list for those services (see How Many Consumers With I/DD Are Served By Medicaid HCBS Waivers & How Many Consumers Are On A Wait List?: An OPEN MINDS Market Intelligence Report).
The raises the question, what’s the hold up? A recent congressional briefing identified four major challenges to HCBS availability for consumers with I/DD (see Congressional Briefing Identifies Waiting Lists, Workforce, Caregivers & Housing As Key Challenges To Medicaid HCBS For I/DD). These challenges include lack of state funding causing waiting lists, high staff turnover rates and overall lack of adequate numbers of direct support professionals, state reliance on unevenly skilled family caregivers, and limited housing opportunities. Without addressing these issues, the numbers of consumer with I/DD with the option of living in the community will continue to lag.