Disability and health journal · 2026
Medicaid home and community based services are vital for adults with intellectual and developmental disabilities: A descriptive study of service use among all adult enrollees, 2022.
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Rosenberg Samuel, Garcia Estrada Josue Antonio, Tewolde Salina, Higgins Alianna, Tao Junjun, Levine A Alex, Sisson Emily Q, Michals Amy, Rubenstein Eric
Аннотация
BACKGROUND: Home and Community Based Services (HCBS) are Medicaid funded services that support independence, person-centered care, and connection to community for disabled people. With drastic Medicaid cuts on the horizon due to the 2025 Budget Reconciliation Bill, HCBS will likely be impacted.
OBJECTIVE: To describe HCBS among adults in Medicaid with intellectual and developmental disabilities (IDD) in 2022.
METHODS: We used Medicaid data from all with claims for autism, intellectual disability, and Down syndrome and identified HCBS use using established algorithms. We described differences by state, IDD type, and race/ethnicity and used multi-level models to account for confounding and state-level differences.
RESULTS: Of 1,400,630 adults with IDD, 68.3% (N = 957,220) received HCBS in 2022. The most used HCBS types were case management (35.4%), home-based services (34.6%) and non-medical transportation (19.8%). There were limited differences by race and ethnicity in overall HCBS use. Asian Americans were more likely to use home-based services and less likely to use case-management compared to white peers. After adjustment, Autistic individuals without intellectual disability were 18.3 percentage points less likely and autistic people with intellectual disability were 4.6 percentage points more likely to receive any HCBS compared to people with intellectual disability without autism.
CONCLUSION: Disabled people have care needs that exist beyond the scope of typical healthcare system. HCBS are widely used optional services that are not mandated to be covered. With pending Medicaid cuts, HCBS loss may be an area where services are lost, which will disproportionately harm the IDD community.
OBJECTIVE: To describe HCBS among adults in Medicaid with intellectual and developmental disabilities (IDD) in 2022.
METHODS: We used Medicaid data from all with claims for autism, intellectual disability, and Down syndrome and identified HCBS use using established algorithms. We described differences by state, IDD type, and race/ethnicity and used multi-level models to account for confounding and state-level differences.
RESULTS: Of 1,400,630 adults with IDD, 68.3% (N = 957,220) received HCBS in 2022. The most used HCBS types were case management (35.4%), home-based services (34.6%) and non-medical transportation (19.8%). There were limited differences by race and ethnicity in overall HCBS use. Asian Americans were more likely to use home-based services and less likely to use case-management compared to white peers. After adjustment, Autistic individuals without intellectual disability were 18.3 percentage points less likely and autistic people with intellectual disability were 4.6 percentage points more likely to receive any HCBS compared to people with intellectual disability without autism.
CONCLUSION: Disabled people have care needs that exist beyond the scope of typical healthcare system. HCBS are widely used optional services that are not mandated to be covered. With pending Medicaid cuts, HCBS loss may be an area where services are lost, which will disproportionately harm the IDD community.