NASUAD WebinarFebruary 27, 2019

Amie Lulinski, PhD, FAAIDDEmily Shea Tanis, PhD, FAAIDD

Joy Wu, PhD

“Don’t tell me what you value, show me your budget, and I’ll tell you what you value.”

~Joe Biden, 47th Vice President of the United States

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

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/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. 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 AssistanceE. 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).

Institutional Settings (16+)

• Public & Private ICF/ID

• Nursing Facilities• Other

Community and Residential Settings

(7-15)

• Public & Private ICF/ID

• Other Residential

Community and Residential Settings

(1-6)

• Public & Private ICF/ID

• Supported Living• Personal

Assistance• Family Support• Other Residential

Day/Work Program

• Sheltered Employment/Work Activity

• Day Habilitation• Supported

Employment

Technology

• Smart Homes• Individual Support

Technology • Remote

Monitoring

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Preliminary FY 2016-17 data Additional analysis in progress

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

13.1%

19.0%

Total IDD spending:$71.6 billion

Total IDD Medicaid spending: $31.4 billion

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

-91%

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

1. District of Columbia (1991)2. New Hampshire (1991)3. Vermont (1993)4. Rhode Island (1994)5. Alaska (1997)6. New Mexico (1997)7. West Virginia (1998)8. Hawaii (1999)9. Maine (1999)10. Minnesota (2000)11. Indiana (2007)12. Michigan (2009)13. Oregon (2009)14. Alabama (2012)

Source: Braddock, D., Hemp, R., Tanis, E.S., et al.(2017).The State of the States in Intellectual Disabilities:2017

Rank State Census1 Montana 21 2 Idaho 25 3 Delaware 48 4 Nevada 48 5 Oklahoma 50 6 Tennessee 60 7 Wyoming 64 8 North Dakota 74 9 Arizona 83 10 Maryland 92

Rank State Census1 Texas 3,025 2 Illinois 1,656 3 New Jersey 1,437 4 North Carolina 1,125 5 Mississippi 938 6 Arkansas 907 7 Pennsylvania 880 8 California 787 9 Florida 774 10 Ohio 702

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

1980 1990 2000 2010 2015 2020 2030Fiscal Year

0

200

400

600

800

1,000

Thou

sand

s of

Per

sons

259,909321,552

441,101

594,389680,851

737,950

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

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

4% 6% 10%14% 15% 17%

2.792.85

3.053.11

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

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 16 17

Mill

ions

of c

areg

ivin

g fa

mili

es

Fiscal year

IDD caregiving families and families supported by state IDD agencies: FY 1988-2017

Families supported by state IDD agencies

Total IDD caregiving families

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Growth between 1993 – 2017:Supported Living/Personal Assistance: 1746%Total Spending: 915%Family Supports: 889%Supported employment: 74%

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Financial and Programmatic Trends Through FY 2015

Published by

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

www.StateoftheStates.org

Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

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Source: Tanis, E.S., Lulinski, A., Wu, J., Braddock, D., & Hemp, R. (in preparation). State of the States in Intellectual and Developmental Disabilities: FYs 2016-2017. Aurora, CO: Department of Psychiatry, University of Colorado Anschutz Medical Campus.

To learn more about the Coleman Institute visit www.ColemanInstitute.org

For more information about State of the States visit: http://www.StateoftheStates.org

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Email us:Shea.Tanis@cu.eduAmie.Lulinski@cu.edu

Financial support was obtained from the U.S. Administration on Intellectual and Developmental Disabilities and the Coleman Institute for Cognitive Disabilities, University of Colorado.