sos coleman presentation 10.25€¦ · 2. federal funds a. federal icf/id b. title xx/social...

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


• 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)


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


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%


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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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


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)


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


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


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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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



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


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


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

11/9/2017

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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 .


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.


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


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%


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%


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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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.


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


http://www.StateoftheStates.org/


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


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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.

sos coleman presentation 10.25€¦ · 2. federal funds a. federal icf/id b. title xx/social...

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