Academic journal article Mental Health Aspects of Developmental Disabilities

Adults with Dual Diagnoses of Intellectual and Psychiatric Disability Receiving Medicaid Home and Community-Based Services (HCBS) and ICF/MR Recipients in Six States

Academic journal article Mental Health Aspects of Developmental Disabilities

Adults with Dual Diagnoses of Intellectual and Psychiatric Disability Receiving Medicaid Home and Community-Based Services (HCBS) and ICF/MR Recipients in Six States

Article excerpt

This paper addresses the topic of intellectual disability and psychiatric disorder among persons receiving Medicaid Home and Community-Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services. In June 2005 HCBS and ICF/MR programs financed long-term supports for nearly 545,400 persons with intellectual disabilities and other developmental disabilities at a fiscal year 2005 cost of $29.3 billion. This paper describes and compares characteristics and experiences of persons with and without diagnosed psychiatric conditions in addition to intellectual disability in a large, six state, 2720 person sample of HCBS and ICF/MR recipients. Nearly one-third (31.4%) of the sample had psychiatric disorders. Controlling for levels of intellectual disability, they were consistently more likely to be placed in ICF/MR programs and agency-operated congregate care settings, and were less likely to live with family members. They were much more likely to receive medications for mood, anxiety and/or behavior disorders than were persons with intellectual disability only (87% and 32%, respectively). Policy implications include the need to incorporate behavioral health services and supports into state Medicaid waivers for individuals with intellectual disabilities.

Keywords: behavior disorders, intellectual disability, mental retardation, pharmacotherapy, psychiatric

National commitments to individuals with intellectual and developmental disabilities have been articulated in a number of legislative, administrative and judicial statements establishing national policy. These delineate a clear national preference for supporting Americans with intellectual and developmental disabilities in community settings and further promise opportunities for self-determination, choice and personal control in daily life decisions and inclusion in the activities, programs and social and economic life of the community. Among the many sources of these promises are the Americans with Disabilities Act (ADA) and the Supreme Court's affirmation of the ADA's promises in Olmstead et al. v. L.C. et al., President Bush's New Freedom Initiative established in Executive Order 13217, (p.1), and the Developmental Disabilities Assistance and Bill of Rights Act of 2000. (1,4,6,12)

Medicaid Home and Community-Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services are financed by federal and state governments to provide support and assistance to individuals with intellectual and developmental disabilities in a manner consistent with prevailing standards. The ICF/MR program was created in 1971 to provide for the first time federal financial participation for "intermediate care" in certified residential units offering "active treatment" specifically designed for persons with intellectual and developmental disabilities. Although ICF/MR programs can serve as few as four people, most ICF/MR residents have been housed in traditional institutions (16 or more residents). The HCBS program was established to finance home and community services as alternatives to institutional placements. Given its purpose in financing non-institutional services and its flexibility in doing so, the HCBS program was recognized from its initial authorization in 1981 as offering great promise in supporting opportunities for integrated, self-determined lives for persons with intellectual and developmental disabilities. (8) But in the first decade of the HCBS program it was required that states demonstrate reductions in projected ICF/MR residents and expenditures roughly equal to requested increases in HCBS participants. In the early 1990s these requirements were considerably relaxed, and then in 1994 they were dropped in the revised federal HCBS regulations. As a result, after 1992 there was rapid growth in HCBS recipients with intellectual and developmental disabilities, from about 62,500 in June 1992 to about 443,600 in June 2005, while during the same period, there was a steady decrease in populations of ICFs/MR, from 146,260 residents nationwide in June 1992 to 101,800 in June 2005. …

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