By Carli Friedman, CQL Director of Research
People with intellectual and developmental disabilities (IDD) have poorer health outcomes and are more at risk for a number of secondary health conditions compared to nondisabled people. Health disparities, including environmental conditions, access to health care, social circumstances, and genetics, play a key role in people with IDD’s nutrition. For these reasons, the aim of this study was to explore the national service provision of dietician services, particularly in Medicaid Home and Community Based Services (HCBS) waivers as they are the largest providers of long term services and supports (LTSS) for people with IDD. To do so, 111 fiscal year (FY) 2015 HCBS waivers from across the nation were examined to determine if and how they provided dietician services to people with IDD.
Findings revealed approximately $3.3 million was projected for the dietician services of approximately 5,500 people with IDD in FY 2015. While this may seem like a lot, less than 1% of people receiving waiver services were projected to receive dietician services, and less than .01% of funding was directed towards these services. Moreover, approximately half (48%) of people with IDD who did receive dietician services through HCBS waivers were projected to receive less than 7 hours of dietician services annually. The average annual spending per person also varied widely by state (see figure).
Average Annual Spending Per Person By State
Lack of knowledge about diet and exercise is an unmet health care need for people with IDD. “Our findings demonstrate dietetic services are underutilized across the United States in one of the largest funding mechanisms for people with IDD… for this reason, it is imperative that states utilize HCBS waivers to provide dietician services” (Friedman & Spassiani, 2018). Moreover, service organizations can also implement a number of low-cost options regarding nutrition and diet. “Person-centered education can also be utilized to inform people with IDD, their support people, and family about nutrition, and the effects it has on an individual’s health and overall well-being. Education can also be provided to staff to improve staff competencies in health and nutrition so that they are better able to support people with IDD and their nutritional needs… Organizations can also revise organizational policies to ensure they allow people with IDD to be involved in choosing what foods they eat and being able to prepare their own meals” (Friedman & Spassiani, 2018).