By Carli Friedman, CQL Director of Research
The COVID-19 pandemic hit people with intellectual and developmental disabilities (IDD) and the Home- and Community-Based Services (HCBS) system hard, destabilizing the lives of people with IDD significantly. To help improve the quality of services and quality of life of people with IDD during the pandemic, many states temporarily increased their HCBS reimbursement rates and offered retainer payments using Appendix K. The aim of this study was to examine if states’ expanded pandemic payments translated to improved continuity and security among people with IDD during the pandemic. To do so, we analyzed Personal Outcome Measures® interviews from 738 people with IDD who received HCBS, and Appendix K data reimbursement data from the 16 states the people with IDD lived in.
The odds of people with IDD experiencing continuity and security during the pandemic increased by 2.5% for every 1% states increased their HCBS reimbursement rates (see figure below). For example, controlling for all demographics, when a person with IDD lived in a state that increased HCBS reimbursement rates by 10%, the probability of that person experiencing continuity and security was 16.2%. In contrast, when a person with IDD lived in a state that increased HCBS reimbursement rates by 40%, the probability of that person experiencing continuity and security was 28.8%. In addition, when states offered retainer payments, the odds of people with IDD experiencing continuity and security increased by 398% compared to when states did not offer retainer payments.
The Relationship Between Payment Rates and Continuity and Security of People with IDD
“Our findings suggest policy decisions not only directly impact people with IDD’s lives, but also that HCBS spending can help increase the stability of the service system, including in times of crisis. Investing in HCBS is an investment in the quality of life of people with IDD” (Friedman, 2022, p. 9).