By Carli Friedman, CQL Director of Research
Environmental modifications are changes made to physical environments to improve accessibility. For example, a bathroom may be remodeled so what a wheelchair-user can wheel into a shower or reach the sink. Vehicles may also be adapted to add adaptive steering and braking. While inaccessible environments can hinder the inclusion and quality of life of people with intellectual and developmental disabilities (IDD), environmental modifications can promote independence and opportunities. For these reasons, the aim of this study was to examine how states provided environmental modifications for people with IDD in their Medicaid Home- and Community-Based Services (HCBS) programs. To do so, we analyzed fiscal year (FY) 2021 Medicaid HCBS waivers from across the nation.
We found 78% of states provided environmental modifications for people with IDD. They did so to help promote health and safety, increase independence, prevent institutionalization, and promote community integration. The most common examples of environmental modifications were:
- Ramps/lifts
- Widening doorways/hallways
- Bathroom modifications
- Specialized electrical/plumbing for medical equipment
- Grab bars/handrails
- Specialized windows or doors
- Emergency devices, alarms, and detectors
- Adaptive vehicle seating
In FY 2021, a total of $68.8 million of spending was projected for environmental modifications for 12,671 people with IDD. While this seems like a significant amount of money, average spending per person on environmental modifications was relatively small, at $6,297 per person (see figure below). This money which helps keep people in their homes is significantly more cost effective than institutions, which cost $140,000 per person on average (Larson et al., 2022).
Environmental Modifications: Average Spending Per Person
“Most people with IDD want to live in their own home. However, only 1% of the current housing stock in the United States has even the most basic accessibility features… Environmental modifications for people with IDD aligns with Medicaid HCBS’s aims to promote the community integration, self-determination, and independence” (Friedman & VanPuymbrouck, 2024).
References
- Friedman, C., & VanPuymbrouck, L. (2024). Environmental modifications for people with intellectual and developmental disabilities: A policy analysis of Medicaid Home-and Community-Based Services. The American Journal of Occupational Therapy, 78(3), 7803205090. https://doi.org/10.5014/ajot.2024.050393
- Larson, S. A., van der Salm, B., Pettingell, S., Sowers, M., & Anderson, L. L. (2022). In-home and residential long-term supports and services for persons with intellectual or developmental disabilities: Status and trends 2019. University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration.
This article is a summary of the following journal manuscript: Friedman, C., & VanPuymbrouck, L. (2024). Environmental modifications for people with intellectual and developmental disabilities: A policy analysis of Medicaid Home-and Community-Based Services. The American Journal of Occupational Therapy, 78(3), 7803205090. https://doi.org/10.5014/ajot.2024.050393
Environmental Modifications for People with IDD in HCBS