By Carli Friedman, CQL Director of Research
Transportation plays a critical role in the health, community integration, and quality of life of people with intellectual and developmental disabilities (IDD). It helps people access healthcare services, run errands, and integrate into their communities. Despite these benefits, many people with IDD have a lack of access to transportation. For these reasons, the aim of this study was to explore how states allocated transportation services for people with IDD in their HCBS programs. To do so, I analyzed HCBS 1915(c) waivers from across the nation for fiscal year (FY) 2021.
I found all states used HCBS to provide transportation to people with IDD, making HCBS a critical mechanism to reduce people with IDD’s unmet needs for transportation. About one-third of people with IDD were projected to receive stand-alone transportation services, which is services that exclusively provided transportation supports. In addition, transportation was also embedded within other services, often included with residential habilitation and employment services. While allowing these types of services to include transportation can be helpful, given they only allow transportation for specific reasons (e.g., to go to/from work), stand-alone transportation services may allow people with IDD to have more flexibility to travel in a person-centered way.
People with IDD Projected to Receive Stand-Alone Transportation Services
In addition, there were large differences in how stand-alone transportation was implemented across waivers and states. For example, average annual spending per person ranged from only $192 in a year in New Jersey to $7,839 in a year in New Hampshire. It is also important to note that, although reimbursement methods varied, people with IDD were projected to only receive an average of 2,333 miles of stand-alone transportation a year. While this may seem significant, the United States Bureau of Transportation Statistics estimates the average person in the United States travels 14,500 miles in vehicles a year. Even when HCBS was used to provide public transportation tickets, people were projected to only receive less than 1 ticket a day on average.
Average Miles Per Person Allocated in HCBS vs National Average
“Turnbull and Turnbull call the lack of available, accessible transportation for people with disabilities ‘symbolic of dependence and second-class citizenship’ (p. 111). Indeed, unmet transportation needs hinder people with IDD’s community integration, social well-being, health, and independence… The large variation across states, waivers, and services unearthed in our study may contribute to unmet needs and service disparities… Everyone that needs access to transportation should have it; as such, there should be an expansion of transportation services in HCBS” (Friedman, 2024).
This article is a summary of the following journal manuscript: Friedman, C. (2024). Transportation for people with intellectual and developmental disabilities in Home- and Community-Based Services. Disability and Health Journal. https://doi.org/10.1016/j.dhjo.2024.101708
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HCBS is an Important Vehicle to Provide Transportation to People with IDD