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Occupational Therapy Services in Medicaid HCBS Waivers

By Carli Friedman, CQL Director of Research

With the shift from institutional to community living, came an increased need for services that supported people with intellectual and developmental disabilities (IDD) in the community. Occupational therapy (OT) services are one such mechanism to develop the necessary supports to promote community integration. In addition to helping with daily living skills, OT services can include environmental interventions and community inclusion programs – both of which facilitate community integration. For these reasons, the aim of this study was to explore the national service provision of OT 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 OT services to people with IDD.

Findings revealed approximately $14.13 million was projected for the OT services of approximately 7,500 people with IDD in FY 2015. The majority (70%) of those participants were expected to receive less than $2,000 of OT services annually; however, the average annual spending per person varied widely by state (see figure).

Average Annual Spending Per Person By State

Despite the relatively low utilization rate (39%) of OT services in HCBS waivers nationally, waivers may be a particularly useful mechanism for these important services. Unlike state plans that typically cover short-term immediate care, many states in our study utilized waivers to provide long-term OT services, including services provided outside of traditional clinical settings, such as people with IDD’s homes, or in the community. In order to expand the community inclusion of people with IDD, states should expand their provision of OT services in HCBS waivers. Doing so will strengthen the LTSS community infrastructure.

This article is a summary of the following journal manuscript: Friedman, C., & VanPuymbrouck, L. (2018). Occupational therapy in Medicaid home and community-based services waivers. The American Journal of Occupational Therapy, 72(2), 7202205120p1-7202205120p9.