By Carli Friedman, CQL Director of Research
Physical therapy (PT) services can enhance the community participation of people with intellectual and developmental disabilities (IDD) both directly through accessibility technology provision, pain management, secondary impairment prevention,environmental modification, and indirectly through its byproducts, such as confidence, reduced depression risk, and self-efficacy. Because of the benefits of PT services for community participation of people with IDD, among others, the aim of this study was to explore the national service provision of PT 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 PT services to people with IDD.
Findings revealed approximately $17.4 million was projected for PT services for approximately 8,500 people with IDD in FY 2015. The majority (72%) of those participants were expected to receive less than $2,000 of PT services annually; moreover, 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 (<.01% of all HCBS spending) of PT services in HCBS waivers nationally, waivers may be a particularly useful mechanism for these important services as, unlike state plans that cover short-term acute care, many states utilized waivers to provide long-term PT services, including services provided outside of traditional clinical settings, such as people with IDD’s homes, or in the community. Yet, despite legislation and litigation that supports community integration, such as Olmstead v LC and the Medicaid HCBS settings rule, as well as other advocacy work by people with disabilities and their allies, based on our findings, it appears there has been limited progress in expanding HCBS waiver PT services for people with IDD.