By Carli Friedman, CQL Director of Research
Speech, language, and hearing services can help facilitate the communication skills of people with intellectual and developmental disabilities (IDD), as well as their communication partners through the use of augmentative and alternative communication systems, training, and education. As such, speech, language, and hearing services can result in not only increased language comprehension and expression, but also social interaction and community participation. The Communication Bill of Rights purports that all people have “the right to access supports and services that facilitate their equitable participation in daily communication interactions, including those impacting their health and medical services” (Friedman & McNamara, 2018, p. 113). For these reasons, the aim of this study was to explore the national service provision of speech, language, and hearing services in Medicaid Home and Community Based Services (HCBS) waivers as they are the largest funding mechanism 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 speech, language, and hearing services to people with IDD.
Findings revealed, in FY 2015, approximately 13,000 people with IDD were estimated to receive speech, language, and hearing services via HCBS waivers. A total of $23.1 million was projected for speech, language, and hearing services for people with IDD (see figure 1). While this may seem like a lot, it amounted to less than 0.1% of all HCBS IDD waiver spending in 2015. Moreover, only 2% of IDD waiver participants were estimated to receive these services, despite the prevalence of speech, language, and hearing disorders being approximately 10%.
Total Projected Spending on Speech, Language, and Hearing Services
The average spending per person ranged widely per service from $19 to $9,306, with the majority of services (70%) projecting less than $2,000 per person annually (see figure 2). The majority of people with IDD receiving these services (60%) were projected to receive between 1 to 50 hours of speech, language, and hearing services annually (see figure 3).
Average Annual Service Provision Per Participant
Average Spending Per Participant
“Given the crucial role that communication plays in key aspects of independent living, like interpersonal relationships, safety, and employment, speech, language, and hearing services offered through HCBS waivers are an essential element of equitable access to autonomous living for people with IDD. Despite this, current allocation of speech, language, and hearing services through HCBS waivers are not only unreliable from state to state, but are insufficient overall when compared to national bench markers, like the MPFS, which serves as a standard for reimbursement by third-party payers. Such a discrepancy in reimbursement reflects a depreciation of speech, language, and hearing services offered in community-based settings… Speech, language, and hearing are essential to ensure [people with disabilities] right to a self-determined autonomous life through communication” (Friedman & McNamara, 2018, pp. 120-122).