Bridging the Aging and Developmental Disabilities Service ... - rrtcadd

success in controlling health care costs led states such as Minnesota, Wisconsin, and Colorado to
begin including long-term services and supports in their managed care programs. States have
included segments of the Medicaid beneficiaries in managed health care to care for older persons
and people with developmental disabilities. In contrast, fewer states have been moving people
with developmental disabilities into Medicaid long-term care programs due to strong opposition
from disability advocates, DD professionals, and some providers, especially nursing homes, who
view managed care as an economic threat.
SUMMARY OF KEY ISSUES
The major reforms in health and long term supports nationally highlight the gaps and challenges
in addressing both the populations who age into disability and those who age with disabilities.
Both of these populations have similar needs for supports that are community based, personcentered,
and coordinated with their health care needs. Yet, unique needs exist for individuals
with developmental disabilities who require life-long supports. Also there are differences in the
structure and philosophies of the aging and DD networks. Previous efforts to bridge the two
systems have had mixed results and provide insights into fostering future collaborations. The
recent ADRC initiative offers us as example of the challenges in working across systems.
The following are key findings of this project:
People aging with developmental disabilities and their families have unmet
needs for health and long-term supports that will continue to grow as the
population ages.
• People with developmental disabilities consumed 72% of 2006 Medicaid waiver
expenditures although they accounted for only 40% of Waiver enrollees. They need
lifelong services and many individuals have extensive support needs. The 2008 average
expenditure per person was $42,896 for developmental disabilities, $9,510 for aged and
$18,043 for physically disabled Medicaid 1915(c) Waiver funded HCBS. 36
• People with developmental disabilities experience long waiting lists for services. In 2010,
268,220 people were on state wait lists for Medicaid 1915 (c ) HCBS DD waivers which
is double the combined wait list size for elderly adults and people with physical
disabilities, and their average waiting period for a waiver slot to open was three times as
long. The average waiting time to receive DD waiver serves is 36 months compared to 9-
13 months for the aged and disabled waivers. 36
• Approximately 1.36 million adults with developmental disabilities live independently or
with a spouse. Most probably do not receive DD services and after age 60, are likely to
be referred to the aging network for any needed supports and services. Emerging
Bridging the Aging and Developmental Disabilities Service Networks Page 40