RISP Data Bytes

Background

Funding for support for people with IDD comes from a variety of funding sources (i.e. funding authorities). Medicaid Home and Community-Based Services (HCBS) fund supports for people with intellectual disabilities in home or community settings. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) are Medicaid-funded residential institutions for people with IDD. While Medicaid is most common source of funding, states may also other funding authorities to support residential and other services in their state. Some people with IDD receive supports through more than one funding authority. Annually, RISP collects data from states about which funding authorities they utilize to support individuals with IDD in their state.

Key Finding

In 2020, 50 states and the District of Columbia reported using one or more Medicaid State Plan funding authorities to support LTSS for people with IDD. Most state utilized Medicaid ICF/IDD funding (48 states) as well as other non-Medicaid funding (47 states). States varied on how their used their Medicaid HCBS waiver funding.

Bar graph showing the number of states with various funding authorities in 2020. 51 states (all of US plus DC) offered Medicaid Waiver-funded Home and Community Based Services (HCBS). 47 states offered 1915(c) HCBS Waivers. 13 states offered 1115 Demonstration Waivers. 7 states offered 1915(a), (b), or (b/c) Managed Care Waivers. 51 states offered a Medicaid State Plan service. 48 states had Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). 36 states offered targeted case management. 7 states offered 1915(i) state plan HCBS and another 7 offered 1915(k) Community First Choice. 26 states offered other state plan LTSS. 47 states offered state or locally funded non-Medicaid services. — Medicaid Long-Term Services and Support Recipients with IDD 1982 to 2020

Recommendations

Medicaid Home and Community Based Services (HCBS) is a critical lifeline for millions of people with disabilities nationwide. It is important for policy makers and the public to know about how their services are funded, and through which funding authorities. We should continue to develop and fund home and community options for all people with IDD. A range HCBS funding authorities facilitates more options for people with IDD to live in their communities.

Data Source

Larson, S.A., Neidorf, J., Begin, B.C., Pettingell, S., & Sowers, M. (2024). Long-term supports and services for persons with intellectual or developmental disabilities: Status and trends through 2020. Minneapolis: University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration.

Authors

Sheryl A. Larson, Kelly Nye-Lengerman and Jon Neidorf. The authors acknowledge the contributions by Jerry Smith, Sarah Curtner and John Smith to this product.

The RISP project gets funds from the Administration on Community Living, U.S. Department of Health and Human Services, Cooperative Agreement #90DNPA0006 with supplemental funding from the National Institutes on Disability, Independent Living and Rehabilitation Research Grant #90RTCP0011.

Abbreviations used: IDD Intellectual or Developmental Disabilities; HCBS Home and Community Based Services

Updated 7/15/25