Adults with dual diagnoses of intellectual and psychiatric disability receiving Medicaid Home and Community-Based Services (HCBS) and ICF/MR recipients in six states

This paper addresses the topic of intellectual disability and psychiatric disorder among persons receiving Medicaid Home and Community-Based Services (HCBS) and Intermediate Care Facility (ICF/MR) services. In June 2005 HCBS and ICF/MR programs financed long-term supports for nearly 545,400 persons with intellectual disabilities and other developmental disabilities at a fiscal year 2005 cost of $29.3 billion. This paper describes and compares characteristics and experiences of persons with and without diagnosed psychiatric conditions in addition to intellectual disability in a large, six state, 2720 person sample of HCBS and ICF/MR recipients. Nearly one-third (31.4%) of the sample had psychiatric disorders. Controlling for levels of intellectual disability, they were consistently more likely to be placed in ICF/MR programs and agency-operated congregate care settings, and were less likely to live with family members. They were much more likely to receive medications for mood, anxiety and/or behavior disorders than were persons with intellectual disability only (87% and 32%, respectively). Policy implications include the need to incorporate behavioral health services and supports into state Medicaid waivers for individuals with intellectual disabilities.