Assistive technology for people with intellectual and developmental disabilities in the United States in Home- and Community-Based Services

Abstract

Purpose

Unmet needs for assistive technology (AT) contribute to health and quality of life disparities among people with intellectual and developmental disabilities (IDD) [1–4]. The biggest barrier people with IDD face accessing technology is affordability and a lack of funding [1,3–6]. The purpose of this study was to examine how AT were provided to people with IDD in Medicaid Home- and Community-Based Services (HCBS) in the United States, the largest funding source for Long-Term Services and Supports for people with IDD.

Materials and methods

We analysed Medicaid HCBS 1915(c) waivers for people with IDD from across the USA in fiscal year (FY) 2021 using content analysis and descriptive statistics.

Results and conclusions

In FY2021, 31 states and the District of Columbia provided AT (stand-alone and combined services) through 68 waivers for people with IDD to improve functioning, communication, independence, and community integration. In total, $63.3 million was projected for the AT services for 23,753 people with IDD. Average spending per person on AT services was $2,663. We found significant variability in terms of how states allocated AT to people with IDD in their HCBS programs. Not only were less than 3% of people with IDD with HCBS projected to receive assistive technology services, there was also large variance across services and states. Assistive technology promotes the health, safety, quality of life, independence, and community integration of people with IDD – they align with the very aims of HCBS, and thus, should be expanded.

Implications for Rehabilitation

• Only a small proportion of people with intellectual and developmental disabilities (IDD) were projected to receive assistive technology (AT) in Home- and Community-Based Services (HCBS), which may result in unmet needs among people with IDD.

• Wide variability in how states allocate AT in their HCBS waiver programs can lead to discrepancies and disparities.

Keywords:

• People with intellectual and developmental disabilities
• assistive technology
• Medicaid Home- and Community-Based Services (HCBS)
• long-term services and supports (LTSS)

Acknowledgements

Thank you to Mary Kay Rizzolo for reviewing this manuscript and providing feedback.

Geographic location

Data from this study are about the USA.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data are available at Medicaid.Gov.

Notes

1 Intellectual disability is defined as “Significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18” while developmental disability is “A severe, chronic disability of an individual that: (a) is attributable to a mental or physical impairment or a combination of mental and physical impairments; (b) is manifest before the individual attains age 22; (c) is likely to continue indefinitely; (d) results in substantial functional limitations in 3 or more major life activity areas; and (e) reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, and other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated” [7, p. 224]. An estimated 7.4 million people in the United States had IDD as of 2019 [8].

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.