Edinburgh Napier University

  Background. People with intellectual and developmental disabilities (IDD) experience significantly poorer health outcomes and a shorter life expectancy when compared to the general population. People with IDD are also more likely to become over weight or develop obesity because of poor nutrition and lack of education. Due to the health disparities that people with IDD experience and the high prevalence of developing obesity it is important that preventive health measures, such as cost-effective nutrition interventions and services, are readily available.
Specific Aims. The aim of this study is to explore how Medicaid Home and Community Based Services (HCBS) 1915(c) waivers – the largest providers of long term services and supports for people with IDD – across the United States provided dietician services for people with IDD.
Method. This study analyzed fiscal year (FY) 2015 HCBS waivers for people with IDD from across the United States (n = 111) to determine how dietary services were provided, particularly focusing on service utilization and expenditures, including unduplicated participants, total projected spending, average spending per participant, reimbursement rates, and average annual service provision per participant. Services’ definitions were also analyzed for trends.
Findings. We found that dietician services were not widely provided in HCBS waivers – less than 1% of the approximately 630,000 people with IDD supported by HCBS waivers in FY 2015 were projected to receive dietician services. Moreover, despite being useful for health promotion, .01% of FY 2015 funding ($26.5 billion) was projected for dietician services. There was also a lack of consistency across states and services
Discussion. People with IDD who do not receive support services are less likely to engage in health services or health promotion activities and more likely to develop secondary conditions;for this reason, it is imperative that states utilize HCBS waivers to provide dietician services.