United States Medicaid home and community-based services for people with intellectual and developmental disabilities: A scoping review.
Kiley J McLean, Allison M Hoekstra, Lauren Bishop
PMID 33247520WHAT IT FOUND
Medicaid home and community-based services waivers for people with intellectual and developmental disabilities are associated with reduced unmet healthcare needs for children with autism, fewer parents stopping work to provide care, and lower psychiatric hospitalization risks when respite and aide services increase.
Key findings
01Medicaid home and community-based services waivers significantly decrease unmet healthcare needs for children with autism spectrum disorder and reduce the likelihood that a parent had to stop working to care for the child.
02Increasing respite and home and community aide services provided through Medicaid waivers decreased the risk of psychiatric hospitalizations for children, adolescents, and young adults with autism spectrum disorder.
03Families receiving services through Maryland’s Medicaid waiver programme reported higher family quality of life, improvement in independent living skills, and better employment status.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review included only seven studies, limiting the breadth of evidence. Most included studies focused on individuals with autism spectrum disorder rather than the wider intellectual and developmental disabilities population, so findings may not generalize to other disabilities. Scoping reviews do not assess the quality or risk of bias of the included studies. The included studies relied on administrative or survey data, which may not accurately capture all outcomes. The review could not establish causal relationships between policy changes and outcomes due to a lack of causal modeling in the source studies.
The easy way to misread this
Do not interpret these associations as proof that Medicaid waivers cause these improvements. The review explicitly states that the included studies lacked causal modeling, meaning the relationship between policy and outcome is correlational. Furthermore, the findings are heavily driven by studies on autism spectrum disorder and may not apply to all people with intellectual and developmental disabilities.