Abstract
Abstract:
Background: Home and Community-Based Service Medicaid waivers may reduce unmet healthcare needs for individuals with Intellectual and Developmental Disabilities (IDD). However, whether certain groups of individuals are relatively disadvantaged in accessing Medicaid waivers is unclear.
Objectives: This cross-sectional study aimed to identify factors associated with having an active state waiver at the time of establishing adult care in a medical home for adults with IDD.
Methods: Electronic medical records of individuals with IDD aged 19 and up including templated social work and clinician notes at the time of establishing care with a single-center medical home for adults with IDD were reviewed to determine if they had an active waiver and record clinical and demographic variables. Logistic regressions were used to test the associations between patient factors and having an active waiver.
Results: 1042 patients were included with 524 (50.3%) having an active waiver. Older age (adj. OR 1.91, 95% CI: 1.47, 2.47), having Medicaid (adj. OR 7.29, 95% CI: 3.55, 14.98), and requiring a feeding tube (adj. OR 2.16, 95% CI: 1.45, 3.23), ventilator (adj. OR 3.35, 95% CI: 1.21, 9.28), wheelchair (adj. OR 1.65, 95% CI: 1.20, 2.26), or vagal nerve stimulator (adj. OR 2.53, 95% CI: 1.16, 5.55) were more likely to have an active waiver. Hispanics (adj. OR 0.46, 95% CI: 0.34, 0.64) and Asians (adj. OR 0.43, 95% CI: 0.21, 0.89) were both less likely to have an active waiver than Non-Hispanic Whites. Individuals with Down syndrome (adj. OR 0.67, 95% CI: 0.45, 0.98) and those with intellectual disability (adj. OR 0.52, 95% CI: 0.34, 0.81) were also less likely to have an active waiver.
Conclusions: This study highlights the need to identify barriers and facilitators influencing access to waiver enrollment for individuals with IDD.
Key Take Away Points
- In a single-center adult IDD clinic in Texas, only 50% of young adults establishing care had an active state waiver demonstrating an opportunity to increase access to home and community-based services.
- Hispanics and Asians were less likely to have a waiver indicating a need for culturally competent strategies to increase waiver access in these groups.
- Those without technology dependence were less likely to have a waiver indicating a need to increase access to home and community-based services for this group of individuals with IDD.
Author Biography
Ellen Fremion, MD is a combined trained Internal Medicine and Pediatrics physician and a clinic director at the Baylor Transition Medicine Clinic, a medical home for adults with IDD. Ananth Panchamukhi is a medical student at Baylor College of Medicine and a member of the student chapter of the American Academy of Developmental Medicine and Dentistry. Kristen A Staggers, MS is a Senior Biostatistician at the Baylor College of Medicine Institute for Clinical & Translational Research. Taylor Mann is a physician assistant student at Baylor College of Medicine. Ambrielle Davis, MSN, APRN, FNP-C is a nurse practitioner at the Baylor Transition Medicine Clinic. Tiffany Castenell, LMSW is a Medical Social Worker at the Baylor Transition Medicine Clinic. Samuel Garcia, LMSW, LCDC is an Instructor and Senior Medical Social Worker at the Baylor Transition Medicine Clinic.
Recommended Citation
E Fremion, A Panchamukhi, KA Staggers, et al. (2025) "Cross-Sectional Study: Factors Associated with having a Medicaid Waiver at Transfer to Adult Care for Individuals with Developmental Disabilities," Journal of Applied Research on Children: Informing Policy for Children at Risk: Vol. 14: Iss. 2, Article 7.DOI: https://doi.org/10.58464/2155-5834.1535
Available at: https://digitalcommons.library.tmc.edu/childrenatrisk/vol14/iss2/7
