Factors associated with expenditures for medicaid home and community based services (HCBS) and intermediate care facilities for persons with mental retardation (ICF/MR) services for persons with intellectual and developmental disabilities.

Charlie and the team looked at Medicaid bills for adults with intellectual or developmental disabilities. They compared two service types: home-and-community-based care (HCBS) and large state-run centers (ICF/MR).

The study pulled one year of cost data from every state. No new treatment was tested; the researchers simply added up what Medicaid already spent.

HCBS cost about half as much as ICF/MR each year. The average HCBS bill was $62,000, while the average center bill was $128,000.

Family-based HCBS was the cheapest of all. When the adult lived with family or a host family, savings were biggest.

Shearn et al. (1997) saw the same pattern in Northern Ireland: community care beat hospital costs. Their data came ten years earlier, so Lakin et al. (2008) acts as a later US mirror.

Clarke et al. (1998) in Wales also found community housing outperformed traditional services. Yet both older papers warn that spending more inside the same setting does not buy better outcomes. Charlie’s dollar figures now give US planners hard numbers to weigh.

Schieltz et al. (2020) shift the lens to telehealth, showing how modern tools can keep people in cheap community slots. Together the four papers trace a line: move care out of large buildings, then use tech to keep it there.

If you write budgets, transition plans, or waiver applications, wave this $66,000 gap at funders. Push for family or host-family placements first; the data say they drain the least cash. Pair those slots with telehealth coaching as Schieltz et al. (2020) suggest and you hold quality up while costs stay down.