Medicaid Home- and Community-Based Services Waivers for People With Intellectual and Developmental Disabilities.

Friedman (2023) counted every Medicaid Home- and Community-Based Services waiver dollar spent on people with intellectual or developmental disabilities in 2021.

The team looked at all 50 states and added up costs for 861,038 people. They sorted spending into service types like residential help, day programs, and job supports.

Total spending hit $43.2 billion, or about $47,315 for each person.

The biggest slice paid for group homes and in-home aides. Day habilitation came next. Job services got a smaller share.

Domin et al. (2013) warned that only a large share of people with IDD hold real jobs. Carli’s numbers show waiver dollars still follow that pattern—most money goes to day and residential care, not work.

Wehman et al. (2014) proved supported employment raises job rates for youth with IDD. Carli’s data reveal the cash is there; it just isn’t flowing to those proven job models.

Barton et al. (2019) found kids use fewer than half of approved ABA hours. Carli’s report hints the same leak may hit adult services—funds are approved but may not reach clients.

You now have a price tag: $47k per client. Ask where it goes. If the goal is community work, shift more waiver funds toward supported or customized employment shown to work by Wehman et al. (2014) and Wilson et al. (2023). Track hours like Barton et al. (2019) did to be sure money turns into real services.