Cross-Sectional Study: Factors Associated with having a Medicaid Waiver at Transfer to Adult Care for Individuals with Developmental Disabilities

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.