Understanding the I/O Waiver in Developmental Disabilities
Learn about the Individual Options (I/O) Waiver, a Medicaid waiver for individuals with developmental disabilities, providing services in their homes instead of facilities. Explore demographics, medical expenses, dual-diagnosis, and clinical condition groups related to the I/O Waiver program.
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Presentation Transcript
Cost of Serving People on an Individual Options (I/O) Waiver Joslyn R. Tijerina, MPH
Study Population December 2015 snapshot of all individuals with an I/O Waiver 19,371
What is the Individual Options (I/O) Waiver? Medicaid waiver for people who have developmental disabilities Allows eligible people to receive the services and supports in their homes, rather than live in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) A more comprehensive waiver, as it has a higher funding limit and was developed to meet individualized needs
Demographics of I/O Waiver Individuals Sex Age 2 to 4 5 to 13 14 to 18 19 to 20 21 to 44 45 to 59 60 to 64 65 to 74 75 to 84 85+ Count 1 228 723 465 8,869 5,589 1,398 1,401 333 62 Female 8,105 Male 11,266 *2 individuals with unknown age
Medical Expenses of Those on I/O Waivers In CY 2015, $1.5 billion was spent by Medicaid on the I/O Waiver participants Average Cost Per Person: $78,218.20 Distribution of Costs Medical Services 15% Case Management & Waiver Services 85%
What Do We Mean by Dual-Diagnosis in this Study? Medicaid Data Warehouse (QDSS) has 9 Mental Health Clinical Conditions groups pre-identified as behavioral health diagnoses Dual-Diagnosis Person has an I/O Waiver Person has at least one pre-identified behavioral health diagnosis
What are the Clinical Condition Groups? Clinical Condition Example Diagnoses Antisocial personality disorder, Pyromania, Homicidal ideation, Socialized conduct disorder Mental Hlth-Antisocial Behav Mental Hlth-Anxiety Disorder Generalized anxiety disorder, Panic disorder Mental Hlth-Bipolar Disorder Bipolar disorder, Manic disorder Mental Hlth-Depression Major depressive disorder, Adjustment disorder Social phobia, Personality Disorder, Gender Identity disorder, Pica, Insomnia, ADD/ADHD, Developmental delay Mental Hlth-Obsess-Compulsiv Obsessive-compulsive disorder, Fluency disorder Delirium, Dementia, Paranoid state, Psychosis, Pervasive developmental disorder Mental Hlth-Schizophrenia Schizophrenias Alcohol and/or drug withdrawal, addiction, dependence, poisoning, and/or abuse, Alcoholic cirrhosis Mental Hlth-Neuroses, NEC Mental Hlth-Psychoses, NEC Mental Hlth-Substance Abuse
Behavioral Health Diagnosis: Yes or No? 12000 10,807 Number of individuals served 10000 8,555 8000 6000 4000 2000 0 No behavioral health diagnosis At least one behavioral health diagnosis *9 people excluded
Total Medicaid Costs for I/O Waiver Individuals $1,000,000,000 $949,465,124.47 $900,000,000 $800,000,000 $700,000,000 $564,941,216.50 $600,000,000 $500,000,000 $400,000,000 $300,000,000 $200,000,000 $100,000,000 $- No behavioral health diagnosis At least one behavioral health diagnosis
Average Medicaid Costs Per Person $100,000 $87,856.49 $90,000 $80,000 $78,218.20 $66,036.38 $70,000 $60,000 $50,000 $40,000 $30,000 $20,000 $10,000 $- No behavioral health diagnosis At least one behavioral health diagnosis
Number of Individuals with each Behavioral Health Diagnoses 4,000 3,705 3,500 3,141 3,123 3,000 Number of individuals served 2,500 2,185 2,000 1,774 1,738 1,603 1,500 1,000 622 500 225 0 Neuroses, NEC Psychoses Depression Bipolar Schizophrenia Antisocial Personality Disorder Anxiety Obsessive - Compulsive Substance Abuse Behavioral Health Diagnoses
Total Medicaid Cost Compared to Average Per Person by Behavioral Health Diagnoses $350,000,000 $120,000 $300,000,000 $100,000 $250,000,000 Average Per Person Cost $80,000 Total Medicaid Cost $200,000,000 $60,000 $150,000,000 $40,000 $100,000,000 $20,000 $50,000,000 $0 $0 Neuroses, NEC Psychoses Depression Bipolar Antisocial Personality Disorder Schizophrenia Anxiety Obsessive Compulsive Substance Abuse Medicaid Cost Average Per Person
Average Medicaid Cost Per Person by Behavioral Health Diagnoses $120,000 $100,000 $80,000 $78,218.20 $60,000 $40,000 $20,000 $0 Antisocial Schizophrenia Bipolar Psychoses Substance Abuse Neuroses, NEC Obsessive - Compulsive Depression Anxiety
Conclusion Developmentally disabled individuals on an I/O waiver with at least one behavioral health diagnoses have higher average Medicaid costs I/O Waiver individuals with Neuroses (NEC), Psychoses, and Depression had the highest total Medicaid costs The average cost per person was highest for Antisocial Personality Disorder, Schizophrenia, and Bipolar
Limitations Data is representative only of Ohio DODD population with Medicaid Data may look different in other states or within counties or regions of Ohio Clinical conditions were defined by Medicaid and are very broad
Future Analyses In the future, it would be beneficial to repeat this analysis and compare outcomes based on: Age Ohio Region/County Other States
Thank You! Questions? Contact us! Hope McGonigle: hope.mcgonigle@dodd.ohio.gov Joslyn Tijerina: joslyn.tijerina@dodd.ohio.gov Arati Sharma: arati.sharma@dodd.ohio.gov
