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Myth of a Medicaid Institutional Bias

The allegation of a Medicaid institutional bias for people with intellectual and developmental disabilities (I/DD) is simply not true. It is based on two false premises:  (1) that all institutional services are mandatory and all home and community-based services (HCBS) are optional, and (2) that more dollars are spent on institutional services than on HCBS services.


Cost Comparison Study

A 2003 peer-reviewed study of existing cost comparison literature and related 2009 Update found that community settings for persons with developmental disabilities are not always less expensive than facilities, as some advocates claim. (Walsh, et al., "Cost Comparisons of Community and Institutional Residential Settings: Historical Review of Selected Research, Mental Retardation, Volume 41, Number 2: 103-122, April 2003; See Summary and 2009 Update). Cost savings at the macro level are relatively minor when institutional settings are closed, and if there are any at all, they are likely due to staffing costs when comparing state and private caregivers. For a single copy of the original cost study, or to purchase a quantity of original reprints, contact Tamie Hopp at 877-399-4VOR; or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Connecticut: No cost savings if facility closes

Southbury Training School Press Release *  September 19, 2011

In studies done in 2002 and 2010, the state Department of Developmental Services projected high costs associated with closing the state-run Southbury Training School, and declined to project any significant savings in the closure.
The findings by the DDS are at odds with current statements by a number of Connecticut legislators and other policy makers that STS is prohibitively expensive to continue to operate and should be closed.
"We believe that when apples to apples are compared, the care provided at STS will be found to be cost effective," said Sally Bondy, president of the STS Home & School Association, a family-supported, nonprofit organization that is fighting to keep this critically important facility open for its current residents.  "In fact, we believe the DDS previously reached that same conclusion."
"No significant savings will ever result from the closure of Southbury (STS)," the 2002 DDS study flatly stated.   In a November 2010 update, which was provided to the incoming Malloy administration, DDS staff cited "substantial cost implications" in closing STS, which the update stated would be associated with "developing an infrastructure to accommodate a parallel service system in the community."  Read more.



Legislator Toolkit

This site aims to provide State and Federal Legislators, Officials and their staff with the information needed to make informed law and policy decisions on behalf of citizens with mental retardation and developomental disabilities. Resources which relating to lack of quality in some community settings, information about community versus facility costs, Olmstead and more are available through links within this summary, as well as in the articles to follow.
Given the diversity of persons within the developmental disability community, VOR strongly supports community expansion AND strongly objects to deinstitutionalization. We do not believe expanding desperately needed quality community options must or should come at the expense of individuals whose profound cognitive disabilities, medical needs, and behavioral challenges are best served in facility based settings (a/kl/a Intermediate Care Facilities for Persons with Mental Retardation; ICFs/MR; "institutions").
As the resources here will illustrate, often State's close facilities serving people with profound developmental disabilities believing money will be saved and care will be improved. As the resources here will show, rarely is money saved - the individuals leaving facilities have expensive needs no matter where they reside. If not adequately funded, community placements often fail, with tragic results.
Thank you for visiting VOR's website and its Toolkit for Legislators. Please come again.

Families' Arguments Against Closure

November 17, 2006
The Toronto Star

Families fighting to keep Ontario's remaining institutions open the concerns that follow.  In the full article, each concern is more full explained. Click here for the full article:

  • Increased mortality rates (see also, California Comparative Mortality Studies; scroll down to Compartive Mortality reference)
  • Lack of medical expertise
  • Family wishes
  • Higher hospitalization rates
  • Community systems strained
  • Queue jumping
  • No fallback when placements fail
  • Public attitudes oppose closing

Chamber of Commerce: Closure = Lost Revenue

On March 2, 2011, the Greater Topeka Chamber of Commerce testified against the closure of the Kansas Neurological Institute, a state operated ICF/MR, noting the human and fiscal impact of closure.

Fiscal Impact

"There are also the economic consequences to closing KNI. The Topeka Chamber commissioned an economic impact analysis of KNI's fiscal year 2010 spending, by Impact Data Source, Austin, TX. . . .KNI will have a significant impact on the Topeka area economy during FY 2010. KNI's revenues and expenditures and its employees and their salaries provide direct economy activity. In addition, this activity will ripple through the area's economy supporting indrect benefits including sales in local businesses and organizations, as well as indirect jobs and salaries. The estimated direct economic impact of KNI in FY 2010 was $28 million. The direct revenues of KNI, its spending and the spending of its workers will generate another $37 million in sales or economic output in area businesses and other organizations. In total, the economic impact of KNI in FY 2010 will be $66 million."

Human Impact

"KNI is a shining example of such important work on behalf of their client's families and all Kansans. The citizens that live at KNI are very fragile; ninety percent of their population is profoundly disabled, many with multiple disabilities. Thirty-five percent of the 156 residents cannot eat through their mouths. . . . These fragile Kansans need care around the clock; they need specialized medical & dental care, they need appropriate transportation, special equipment, maintenance, appropriate food and special means to provide nourishment. It is unlikely the community-based facilities already have this level of care available in their locations across the state. We believe providing appropriate care woudl again require cost shifts from KNI spending to community-based spending for specialized transportation, equipment, maintenance and other needs. . ."

The Chamber's Testimony and Economic Impact Report are here.

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