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Penetration Rates in Participant Direction

Post by: Marc Fenton 

We have long observed that there are different penetration, or utilization rates in participant direction across the country. We know there are many reasons for this: state program priorities, budgets and waivers for new services, impact of advocates, legislative politics, state leadership, But we also know that there are differences among populations who are served.  In a recent international conference presentation Val Bradley, President of the Human Services Research Institute in Cambridge, MA, presented national data on penetration rates for participants with developmental and intellectual disabilities.  Val stated that these rates have plateaued at 8% to 10% nationally. Looking at the data that PCG-Public Partnerships has collected from various states shows that the population with DD and IDD is usually in the single digits. In contrast, the penetration rates of those with disabilities and problems of aging are much higher -up to 40% to 45%.  

The Wyoming RFP we recently received calls for a proposal to serve both populations. We are currently serving 343 participants in the DD/IDD waiver, or about 15% of those eligible.  For the long term care waiver serving elder and disabled the population served is 1542 or a penetration rate of 41%.  This is a state that has been prominent in offering self-direction as a choice to both populations.

In a recent conversation with Nancy Thaler, the new PA Assistant Secretary of the Office of Persons with Disabilities (OPD), agreed with my observation of different penetration rates and offered a clear and insightful reason why. “People who are aging or disabled are looking to maintain their independence as they age; they don’t want to lose any elements of independence.  Self –direction is an easy sell because it promises them continued independence” she observed. “People with intellectual and developmental disabilities are usually receiving services, often substantial services, and they and their families feel they are at risk of losing services if they self-direct.  It is a risky sell.”  I think she is right.