BACKGROUND: Day and employment services provided by state intellectual and developmental disabilities (IDD) agencies, with funding from Medicaid Home and Community Based Services (HCBS), have shown little growth in the employment rate of people with IDD. In attempt to prepare individuals with IDD for employment, prevocational services may be provided. The goal of prevocational is to develop or improve the job and non-job skills, develop work tolerance, and increase preparedness to have a job in a community based and/or competitive setting. OBJECTIVE: The aim of this study was to examine how prevocational services were allocated in HCBS 1915(c) waivers for people with IDD across the United States in fiscal year (FY) 2014. METHODS: 111 HCBS IDD waivers were examined to determine if and how they provided prevocational services. Prevocational services were then compared to determine projected expenditures and service utilization. RESULTS: In FY 2014, approximately $750 million of funding was projected for prevocational services of approximately 87,500 participants; projected allocation varied widely by state and service. CONCLUSIONS: Without a clear pathway to competitive integrated employment, the very notion of prevocational services does not necessarily fit well within shifting policy paradigms that prioritize inclusion, competitive wages, and funding for integrated employment.
- intellectual and developmental disabilities
- Medicaid Home and Community Based Services (HCBS) 1915(c) waivers; community living
- Prevocational services