Exploring the role of prevocational services for people with intellectual and developmental disabilities in Medicaid HCBS waivers

Carli Friedman, Kelly Nye-Lengerman

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)127-138
Number of pages12
JournalJournal of Vocational Rehabilitation
Issue number1
StatePublished - Jan 1 2018

Bibliographical note

Funding Information:
Funds for this project were provided by a subcontract from the State of States in Developmental Disabilities project at the University of Colorado, School of Medicine. The State of State in Developmental Disabilities project is funded by the Administration on Developmental Disabilities in the U.S. Department of Health and Human Services (HHS). Portions of this publication were also supported by Cooperative Agreement #H133B080005 from the National Institute on Disability Independent Living and Rehabilitation Research (NIDILRR), within the Administration for Community Living (ACL), Department of HHS, which was awarded to the Research and Training Center on Community Living (RTC-CL) at the University of Minnesota. The content is solely the responsibility of the authors and does not necessarily represent the official views of the HHS and you should not assume endorsement.


  • intellectual and developmental disabilities
  • Medicaid Home and Community Based Services (HCBS) 1915(c) waivers; community living
  • Prevocational services


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