Individuals with intellectual and developmental disabilities (IDD) represent a diverse group of people with significant personal care and medical needs, often relying on Medicaid and other federal healthcare services to survive. Changes to Medicaid could have serious implications on the lives of this population. In recent health care reform discussions, it has been argued that Medicaid expansion diverted funds from services for individuals with IDD.


The Center for Epidemiological Research for Individuals with Intellectual and Developmental Disabilities (CERIIDD) conducted an analysis of the Coleman Institute’s states’ fiscal effort for services for individuals with IDD per $1,000 of personal income between 2013 and 2015. The analysis focused on changes in fiscal effort between 46 states and Washington D.C., 25 states who expanded Medicaid on January 1, 2014, and 21 states who did not expand Medicaid during the three-year study period. Five states were excluded from the analysis because their Medicaid expansion was put into effect after 1/1/2014.

Results and Discussion

Over the three-year period, expansion states increased their fiscal effort by 4%, while non-expansion states remained flat (Figure 1). In each year of the study, expansion states had higher average fiscal effort than non-expansion states (Figure 2). Throughout the three-year period, the fiscal effort in non-expansion states represented a fraction of expansion states’ fiscal efforts. In 2013, non-expansion states’ fiscal effort represented 82% of the expansion states’ fiscal effort, then decreased to 79% in 2014, and 78% in 2015. Fiscal effort for services for individuals with IDD remained higher in expansion states than non-expansion states. This analysis does not support the assertion that Medicaid expansion hindered these state’s ability to fund services for individuals with IDD.

Data Brief: Fiscal Effort for IDD Services Pre- and Post- Medicaid Expansion (pdf)