How well states' Medicaid programs perform in serving people with mental retardation and developmental disabilities is not necessarily linked to funding levels or a state's tax burden, an advocacy group said in a March 22 report.

The group, United Cerebral Palsy, ranked the states in how they are serving this population, and found that the key factor is whether a state "prioritizes community inclusion with its funding."

UCP said high tax burdens do not necessarily buy better results, and a key factor is not whether Republicans or Democrats control the governor's office and the state Legislature. "High and low rankings cut across party lines," the report said.

States doing the best include top-ranked New Hampshire, followed by Maine, Massachusetts, Vermont, Alaska, Nebraska, Washington, and Delaware. States doing the worst include lowest-ranked Texas, as well as Mississippi, Virginia, Louisiana, Florida, and Illinois, the report said.

Large Institutions v. Community Services

An example of a problem, according to the group, is that too much funding for individuals with mental retardation and developmental disabilities (MR/DD) "is directed at large institutions rather than community-based services."

"Like all Americans, individuals with MR/DD deserve to live in the community and experience a quality, meaningful life. Medicaid can play a crucial role in making that a reality," the report said. "However, the experiences of individuals throughout the 50 states and the District of Columbia show that this goal is not always the reality."

The report said that nationwide, Medicaid serves almost 530,000 individuals with MR/DD, spending $27.4 billion in fiscal year 2004 or almost $52,000 per person per year. "Although this is a tiny portion of the 41.3 million individuals enrolled in Medicaid and the total $288 billion spent in FY2004 (about $7,000 per person per year), Americans with disabilities such as MR/DD are some of the most vulnerable Medicaid recipients."

The report said individuals with MR/DD make up just 1.3 percent of all Medicaid recipients, but 9.5 percent of Medicaid spending. "Despite these figures, too often this population is glossed over in the larger Medicaid discussion," the report said.

The report also said many states are not helping individuals make a transition from Medicaid to work. For example, just 27 states have "a Medicaid buy-in" for people with disabilities who are working, the report said. However, the report noted that three more states passed legislation in 2005 to apply for a federal waiver allowing this buy-in, which the group said allows people to work, grow income, and improve the quality of their lives while still receiving Medicaid coverage.