R-3, HCBS Waiver: Economic Utility and Related Health Outcomes

Measuring the Relationship Between HCBS and Health

What's the Bottom Line?

This project creates an assessment model that state Medicaid programs can use to monitor the cost effectiveness and health outcomes of people with disabilities who are on a Home and Community-Based Services (HCBS) waiver.


People with disabilities continue to have unacceptably high rates of disease. Major health disparities continue despite the implementation of the Americans with Disabilities Act and increased awareness of the health of individuals with disabilities.

This project is based on these hypotheses:

  • Health care use and expenditures for individuals with physical disabilities will decrease when they move into a community setting using the HCBS waiver.
  • Secondary health conditions will also decrease when they move into a community setting using the HCBS waiver.
  • A person’s level of community participation influences the extent of health care use and expenditures.

Likewise, the extent of health care need and use influences the level of community participation among people with physical disabilities.

How This Research Will Improve Community Participation for People with Disabilities

By measuring the relationship between health, personal assistance services and community participation, we can identify areas of concern to individuals with disabilities and advocate for change in those areas. In addition, we can use our relationships with state partners to create interventions that directly address these areas of concern.

What We’ve Learned So Far

  • People with disabilities are significantly more likely to report a poor or fair health condition (37.44% vs. 5.36%) and less likely to report an excellent or very good health condition (29.38% vs. 68.25%) than those without disability.
  • People with disabilities have a greater prevalence of disease risk factors than those without disabilities.
  • Prevalence rates for major disease categories were higher for people with disabilities than for those without disabilities.
  • Diabetes is of special concern. A person with a disability has a 6.64 greater chance of developing diabetes than a person without a disability.
  • Women with disabilities were significantly less likely to receive a Pap smear and mammogram than women without a disability (70.4% vs. 83.8% for Pap smear, 69.3% vs. 73.7% for mammogram).

For more information, contact Amanda Reichard, Ph.D., reichard@ku.edu; Martha Hodgesmith, J.D., marthah@ku.edu; or the Research and Training Center on Measurement and Interdependence in Community Living at the RTC/IL, 4089 Dole, 1000 Sunnyside Avenue, Lawrence, KS 66045, Phone: 785-864-4095 (voice), 785-864-0706 (TTY)


National Institute on Disability and Rehabilitation Research grant H133B060018