Minnesota drops rank in new inclusion report

Stagnant or declining investments in state programs that help individuals with intellectual and developmental disabilities lead more independent and productive lives have resulted in Minnesota dropping from 7th place in 2015 to 21st place today in state rankings, according to the Case for Inclusion. The report is compiled by the ANCOR Foundation and United Cerebral Palsy (UCP).

The report, The Case for Inclusion 2019, ranks all 50 states and the District of Columbia on how well state programs, primarily Medicaid, serve people with intellectual and developmental disabilities. The states are ranked in five key areas critical to the inclusion, support and empowerment of individuals with intellectual and developmental disabilities and their families. The five areas are promoting independence, promoting productivity, keeping families together, serving those in need, and tracking health, safety and quality of life.

“This report should be a wake-up call for policy makers and community leaders that Minnesota is indeed on a troubling track when it comes to the direction of community-supports for people with disabilities,” said Sue Schettle, CEO for the Association of Residential Resources in Minnesota (ARRM). “We need broad political and community action to enhance the many bright spots across Minnesota where progress is being made and get
Minnesota back on the right path.”

According to the report, the biggest factors affecting Minnesota’s lower rankings were stagnations in key measures, including in the number of people on waiting lists to receive residential Home and Community-Based Services (3,564, compared to 3,575 in the 2016 Case for Inclusion report) and the percentage of residents with intellectual and developmental disabilities receiving Medicaid-funded services (92 percent—virtually unchanged from the 2016 report). Minnesota’s particularly challenging workforce conditions and volatile public policy landscape drove poorer performance as compared to other states.

The Case for Inclusion, which has been published regularly since 2006 by UCP, compiles the most recent data available (generally from 2016 for this report) and analyzes 30 outcome measures in the five major categories. The ANCOR Foundation joins UCP this year in publishing the report. Among the other key findings on Minnesota’s performance:

Minnesota’s worst performances were in the categories of reaching those in need, where the state ranked 45th, and promoting independence, where the state ranked 31st.

A bright spot is that Minnesota joins 13 others plus the District of Columbia in having eliminated all large, state-run institutions. But at the same time, the state has lagged behind in moving people into increasingly “home-like” settings with three or fewer people living together.

The state has a great deal of room for progress in the area of promoting productivity. Only nine percent of working-age residents with intellectual and developmental disabilities in Minnesota worked in competitive employment jobs, meaning they worked alongside individuals without disabilities and at market-driven wages. This rate is less than half the national average of 19 percent.

Nationally, the report found that notable advances in the support of individuals with intellectual and developmental disabilities have stalled. For instance, just 29 states— two more than in the 2016 Case for Inclusion—report that at least 80 percent of these Americans are served in home-like settings, such as a family home, their own home or a small group setting—a number that hasn’t budged from the 2016 findings.

The report documented downward trends in two critical areas, the number of people on waitlists for residential and community services, and the number of individuals working in competitive employment. The Case for Inclusion 2019 found the number of people on waiting lists for Home and Community-Based Services nationally was up 75,000 from the 2016 report to almost 424,000. Just seven states, down from 10 in 2016, reported at least 33 percent of working-age individuals working in competitive employment.

“Individuals with intellectual and developmental disabilities, including the young and the aging, want and deserve the same opportunities and quality of life as all Americans. Yet some states do much better than others in demonstrating the needed political will and implementing the sound policies and focused funding necessary to achieve this ideal,” the report stated.

Factors driving the stagnating or downward trends include states forgoing Medicaid expansion and growing shortages in direct support professionals (DSPs), the frontline workers who help those with disabilities integrate into the community.

“The DSP workforce crisis may be the most significant challenge we face in improving the outcomes tracked by the annual Case for Inclusion,” said ANCOR and ANCOR Foundation CEO Barbara Merrill. “Without the professional staff needed to provide the supports and services that enable people to be integrated into the community, provider agencies have little hope of maintaining or expanding on any progress they’ve seen in the past decade.”

In Minnesota, providers report an average DSP vacancy rate of 15 percent, or approximately 10,000 positions, and annual DSP turnover rates of more than 50 percent. At the same time, Minnesota’s unemployment rate ranks among the lowest in the country, at 2.8 percent.

Armando Contreras, President and CEO of UCP, notes that “across the country, we see efforts by state policymakers to enhance their approach to Medicaid services and supports and related programs by making the best use of existing and scarce resources. Of course, additional funding to keep pace with the diverse needs of this population would help, but new ideas and shared best practices from successful states have the potential to drive improvements even absent additional funding.”

The full Case for Inclusion 2019 report, along with scorecards for each state and additional resources, can be downloaded at www.caseforinclusion.org.