Evaluation of a Medicaid Home and Community-Based Alternatives to PRTF Demonstration

As a response to nationwide efforts to remove barriers to community living for people with disabilities, the Deficit Reduction Act of 2005 authorized up to $217 million for a demonstration program for nine grantee states to use Medicaid funding for home and community-based services (HCBS) as an alternative to psychiatric residential treatment facilities (PRTF). The demonstration is also a response to States and advocates that have long hoped to extend the HCBS waiver authority to children/youth eligible for the PRTF level of care, so children/youth could stay with their families and receive services in their home/communities.

The demonstration is marked by a substantial diversity in program design, populations served, and state-level measures employed. We, the national evaluation team, will answer two primary questions as defined by Congress: 1) Does the Demonstration result in the maintenance or improvement in a child's functional status? and 2) Does the Demonstration, on average, costs no more than anticipated aggregate PRTF expenditures in the absence of the demonstration?

We are collecting and evaluating data on a set of youth functional status, including: mental health, community living, school, juvenile justice, alcohol use, and family functioning. Our approach follows the same format of multi-site evaluations: cross-listed common elements and multi-tiered analysis. State-centric finding, use of comparison groups (where possible), and data across multiple states (where available) will help to minimize internal validity of the results and increase an assessment that the wraparound service intervention that produced the observed maintenance or change in youths' functioning.