State funded services for people with developmental disabilities and their families fall under the Department of Human Services, Office of Developmental Disabilities (DHS/DD). In 1996, the Office (then known as the Department of Mental Health and Developmental Disabilities, [DMHDD]) operated nine developmental centers and two developmental disability units in state mental health facilities, and a supported a wide range of community services.
Illinois' total spending fiscal effort has lagged behind the national average during the 20-year period of this study. In 1996, community services fiscal effort was 42% below the national mean, and congregate spending fiscal effort was 48% above the national mean. In spite of its higher congregate fiscal effort, Illinois' daily institutional costs per resident were ranked 36th in the nation. Total spending fiscal effort ranked 32nd nationally, up from 35th in 1992.
Illinois was one of the eight states in 1996 that allocated fewer resources to community services than it did for congregate services: Community services spending as a share of total spending was 45% in 1996. Only Kentucky and Mississippi allocated a smaller proportion of the MR/DD resources to community services. Congregate spending was at a plateau during 1977-89, increasing during 1990-96. Community spending has increased steadily since 1984, but the increases have been quite limited.
Community Services residential options for six or fewer individuals and the average number of persons served during 1996 consisted of "Community integrated living arrangements (CILA)" in apartment settings (1,434 served), community integrated living arrangement in group home settings (1,433), "Community residential alternatives (CRA)" (696), private ICFs/DD (204), "special home placements (94) and supported living (1,932). In 1996, 34% of Illinois' total residential placements were in settings for six or fewer people.
A number of private ICFs/DD initially licensed and certified for 15 people were re-certified for 16 people beginning in 1988. Project staff continued to classify these settings as ICFs/DD for 7-15 individuals. A total of 2, 399 lived in these facilities in 1996.
Illinois began operation of its HCBS Waiver in 1994. Federal CHBS Waiver reimbursement in 1996 included $2,440,352 representing part-year funding for former CSLA participants. Federal-state Waiver spending totaled $68,719,296 for 5,267 participants, for an average of $13,047 per participant in 1996. Per capita spending for the CHBS Waiver was 68% lower than the national mean; the largest source of federal funds for community services in 1996 was for the ICF/MR program.
Other federal Medicaid program funding in 1996 consisted of $1,000129 for one concluding quarter of the SCLA funding; $2,676,300 for pre-admission screening and annual resident review (PASARR) administration pursuant to PL 100-203 ; and $30,000,921,550 in rehabilitation funding for "developmental training (DT)" programs.
Local appropriations for community services consisted of $14,252,213, which was estimated on the basis of 4% annual increases during 1993-96. This local funding consisted of county and township tax funds and municipal (city of Chicago) funding authorized by three statutes: House Bill 377, Senate Bill 553, and House Bill 708. Local spending represented 3% of total community services spending in 1996. Federal spending comprised 34% of total community Services spending in 1996
Spending for individual and family supports in 1996 represented 4% of total MR/DD spending; the national average was 7% Spending for supported living in 1996 totaled $10,267,350 for 1,932 participants and spending averaged $5,314 per participant in 19996. Illinois Per Capita supported living spending ranked 32nd in the country. Supported living data were estimated based on data reported for the state's "supported living arrangement program (SLA), for SCLA, and, in 1996 for the CHBS Waiver.
Supported employment averaged $3,895 per worker in 1996. Spending for supported employment totaled $6,204,600 for 1,593 workers. The portion of total day-work participants receiving supported employment services was 6% in 1996. This was 68% lower than the national mean.
Illinois provided family support funding for cash subsidies, respite care, and for other supports consisting of counseling, in-home services, adaptation of the home and of equipment, and other supports. Total family support spending averaged $1,696 per family in 1996.; cash subsidies averaged $8,839. Illinois was one of the first states to pass legislation initiating family support subsidies, which began in 1991. The program was modeled after the long-established subsidy program in Michigan, and the Illinois program as grown from $.7 million for 204 families in 1991 to $5.4 million for 612 families in 1996. In 1996 Illinois cash subsidies spending ranked 5th, and total family support spending per capita ranked 19th in the country.
Congregate services for 16 or more individuals consisted of nine developmental center, two mental health/developmental disabilities centers, private ICFs/DD, and other private residential settings. The state facilities , and their populations during 1996 were: Shapario Developmental Center in Kankakee (761), Ludeman, Park Forest (452), Lincoln (446), Kiley, Waukegan (407), Howe, Tinley Park (384, Murray, Centralia (354), Jacksonville (306), Fox, Dwight (171) and Mabley, Dixon (111). The mental health and developmental disabilities centers were Chote, Anna (200) and Singer, Rockford (52). The developmental disabilities percentages of total population in these facilities were Anna, 51.4% and Rockford, 25.1%. Institutional closures included Chote in Anna, Meyer in Decatur (1993) and Alton (1994). The Kiley center in Waukegan was scheduled for closure in the Governor's March, 1996 budget address, but the projected closure date has been designated a facility phase-down. Institutional spending totaled $300,131,505 in 1996, or an annual average of $82,341 per resident. Health benefits for institutional employees were estimated by DMHDD officials on the basis of an annual benefit amount.
Public institutional populations remained nearly constant during 1985-92; the average annual decline rate was 1% per year, compared to 3-5% per year nationally during that period. During 1992-1996, Illinois public institutions declined an average of 4% annually. Inflation-adjusted congregate cares spending increased 14% during 1992-96. Nationally, congregate spending declined 9% during that same period. The staff to resident ratio in Illinois' public institutions was the six lowest in the country.
Private ICF/MR facilities termed ICFs/DD served 4,869 individuals in 1996. Included within this total were "specialized living center (SLCs)" (363) and former "skilled nursing facilities/pediatric" settings which in 1992 were certified as ICFs/DD (908). Other private settings consisted of "community living facilities serving from 20-40 individuals per facility (671) and child care institutions (507). Spending for the ICFs/DD totaled $198,390,972, and spending for the other private congregate facilities totaled $31,757,000 in 1996. Illinois had the second largest portion, 23%, of total residential services recipients living in private congregate facilities in 1996. Illinois also had the second highest number of public-private congregate residents per capita.
During 1996, an average of 1,971 people with developmental disabilities or other related conditions were living in nursing homes in Illinois; spending for these individuals totaled $37,258,502. With the exclusion, during 1986-92 of approximately 1000 former skilled nursing/pediatric residents whose facilities were certified as ICFs/DD in 1992, the Illinois nursing home population of persons with mental retardation and closely related developmental disabilities declined by %51% between 1986 and 1993. However, since 1993 the number of nursing home residents increased by 312.
Source: Institute on
Disability and Human Development
University of Illinois at Chicago
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