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A database was assembled from data collected on all people served by the Developmental Disabilities divisions of Nebraska, South Dakota, and Wyoming, including state institutions and state-funded programs (n=5,928). Information included provider expenditures associated with each individual, allocations made by individual reimbursement rates, services/supports received, funding sources, and individual characteristics as measured by the Inventory for Client and Agency Planning. Results from the analysis found institutions had the highest costs. Although Home and Community-Based Service recipients experienced lower levels of independence than people funded with state money, their costs were higher. South Dakota's people had the highest independence scores. This was attributed to their relatively high utilization of supervised apartments and supported living. Wyoming's costs and rates were higher than those for the other two states, presumably a result of the "Weston v. Wyoming" lawsuit. Supported employment was less expensive than community facility-based daytime programs but this finding was not consistently found in all states. South Dakota, which had a relatively higher utilization of supported employment, also had significantly higher supported employment costs. Evidence substantiated a diseconomy of scale function, as costs increased steadily with agency size. (Contains 23 references.) (CR)

This report describes the outcomes of a Wyoming program that provides host families for individuals with developmental disabilities. Host families work with certified Medicaid providers of home and community-based services for people with developmental disabilities and provide residential habilitation to an adult who is accepted as a member of their family. The first part of the report discusses findings from a study involving 13 adults with mental retardation who were in host families for 9 to 11 months. Results from the study indicate there was a positive change in the individuals when they lived with host families compared to the same individuals while they lived in an institution or at the beginning of their placement with a regional service provider. Incident reports of inappropriate behavior decreased significantly in eight individuals who had had maladaptive behaviors. All 13 individuals maintained or improved their health status, including 3 individuals who lost an average of 42 pounds. Two individuals have been able to slightly decrease psychotropic medications since their move to a host family. The second part of the report presents case studies of four participants who have lived in a host family and have made exceptional gains. (Contains 16 references.) (CR)