Medicaid spending on I/DD services has grown dramatically over the past decade. While that shows more people are getting supports in their communities, it also raises serious concerns about the sustainability of autism supports. If nothing changes in how these supports are delivered, we’re heading toward a funding crisis. Fewer people will gain access to services, and those who do may not receive the support they need.
How we got here: from institutions to personalized supports
For much of the 20th century, most adults with disabilities lived in institutions, often far from their families. From the 1970s and 80s, advocates and policymakers pushed for a change so people could live and receive supports in regular neighborhoods, alongside everyone else.
This shift, known as deinstitutionalization, gave people more freedom and the ability to stay connected with their friends and families. But it also meant higher costs: while institutions share resources and staff across many people, community-based supports are individualized and often require more staff per person.
Today, Medicaid spends significantly more to support adults with disabilities than during the institutional era. As demand and costs continue to rise, we need approaches that allow individuals to live well while managing expenses responsibly.
These cost-efficient alternatives already exist, and they often lead to better outcomes for the people we serve.
Traditional models vs. supported independent living: a cost comparison
Different approaches to daily living supports create very different costs and outcomes.
In traditional group homes, residents live with several other people and have staff on hand at all times to help with meals, meds, cleaning, transportation, and any issues that come up.
This model works well for those who need around-the-clock care, with constant supervision and hands-on help. But for those who would benefit from less restrictive supports, a group home can be costly as well as hard to sustain. Providers must cover 24/7 staff wages, benefits, facility overhead, and administrative expenses. Staff often spend time waiting, rather than actively helping residents. The key is to identify who truly needs the structure of a group home and who could transition to supported independent living.
Other individuals live at home, either alone or with family, while receiving in-person support with daily routines, personal care, meals, or managing health needs. While it’s more personalized than group settings, this model can still be expensive, especially if staff must be there for large portions of the day or week. And as demand for this type of support increases, finding and keeping reliable staff is becoming more difficult.
In many cases, full-time support hours can be reduced without compromising safety or quality of life. That’s where more innovative, flexible alternatives come in — like remote support, smart technology, or short check-ins by a direct supports professional instead of long shifts. For example, someone might get help with their morning routine through a video call, follow visual prompts from a tablet to complete chores, and receive a drop-in visit once a day instead of needing a support worker present all day long.
These approaches don’t just cut costs; they shift the focus from immediate needs to greater independence in the long term. With the right mix of tools in place, people can do more on their own while still having access to backup support when needed.
Smart technology: scaling supports without adding staff
Technology is one of the most practical ways to offer cost-efficient supports while making sure people stay safe. Smart tech can provide security at a fraction of traditional staffing costs for people who need around-the-clock monitoring but not constant hands-on support.
Smart tech in action: overnight monitoring
Traditional overnight supports typically mean a staff member is in someone’s home for eight hours every night, year-round. That adds up to thousands of hours of wages and benefits for someone who spends most of their time waiting. Many people sleep peacefully through the night and never need assistance, but staff must be there “just in case.”
Smart technology offers a practical alternative. Sensors can monitor movement patterns or detect unusual activity and alert remote support staff if something seems wrong. Motion sensors on bathroom doors, sleep monitors, and other devices can track health metrics and routine. When patterns change significantly, the system flags it for human attention.
Not only does this solution save money, it’s also more efficient. Smart sensors can catch patterns that someone in the next room might miss entirely.
Smart tech, combined with remote monitoring
Remote monitoring means one support person can oversee multiple people at the same time. Our Smart Living apartments are a good example: these tech-enabled homes provide 24/7 monitoring, with remote support available as a backup.
When sensors detect a potential issue, remote support staff can check in by phone and dispatch help if necessary. Instead of paying for thousands of hours of staffing per year or living in a residential facility for constant coverage, support is provided only when it’s needed.
This approach shifts the staffing ratio from 1:1 support for each person to 1:15 monitoring: a major reduction in labor costs while maintaining or even improving safety through consistent oversight.
That said, smart technology requires thoughtful planning. You’ll need backup procedures for system outages, staff trained to provide remote assistance, and documentation that meets regulatory requirements.
Combining assistive and enabling technology with remote support helps us bridge the gap between full independence and intensive supports. But technology alone isn’t enough to keep supports sustainable; what happens during the day matters too.
→ Find out more about how remote support works in our Smart Living apartments.
Employment: lowering healthcare costs through connection and routine
A fulfilling job brings benefits beyond paychecks — it can reduce long-term Medicaid costs in real, measurable ways. Research shows that adults with autism who work often experience better physical and mental health, stronger social connections, and greater life satisfaction. Work adds structure to daily routines and builds social networks that provide natural support. Employed people are also more likely to stay on top of preventive healthcare and less likely to need crisis help.
Employment training programs like FastTrack to Work pay off over time. While job coaching and skills training come with upfront costs, they’re often offset by a reduced need for other supports as people gain confidence, skills, and purpose through work. Many people who find work through such a program need significantly fewer ongoing supports than before starting employment.
→ Find out more about our work readiness and employment programs
Skill-building: reducing long-term dependency
The most cost-effective supports lead to people needing less help over time. This requires a fundamental shift from doing things for people to working with them to build skills and confidence.
Traditional models often focus on safety and getting tasks done rather than personal growth. Staff complete tasks and do chores instead of teaching the person how to do them. Research by Australian Policy Online (APO) shows that while this approach is cost-effective and saves time in the short term, it can create permanent dependency that becomes expensive.
With supported living, skill-building might take longer initially, but it creates lasting independence. Instead of preparing meals for someone, staff might work with them over several months to learn cooking skills, grocery shopping, and meal planning — moving from daily help to doing it independently, with only occasional (and often remote) support.
This approach works across all areas of daily living. People learn to manage their own schedules, handle finances, maintain their homes, and access community resources.
Services like our Supported Living program demonstrate this philosophy in practice. Instead of group homes where staff make decisions for residents, we work with people in their own homes to develop the skills they need to increase their autonomy.
Keep in mind that skill-building doesn’t always need in-person support. In our Smart Living homes, participants can get help through two-way video and audio devices when cooking, managing money, or tracking health, encouraging independence while keeping backup available.
The path forward: sustainable support models
The current funding model for disability supports isn’t sustainable. Medicaid costs are rising, but that’s not reflected in improved outcomes. We need innovative approaches that guarantee safety and quality of life, while building toward greater independence and reduced long-term costs.
The choice doesn’t have to be between quality and cost-effectiveness. The best solutions deliver both because they help people grow rather than keep them dependent.
Everyone deserves to live a full, independent life, and with the right combination of supports, this is both possible and financially sustainable.
These ideas aren’t just theory; they’re already working for many people. Want to talk about what’s possible for yourself or a loved one? Get in touch with one of our supports professionals today — we’re here to help you figure out what fits.
