The State of Medical Care for Adults With Intellectual and/or Developmental Disabilities

For more than 2 decades, medical care for adults with intellectual and/or developmental disabilities (IDDs) has been difficult to access and has not substantially changed the persistently poor health status that is common in this population cohort. While there has been some progress in the development of models of care that are designed with and for adults with IDD, it has been slow and sporadic, with little data or analyses of efficacy or effectiveness. Very few medical schools and other health science professional education in the United States include curricular content on adults with IDD, resulting in health care practitioners being under or altogether unprepared to provide care to them. Public and private health care policy and financing are not responsive to the medical care needs and experiences of adults with IDD. More recently, the impact of the COVID-19 pandemic on adults with IDD was disproportionally more severe, with significantly higher rates of morbidity and mortality than on adults without IDD, having nothing to do with the presence of an IDD itself. This commentary reviews persistent barriers to accessible, responsive medical care for adults with IDD and reviews a number of health care models that have been developed since the turn of the 21st century. It also offers a brief review of Medicaid Managed Care as a potential policy and financing solution to long-standing financing and related obstacles to optimal medical care.