🧩 IDD Services: Understanding Care Denials

🧩 1. States Redefine “Appropriate” Care

Federal law guarantees access to intermediate care facilities for individuals with intellectual disabilities (ICF/IID) services for those who need them. But states like Massachusetts:

• Use biased evaluations to declare ICF/IID “inappropriate”
• Claim that community-based services (HCBS) meet everyone’s needs
• Treat ICF/IID as a last resort, not a valid first-line option

This allows them to deny care while appearing compliant with Medicaid and Olmstead.

🏛️ 2. Courts Defer to Agency “Expertise”

When families challenge these denials:

• Courts often defer to state agencies’ clinical judgments—even when those judgments are conflicted or unsupported
• Judges may view ICF/IID care as outdated or undesirable, influenced by decades of deinstitutionalization rhetoric
• Legal standards like “most integrated setting appropriate” are interpreted narrowly, favoring community placement

Result: The law says one thing, but courts uphold agency decisions that contradict it.

💼 3. Administrative Hearings Partisan and Slanted

• The Massachusetts Department of Developmental Services (DDS) controls the evaluation, the denial, and the appeal
• Hearing officers are appointed and paid by DDS
• Independent evidence is dismissed, and families are denied fair process

This creates a closed loop of denial, where legal rights exist on paper but not in practice.

🧠 4. Systemic Bias Against Institutional Care

There’s a pervasive belief—especially among policymakers and some disability rights groups—that institutional care is inherently bad. This ideology:

• Ignores the needs of individuals with severe disabilities and those with IDD and comorbid chronic medical conditions
• Treats ICF/IID as failure, not choice
• Frames advocacy for intensive care as regressive

Even when families present strong legal and clinical arguments, they’re dismissed as “anti-integration.”