State intellectual and developmental disabilities (IDD) systems are facing a difficult reality. Demand for services continues to grow while states navigate workforce shortages, rising healthcare costs, and increasing pressure to demonstrate that Medicaid dollars are being used effectively. 

    In this environment, every preventable emergency department visit, hospitalization, or crisis event carries a cost, both financially and personally. The question facing state leaders is not simply how to reduce spending. It is how to invest limited resources in ways that improve outcomes while strengthening accountability and system efficiency. 

    One opportunity lies in the earlier identification of health risks. 

    Too often, health concerns are recognized only after they escalate into emergencies. A change in behavior, increased fatigue, weight loss, medication side effects, or subtle declines in function may go unnoticed until they result in an emergency department visit, hospitalization, or other high-cost intervention. For people with IDD, these preventable events can lead to poorer health outcomes, disruptions in services, and increased strain on providers and state systems. 

    Data-informed approaches can help shift systems from reacting to crises toward preventing them. 

    The Health Risk Screening Tool (HRST®), used by provider agencies and state systems across the country, is one example of a standardized approach to identifying health risks earlier and documenting support needs consistently. The HRST is designed to support clinical judgment by providing objective information that helps teams recognize emerging concerns, prioritize interventions, and align services with assessed need. 

    In addition to supporting better health outcomes, standardized health risk information can strengthen documentation and oversight efforts. Consistent, auditable records help demonstrate the relationship between identified risks and service needs, reducing the time spent reconstructing documentation during reviews and increasing confidence in authorization decisions. 

    The potential impact of these approaches extends beyond administrative efficiency. 

    A one-year post-implementation study conducted by Threshold Residential Services, an Ohio provider organization, found significant reductions in preventable, high-cost utilization after implementing the HRST: 

    • 56% reduction in behavior-related unusual incidents
    • 50% reduction in unanticipated hospitalizations
    • 43% reduction in emergency department visits
    • A 638% return on investment during the state-supported pilot, equating to $7.38 saved for every $1 invested

    While no single tool can address every challenge facing Medicaid IDD systems, the findings illustrate what may be possible when states invest in proactive strategies that identify risks before they become crises. 

    As policymakers and state agencies consider how to navigate fiscal pressures while maintaining quality services, the conversation should not focus solely on where to cut. It should also examine where targeted investments can improve outcomes, strengthen accountability, and reduce avoidable costs over time. 

    Supporting people with IDD to live healthier lives and ensuring responsible stewardship of Medicaid resources are not competing priorities. When states leverage data to anticipate need rather than simply respond to emergencies, they can advance both.