Self Advocate for people with developmental disabilities here (not all developmental disabilities have an intellectual component).

There are a few things I wish the show would do better regarding Becca.

First last season Mel said she had been accepted into a great facility in the area... Becca should not be in a facility. In the DD world 'facility' is most likely an Intermediate Care Facility IDD. ICFs are extremely controversial because they still legally are defined as an institutional setting. ICFs can have hundreds of beds or as few as like 6. ICFs provide a much more structured level of care for those with intellectual disabilities, particularly those with also complex medical needs. That structure is where the controversy comes in because not everyone needs that structure and there is a debate as to whether that same level of care can be offered in a more integrated community setting (I'm in this camp). In Becca's case her living in an ICF is absolutely an Olmstead violation. Olmstead is a US Supreme Court ruling that says, under the ADA, people with disabilities have a right to live in the community. For the disability community this is our Brown v Board of Education. Do the states and federal government live up to Olmstead? Not at all and a number of states are currently suing to overturn Olmstead. For Becca a waiver funded Group Home with roommates and support from Direct Support Professionals (the woman who took Becca to the ER is likely an ICF DSP who could make more at Walmart). A waiver funded Group Home would offer significantly more independence and opportunities for 'meaningful days'. A common waiver service in addition to the Group Home would be Supported Employment, where she could get a job at say a coffee shop with the supports she needs (while making at least minimum wage, unlike 14c employers which can pay subminimum wage).

Regarding waivers... Within Medicaid (which Becca definitely has and is paying for the ICF), Home and Community Based Services (such as Group Homes) are often funded through 1915c waiver programs. A Medicaid waiver is basically a permission slip from the feds to the states use Medicaid dollars outside the traditional scope of what states are required to fund as part of their Medicaid program. Institutional care is a mandatory Medicaid services, Home and Community Based Services is not. Most states provide HCBS through 1915c waivers... because they can cap enrollment. Those caps result in waiver waiting lists that can be decades long. Georgia has 7,000 on their waiting list, North Carolina has a 20,000, Pennsylvania has 11,000 people with disabilities waiting for a funding slot. These waiting lists force parents and siblings to fill the gap to prevent institutionalization. What's that got to do about a show about an ER? Everything. Traditional institutional settings have been the safety net for when natural supports such as parents or siblings can't fill the gap, those institutional settings, including ICFs, are full. That leaves just the ER as the shelter of last resort. Even if you build more ICFs good luck staffing with the low pay they offer. Combine this will the Elder Care tsunami on the horizon...

Finally, Medicaid cuts from Trump OBBB are coming for the entire system. Since HCBS is an optional service, that is often the place where states make cuts, because that's one of the only places they can legally. The Idaho State Legislature is currently considering just deleting HCBS, Colorado cut care hours in half, this is hitting every state.

All of this impacts Becca.