BATON ROUGE, La. - Louisiana ranks behind most of the nation in enabling people with developmentally disabilities to receive care and services in their own homes, according to a report released Monday.

Legislative Auditor Daryl Purpera's office says Louisiana has the sixth-highest number of people who are developmentally disabled and living in 24-hour care facilities such as group homes.

The state's Medicaid program covers most costs of the care at the 524 facilities around Louisiana, spending $1.3 billion on them during three budget years from 2011 to 2013. They provide physical and speech therapies, special education and rehabilitation services.

But the high use of such "intermediate care facilities" comes despite a national trend to offer people with disabilities more care options to stay with or near families and communities, rather than separated from loved ones.

"Emphasis is now placed on people living in their own homes, controlling their own lives and being an integral part of their home community," the audit says.

Developmental disabilities are impairments in physical, learning or behavior areas that usually begin at birth or in early childhood and are likely to last throughout a person's lifetime.

Purpera's office notes that home- and community-based care in Louisiana has increased in recent years, even as it continues to lag behind other states. Auditors say the number of occupied beds in the intermediate care facilities dropped from 5,082 in 2011 to 4,789 this year.

The report comes as the state health department is working to shift to a more insurance-based model for providing long-term care services.

Olivia Watkins, spokeswoman for the Department of Health and Hospitals, said the auditor's report will help the agency as it continues to rework its care for people with developmental disabilities.

"Addressing the issues outlined in the informational audit are some of the primary items being addressed in the discussions for managed long-term supports and services," Watkins said in an email.

Purpera's office says Louisiana in recent years has cut the average rate paid to the intermediate care facilities, paying them an average of $161.38 per day this year, compared to $168.57 six years ago. The report says while the facilities' rates are supposed to be increased every three years, that hasn't been done since 2008.

The report also outlines the deficiencies cited at the intermediate care facilities, but notes there are no national benchmarks to specifically compare quality.

The facilities were cited for 2,996 deficiencies over the three years reviewed from 2011 to 2013, including maintenance issues, lack of proper food and equipment and improper administering of drugs. Eleven percent of those were repeat problems, the report says.

An annual ranking of how state Medicaid programs serve people with developmental disabilities done by United Cerebral Palsy ranked Louisiana 12th, according to the auditor's office.