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Families Fret Over Announced Disability Service Redesign

A silouette of a family
Eric Ward
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

By Christine Sexton / News Service of Florida

Two state agencies are set to work on redesigning a Florida program that provides services to more than 34,500 people with disabilities.

And their caregivers and family members are nervous. 

Six years after creating what’s known as the “IBudget,” and amid mounting deficits, lawmakers this year directed the Agency for Persons with Disabilities and the Agency for Health Care Administration to develop an alternative delivery model for home- and community-based service programs.

The agencies were ordered to identify services that are essential for client health and safety and to recommend elimination of other services that are too expensive.

While the plan cannot be implemented without approval from the Legislature, it is something that Florida Developmental Disabilities Council Executive Director Valerie Breen is tracking.

Breen sent an email to about 3,000 people on July 12, encouraging individuals with developmental disabilities and their family members to attend a public meeting about the program redesign in Tallahassee on Wednesday or try to attend via webinar.

Breen also asked family members, individuals and advocates to contact legislative leaders and Gov. Ron Desantis to let them know “in your own words what it would mean if you had to give up any of your services.”

As of Tuesday, Senate President Bill Galvano, R-Bradenton, had received correspondence from two constituents, according to Senate spokeswoman Katie Betta. House Speaker Jose Oliva, R-Miami Lakes, and DeSantis were also copied on the email correspondence.

APD, with a $1.4 billion annual budget, is one of the smaller state health-care agencies. But the agency garnered a lot of attention from the Legislature during the 2019 legislative session that ended in May, due, in part, to recurring deficits in the iBudget program.

In the last two years, the agency’s deficits have totaled $154 million, according to a corrective action report issued in January.

The agency attributed its deficit to a variety of factors. For example, enrollees in the program are getting older, the report said.

The report noted that people with disabilities experience a decline in their health and abilities as they age, which increases their need for additional services to maintain their ability to live safely in a community setting.

Administered through the state’s Medicaid home- and community-based waiver program, the iBudget was implemented in Florida in 2014.

The program serves people who have been diagnosed with intellectual disabilities or other disorders, such as severe forms of autism, spina bifida, cerebral palsy or Down syndrome.

As of January, the program provided services to more than 34,500 Floridians with developmental disabilities. Another 21,900 individuals are on the waiting list for the program.

The iBudget was designed to promote and maintain the health of the clients and allow them to live as independently as possible in their own home or in the community. Each client has an individual budget to spend on the services they require. A person’s budget is determined using a complex algorithm.

As part of negotiations over the state budget this year, lawmakers agreed to increase funds in the iBudget by $49 million. Lawmakers also agreed to fund rate increases for direct service providers who work alongside people with disabilities.

The Senate had pushed for the spending increases, while the House wanted the iBudget redesign.

Former APD Secretary Jim DeBeaugrine told The News Service of Florida that determining which services to put on the chopping block is a risky task.

Currently, clients have access to a variety of covered services, such as medical and dental care, employment services and home companions.

“I think it’s real, real, real tricky,” said DeBeaugrine, who, in addition to his experience at APD, has a family member with a developmental disability.

“What we have seen in the past (is) that you eliminate a service and then, in some instances, it pushes people into a higher cost setting,” DeBeaugrine said. “Or, they substitute the service with a more expensive service.”

The agencies have been directed to submit two interim reports to the Legislature on the planned redesign. The first report is due by July 31, and the final report must be submitted by September 30.