Proposed Medicaid Cuts For Disabled Could Cost State More, Advocates Say

State leaders are proposing changes to a Medicaid program that serves disabled people in order to save money. But advocates say any funding cuts to the services could end up costing the state even more money in the long run.

The Agency for Persons with Disabilities has suggested several changes to a Medicaid waiver program called iBudget. People who were born with disabilities or acquired them at a young age rely on the program to deliver non-medical services that help them live at home and keep a job.

Without these services, more people could be forced to leave their homes and move into institutions where they would receive around-the-clock care, said Valerie Breen, director of the Florida Developmental Disability Council, which met in Tampa on Friday.

“We've committed to this for years and years,” Breen said. “So to go backwards and not fund those essential services to help people stay in their community we're just going to move backwards in terms of institutions and it's going to cost the state a lot more money.”

Florida spends about $35,000 a year to support a person who is living at home, compared to $150,000 in an institution, she said.

The iBudget program helps people who have conditions like cerebral palsy and Down syndrome with everyday tasks, such as cooking, bathing and dressing. About 35,000 people rely on the services and there’s another roughly 22,000 on a waiting list. 

Florida’s share of the costs for these service has gone up every year. The Agency for Persons with Disabilities has a $1.4 billion budget, but the program has operated in the red for years.

Nationally, the state ranks 49th in the amount it spends on Medicaid for children and adults born with disabilities.

“The program started out in a deficit and it’s never been able to catch up,” Breen said. “So the program is functioning on a shoestring.”

The needs of people with developmental disabilities are also changing. Years ago, someone with Down syndrome was not expected to live into their 70s and 80s like they are now. Their family caregivers are also aging, so they need more help.

The Agency for Persons with Disabilities is considering cuts to payments paid to providers and narrowing the type and amount of services provided.

Ultimately advocates fear the state could be taking steps to move the program into the managed care system, which involves private companies running the state’s Medicaid programs. The iBudget program is the only remaining Medicaid program not in the managed care system.

Moving the program to managed care is not a cheaper option, Breen said.

“Once managed care takes on this population, they are going to learn about all the multiple needs that this population has and they are going to ask for more money,” she said. “In the long run managed care costs more than doing it this way.”

State leaders must provide a final plan to the legislature by September 30th.

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