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Report Recommends Changes In Disabilities Medicaid Program

Heather Snyder, 31st Medical Operation Squadron educational and developmental intervention services speech and language pathologist, hands a plastic coin to Nathan Gribble, a patient at the Educational and Developmental Intervention Services clinic.
Staff Sgt. Taylor L. Marr
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Gov. Ron DeSantis’ administration on Monday recommended the state keep intact a Medicaid “waiver” program for people with developmental and intellectual disabilities but called for a redesign of how the so-called iBudget program works, including capping amounts people could spend annually on services designed to keep them at home. 

The DeSantis administration turned over to legislative leaders a required report that contains 11 recommendations for lawmakers to consider when they begin the 2020 session in January. The report does not recommend that the state scrap the existing program and enroll people in managed-care plans, a fear of many advocates for people with disabilities.

“It is certainly much better than what we anticipated,” Florida Developmental Disabilities Council Executive Director Valerie Breen said.

With the report compiled by the Agency for Persons with Disabilities and the Agency for Health Care Administration, the top recommendation is for state economists to begin analyzing spending and enrollment trends as they do for other Medicaid programs.

While the recommendation may sound like inside baseball, it would go far in helping plan financially for the program, said Jim DeBeaugrine, a former director of the Agency for Persons with Disabilities.

“It will give them (lawmakers) a clear idea of what actual expense demands are going to be regarding their planning and budgeting,” said DeBeaugrine, who prior to becoming the agency’s director was a budget analyst for the Legislature and reviewed Medicaid estimates. “They will at least be fully informed that way.”

Without a review of costs by economists who serve on the state Social Services Estimating Conference, the Legislature annually appropriates money to the iBudget program. If the funding falls short, it is considered a “deficit.”

In the last two years, the Agency for Persons with Disabilities has come under fire for spending more than what was appropriated.

The agency, with a $1.4 billion annual budget, is one of the smaller state health- and social-services agencies. But it has garnered a lot of attention because of recurring deficits. Administered through the state’s Medicaid home- and community-based waiver program, the iBudget was implemented in 2014.

It 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. Another 21,900 people are on a waiting list.

The Legislature this year directed the Agency for Persons with Disabilities and the Agency for Health Care Administration, which oversees much of the Medicaid system, to develop an alternative delivery model.

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.

In the iBudget program, participants have individual budgets to spend on the services they require. Budgets are determined using a complex algorithm.

While the report didn’t recommend eliminating services, it included imposing limitations on “life services” such as companion services, employment services and adult day training services. The state would save upward of $2.6 million annually if it limited those services to 48 weeks a year and no more than 30 hours a week. According to the report, about 1,557 people would be affected by the change.

Another recommendation calls for placing a $205,000 individual cap on services in the ibudget program. People who spend more than that would either need to reduce their waiver expenditures to come within the cap or seek institutional care.

“If the costs of an individual’s waiver services exceeds this amount, then the community may not be the most appropriate setting for them to receive their services,” the report reads.

According to 2017-2018 data, 85 people would be affected by the change. If they all withdrew from the iBudget program, it would reduce costs by nearly $20 million, though it would increase costs for the Agency for Health Care Administration. If the 85 people stayed in the community and limited services to the $205,000 cap, it would save $2.4 million annually.

Barbara Palmer, director of the Agency for Persons with Disabilities, has invited a small group of people, including service providers and advocates for people with disabilities, to her Tallahassee office on Tuesday to discuss the proposed recommendations included in the report. AHCA Secretary Mary Mayhew also was invited to the meeting.

The report additionally calls for the Legislature to “appropriate funding sufficient to provide medically necessary services in the most appropriate setting for all enrolled waiver clients.” But the agencies did not indicate what that would cost.

“That’s going to be the question that everybody asks,” Breen said.