Gov. Ron DeSantis’ administration this week urged advocates for people with disabilities and care providers to start lobbying lawmakers to support a redesign of a key state program for thousands of Floridians with developmental and intellectual disabilities.
Agency for Persons with Disabilities Director Barbara Palmer and Agency for Health Care Administration Secretary Mary Mayhew met Tuesday with advocates and providers and went over 11 recommendations to change the so-called iBudget program. The meeting came a day after the recommendations were submitted to legislative leaders.
While the recommendations would make cost-saving changes --- including capping services --- much of the redesign could shift costs of caring for people with disabilities away from the Agency for Persons with Disabilities and to the Agency for Health Care Administration. Dina M. Justice, whose daughter has developmental disabilities, asked Palmer “what is your plan B” if the Legislature rejects the recommendations.
“I can’t answer what’s going to happen with something like that,” Palmer said. “I can just say you better be down there fighting for it not to happen.”
She added that legislators “have been looking for a solution as well. So I believe you are not going to fall on deaf ears. I think you’re going to be listened to because we are putting something that is reasonable out there. Let’s think positively and educate them and go see them in their districts.”
During the meeting, both agency heads took turns explaining the details of the recommendations to the group of people invited to attend.
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 yearly $205,000 individual cap on services in the iBudget program. People who spend more than that would either need to reduce their 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 said.
According to 2017-2018 data, 85 people would be affected by the change. If that group of people withdrew from the iBudget program, it would reduce costs by nearly $20 million, but then the burden for care would likely shift over to the Agency for Health Care Administration, which oversees much of Medicaid. If the 85 people stayed in the program and had their services limited to the $205,000 cap, it would save $2.4 million annually.
The iBudget 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. Another 21,900 people are on a waiting list.
In the program, participants have individual budgets to spend on the services they require. Budgets are determined using a complex algorithm.
But with the Agency for Persons with Disabilities repeatedly running deficits, the Legislature this year directed it and the Agency for Health Care Administration to develop an alternative services-delivery model.
Though advocates for people with disabilities feared the redesign would include a mandate to get services through managed care, it did not.
Mayhew said the agencies worked closely to examine reasons for the costs of the program, but some of the reasons ---- such as an aging population --- cannot be addressed by placing people in managed care.
“The Legislature has to make very difficult decisions,” Mayhew told reporters after the hour-long meeting. “What we have been focused on in our work is reminding them when Medicaid was first created, it was to serve the elderly, the disabled and extremely low-income families. Individuals with developmental disabilities are the core responsibility and mission of state government.”