Peter SchorschFlorida’s Medicaid waiver program for persons with disabilities, iBudget Florida, has hit multiple snags and as many lawsuits during its slow implementation since being created by the Legislature in 2010.
The program was intended to give clients better access and more choices in the services they receive, providing the potential to lower spending, and thus creating an opportunity to reduce the number of people on a wait list who go without resources. Yet as is the case with many programs that seek budget predictability or make changes to service structures, not everyone ends up happy or cared for as necessary. So it is with iBudget.
Under the program, about 40 percent of current clients could see cuts to their allocations by an average of about $7,000, according to a News-Journal report. These cuts are reviewed case by case by the Agency for Persons with Disabilities (APD), yet many clients have little faith in the metrics the agency uses to make these decisions.
For some, these cuts mean losing adult day training, in which skills are learned in a social setting, or lose essential transportation to these venues. However, according to the Agency for Persons with Disabilities, only about 10 percent of people who have transitioned to iBudget have appealed — a rate they consider to be “very successful.”
Some are dubious of the low rate of appeals.
Craig Byrd, president and CEO of UCP/WORC in Flagler and Volusia counties, said, “I believe the reasons for the small percentage of appeals are that individuals with disabilities and their families fear an appeal will cause a further reduction of their funding or they have been told by APD representatives to not waste their time.”
Others are not quiet with their dissatisfaction: A federal lawsuit filed by 10 plaintiffs with disabilities who faced reductions argues that clients are not receiving adequate notice or are not given reasons why cuts are being made.
For an agency that has faced deficits as high as $100 million, spending control is necessary. But the Legislature had lost faith in the APD’s ability to control its own budget; and has seemingly transferred, through iBudget, these burdens onto families. Under iBudget, clients are forced to choose which services they continue on limited resources, a daunting process that has far-reaching consequences.
The economic impact of these changes may be felt beyond the families directly affected. Take for example the mother of Chad Russell — who at 25 needs help with bathing, dressing and medical treatments and communicates with his team at UCP/WORC using sign language they have learned alongside him. She may lose her job working on condo sales if Chad loses his access to adult day training. While she already pays for the majority of his services as well as medical supplies and diapers, he no longer receives speech, physical or occupational therapy due to cuts.
“Adult day training is the most effective cost-saving method there is,” said Jim Freyvogel, president and CEO of the MacDonald Training Center, Inc. “These services enable family members to keep their own jobs rather than being home as unpaid caregivers, and prevent people with disabilities from being forced to live outside their own homes. This is a huge cost saver. If Chad is forced to move into a group home it will cost the taxpayers of Florida an additional $45,000 to $50,000 for his care.”
Florida has worked hard to promote and maintain home- and community-based care; but many fear that changes under iBudget could erode this progress.
“The method in which APD is implementing iBudgets is undermining the system of natural supports which is the cornerstone of the service delivery system in Florida,” said Freyvogel, whose MacDonald Training Center supplements about 22 percent of the actual cost of care, saving taxpayers what he estimates to be about $1.3 million each year.
Freyvogel’s experience is not uncommon.
Byrd says various adult day training programs at UCP/WORC have seen significant drops in clients and a decrease of about $384,000 in combined state, local and federal funding.
Byrd’s concerns with iBudget also hit upon various administrative issues. Prior to iBudget, clients and service providers would receive an authorization for services for one year, providing the ability to plan and budget accordingly. Yet under iBudget, authorizations are required quarterly.
“This means perpetual uncertainty for clients and their families, and from a provider standpoint it is an administrative nightmare,” said Byrd. “iBudget is a wolf in sheep’s clothing. Consumer choice is only the PR piece to make the reductions more palatable. It is nothing more than a cost containment system for the state without regard to the needs of Floridians with disabilities.”
Peter Schorsch, a political consultant based in St. Petersburg, publishes and edits the Florida political blog SaintPetersBlog.com. Readers can contact Schorsch at [email protected].
One comment
Charles Ball
August 19, 2013 at 5:29 pm
The issue is complex enough, but really gets down to this. We need to ensure some means of inducing fiscal responsibility on the recipients and families to make this program work. Is iBudget the best way? maybe or maybe not. but for years I worked to help ensure community based services were rendered to this part of society in a frugal way, only to watch every additional dollar of appropriation get swept up in additional services for the existing set of recipients. The industry advocates say there is just not enough money to go around, and that is somewhat true, but that is no excuse for neglecting others similarly situated. If a poor family has another child they cannot simply say here, you go on the waitlist until everyone else is satisfied that they have all they deserve. In my family growing up we made sure everyone had firsts before anyone had seconds…
SO the legislature did the “right” thing, they ponied up new money, the $36 million referenced above, but they also funded what is called the prior year deficits in APD materials. Fact is that it is a recurring expenditure of money on the existing recipients, paint it as you like. (please see page 396 of SB 1500, section 26) More importantly, please look to see if the legislature has to add another 40 million to this years pot to keep the agency solvent.
I know it is incredibly hard to have a family member with disability. I have struggled myself with how Florida should solve the issue. I believe however that the solution is best arrived at by getting real people who live this challenge every day in the room and talking it through, not having declared that the iBudget will solve it. As much as we may like to, declaring the victory is not going to make the victory. hard work lays ahead for the state and the recipients of the nearly one billion dollars Floridians provide annually to people with developmental disabilities.
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