Medicaid ‘iBudget’ waiting list to shrink amid lingering worker worries

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Lawmakers have agreed to spend an additional $95 million a year to provide more people with intellectual and developmental disabilities access to services they need to live in their communities and out of institutions.

Advocates said it’s the largest increase in recent history in funding to reduce a waiting list in the Medicaid “iBudget” program. But they worry about a worker shortage that, they say, will only grow worse as more people qualify for the program unless lawmakers do something about increasing wages for people who provide services.

“We are very excited about (the $95 million). It will certainly help with getting a larger number of individuals off the waitlist than what we originally anticipated,” said Florida Developmental Disabilities Council Executive Director Valerie Breen. “On the flip side of all of this, we remain hugely concerned about the providers and the individuals that provide direct support to these individuals no matter what setting they go in, because we have a 50% vacancy rate on providing the services. So we still have a huge provider crisis. We are hoping this also will be something that the Legislature will address.”

To address the dearth of service providers, the Legislature last year included $58.4 million in the budget to increase wages of people who provide services such as adult day training. But Gov. Ron DeSantis vetoed the money as part of nearly $1 billion in vetoes he made as the state grappled with economic fallout from the COVID-19 pandemic.

DeSantis did not seek to reinstate the pay raises in a proposed budget he submitted to the Legislature in January. Likewise, pay increases were not included in a $101.5 billion spending plan that House and Senate leaders finished negotiating Monday night. Lawmakers are expected to pass the budget Friday for the fiscal year that will start July 1.

Mark Swain, president and CEO of The Arc of Alachua County, told The News Service of Florida on Tuesday that as the pandemic hit the state, he was short 25 staff members for the 17 group homes he operates. Today, he is down 55 employees.

“We are literally at the point where we cannot operate,” Swain said. “If we go five more down than where we are at now, I’ll have to think about what houses we have to close.”

Swain said he’s not alone and that Arc organizations across the state face similar shortages. He put the blame on low wages, saying the statewide average is $9.50.

“People aren’t going to work for the pay anymore, and they aren’t coming back,”  he said.

The Agency for Persons with Disabilities, which administers the iBudget program, did not comment on how many people would be removed from the waiting list after the $95 million infusion. Melanie Etters, an agency spokeswoman, said the budget won’t be finalized until Friday and that the agency is “still analyzing the proposed budget and how it may impact APD and its customers.”

Jim DeBeaugrine, interim president of The Arc of Florida, remained hopeful  that something can be done to increase payments for iBudget providers and their staff. He is pressing the Legislature to take advantage of enhanced Medicaid funds that the federal government made available to states in the American Rescue Plan Act.  The law provides a 10 percentage-point hike in the amount of federal Medicaid dollars for the delivery of home- and community-based services from April 1, 2021, to March 31, 2022.

Florida already is taking advantage of a separate 6.2 percentage-point increase in Medicaid funds initially made available last year by the Trump administration at the onset of the pandemic public-health emergency. On April 19, the Biden administration extended the emergency for another 90 days, pumping another $400 million into the state’s coffers.

DeBeaugrine estimated that Florida could qualify for an estimated $450 million in additional federal Medicaid dollars if it were to take advantage of the higher 10 percentage-point match for home- and community-based services.

But new rules and regulations would be associated with the money, and the federal government hasn’t  published the rules.

Senate Health and Human Services Appropriations Chairman Aaron Bean said the Senate is looking into the additional funding and whether it could be used as advocates want. Similarly, House spokeswoman Jenna Sarkissian said the House is awaiting federal guidance.

“These are new COVID rules that we are trying to figure out,” Bean said. “We are aggressively reaching out to the (federal) Centers for Medicare and Medicaid Services because we are still trying to get clarification.”

The iBudget program  provides people with intellectual and developmental disabilities access to a variety of services that aren’t traditionally covered by Medicaid or health insurance, including assistance with bathing and dressing.

Because the iBudget is an optional Medicaid “waiver” program, the state isn’t required by the federal government to provide the benefits to all people who qualify. As a result, Florida has long had a lengthy waiting list, with 23,048 people on it as of April 1.

Lawmakers earlier in the budget process agreed to spend $15 million to reduce the waiting list, a move that would have taken about 300 people off of the list. But the funding level was criticized by House Democrats, who said the state wasn’t doing enough to care for the state’s most frail people.

During eleventh-hour budget negotiations Monday night, top budget writers for the House offered to steer another $80 million to the waiting list, and the Senate accepted.

“I think that our advocacy is in favor of people with disabilities. … We’ve been screaming about reducing this waitlist for people with disabilities for some time, but those calls grew louder this session,” Rep. Carlos Guillermo Smith told The News Service of Florida.