Support Revisions to the Developmental Disabilities Waiver Services Programs

Developmental Disabilities Medicaid Waiver Services

During the 2007 regular session, major service reductions, service eliminations and caps on services were approved and changes are currently being phased in across the state. The 2008 session ended with $43 million dollars in provider cuts that further eliminated the ability of individuals with developmental disabilities to access needed services. These service revisions are having a substantial impact on individuals with developmental disabilities and their families including forcing some to have to consider more restrictive levels of care.

The Council’s Position:

The tiered waiver system needs to be modified or eliminated. Except for the top tier that remains uncapped for those with the most intensive needs, cost plans will be capped based on where one lives instead of service need. Individuals living at home will only qualify for tier 1, capped at $14,792 (formerly the small Family and Supported Living Waiver), or $35,000 on the larger waiver. This could force individuals who have cost plans between $35,000 and $55,000 into more costly group care which will not save money and, more importantly, eliminate the choice of living at home. An estimated 6,151 individuals who live at home will have cost plans above the cap limits for the 3^rd and 4^th Tier and will lose between 32.8% and 45.8% of their services while others will lose no services. A valid and reliable assessment process that predicts costs can give the legislature soft caps to work with to contain and predict costs. It will also allow for individuals who fall at the end of a hard cap more consideration of their unique needs so they will not be propelled into crisis.

Fund the Waitlist. The Council wants to see individuals with developmental disabilities who are on the wait list receive the services they need, but the process should not cause a crisis to individuals currently receiving services. The waitlist will not be addressed by shifting the funding from the individuals currently receiving services to those on the waitlist. There will still be individuals waiting for needed services, both on and off the waiver.

Expand Consumer-Directed Care Plus Waiver. The Consumer-Directed Care Plus Waiver (CDC+) is a managed care alternative to the Home and Community Based Services Medicaid Waiver. It provides the opportunity for individuals with developmental disabilities to improve the quality of their lives by being empowered to make choices about the supports/services that will meet their long-term care needs and to help them reach their goals, within a defined budget that takes eight percent off the top for utilization. CDC+ puts the individual with developmental disabilities in charge of directing services and managing a monthly budget that is based on the individual’s support plan and cost plan. The individual (or their “representative”) chooses the services, hires the providers and judges the results. Outcomes are better, people are safer. There is less opportunity for fraud and more opportunity for a good quality life that is based on consumer choice. The Council supports as much consumer direction as possible in all the waivers.