A Seven Year Summary

The following piece is adapted from the Florida Association for Rehabilitative Facilities (ARF) Medicaid Waiver cuts white paper for the developmentally disabled.  It gives a bleak but accurate picture of the cuts seen within the system over the past seven years.

• In July 2003, the State of Florida Agency for Person’s with Disabilities (APD) adopted a system that contained up to 720 billing options for residential habilitation (group home) rates and new rates for most of the 30+ services funded by the Home and Community Based Services Waiver (HCBS).  The legislature started using a reimbursement system that was based on direct care wages funded at the 25^th percentile compared to national averages for wages.
• In November 2003, APD reduced group home rates by 14.3% and Live In Residential Habilitation by 7%.  Also, billable days were limited to 350 per year for homes having more than 3 individuals.  Adult Day Training (ADT) rates were reduced by about 9.5%. 
• In 2004, APD implemented a group home matrix approach which looked at staffing.  In many cases the last two admissions to a six-bed group home received reduced billable hours.   
• In 2006, agencies received a 2.81% Cost of Living Adjustment that applied to all waiver services. 
• During the 2007 Legislative Session, the Florida Legislature mandated changes in Senate Bill 1124 that resulted in limitations and eliminations of Developmental Services Home and Community Based Services (HCBS) Waiver services funded through the Medicaid program.   1) IQ Testing (Psychological Assessments) services were eliminated. 2) APD will be implementing a uniform rate for individuals with intense needs, but a date for implementation has yet to be set. 3) Supported Living Coaching has been limited to no more than 20 hours a month for persons who also receive in-home support services.
• In December 2007, group home rates were collapsed and reduced overall by 7%; however, a settlement agreement reduced the reductions to 4.25%. 
• As a result of the 2007 legislation, Agency for Health Care Administration (AHCA) in consultation with APD sought and obtained federal approval for two additional waivers to implement a four-tiered waiver system. (See blog on tiers)
• In May 2008, proviso language passed that implemented a $43 million across the board rate cut for waiver services that was implemented in July 1, 2008.  Group homes and Support Coordination received a 3% cut effective July 1, 2008, (in addition to the 4% reduction taken in December 2007 for group homes) and other waiver services received a 7.21% reduction in rates. 
• In October 2008, the APD began a rebasing exercise which was intended to freeze individual service expenditures as of January 2009 at the FY 07-08 level plus no more than a 5% increase until June 30, 2009. 
• In January 2009, during a Special Session the Florida Legislature approved a 3% rate reduction ($21 million) for DD waiver services.  However, the rate reduction was vetoed by the Governor and was not implemented.
• The 2010 Legislature decreased the overall funding level for the waiver by $43.8 million, and did not continue anticipated federal stimulus (FMAP) dollars that would continue Florida’s current enhanced FMAP ratio from January 2011 through June 30, 2011. The proviso language approved by the 2010 legislature included a 2.5% provider rate reduction for most waiver services However, the Governor vetoed the rate cut language. 

 The funding level for next fiscal year (FY 10-11) is only about $7 million more than the FY 05-06 amount.  There was a time, when we were actually getting better with funding for those with disabilities in the state of Florida.  However, the current trends show that individuals on the waiver are receiving fewer services while only limited new enrollment is occurring.  There are over 20,000 people on a “waiting list” to receive services in the state of Florida… though I am not a fan of big government or government-run healthcare, who else is going to help those who truly cannot help themselves?  The state of Florida is going to have to respond on behalf of those who can’t speak for themselves…The picture is pretty bleak, but we must continue to advocate for these special people.  After all, if we don’t, who will?