When asked for options, DSHS included changing eligibility for long-term supports
People with cognitive and behavior disabilities face the deepest poverty in the state, and people with disabilities that prevent them from
walking or moving around aren’t far behind. These folks make up the core of
people with developmental disabilities. For those who rely on them, long-term
services and supports are so much more than safety and security:
·
Personal care literally means being able to get out of
bed
· Residential support means access to a home
· Employment support means access to jobs
Without supports, those facing deepest poverty could lose
everything.
So why is there talk about cutting the lifeline for people with
developmental disabilities? Why is there a petition circulating to the governor and state legislators?
Office of Financial Management exercise
First, there is no decision – yet – to cut services. But the situation is dire. In response
to plunging sales tax revenue and an expected gap in the current budget of $2
to $3 billion, the state is doing some “what if exercises.” As in, what are the
options if the state Developmental Disabilities Administration (DDA) had to cut 15
percent of its budget?
All the state agencies did this exercise. The Office of Financial
Management (OFM) will be posting agency responses online on Monday, June 8.
The options shared that affect people with disabilities are devastating, including one to further restrict eligibility for long-term services
through the state Developmental Disability Administration (DDA), part of the Department of Social and Health Services. This proposal involves
more than limiting new enrollment – it would kick people off services they rely
on.- People who face deepest poverty could literally lose the ability to get out of bed, to bathe, or toilet. This could land them in the hospital
- People cared for by aging parents could lose the opportunity to move into an Adult Family Home or get community residential supports. In the event of illness or death of a parent, they could face homelessness
- Families who rely on behavior supports to help their loved one stabilize could spiral into deeper crisis
Other actions suggested are noted, below.
At 41st in spending, Washington state is already near
the bottom when it comes to investing in Medicaid community supports for people
with intellectual and developmental disabilities.
Too many of our loved ones and their families are already in crisis.
Washington is already sending youth out of state because our state doesn’t offer appropriate supports here.
Individuals are already being abandoned in hospitals because caregivers can no longer support them.
Too many of our loved ones and their families are already in crisis.
Washington is already sending youth out of state because our state doesn’t offer appropriate supports here.
Individuals are already being abandoned in hospitals because caregivers can no longer support them.
Families already hear, “I’m sorry, but we can’t do anything for
you.”
At current funding levels, the DDA only offers support to about 30
percent of Washington residents who meet the federal definition of developmental
disability. That is:
- Severe and chronic disabilities that start in childhood, continue indefinitely, and result in substantial functional limitations in 3 or more areas of major life activity
Next steps:
Early last week, 27 organizations supporting or advocating for
people with developmental disabilities and their families sent a statement of
guiding values for budget reductions to the state legislature’s lead budget
writers. You
can read it here.
Over the next 10 months, The Arc of King County will provide information
about the budget process, run advocacy workshops, and share opportunities to
engage. We are working alongside The Arc of Washington, the state Developmental Disability Council, and other partners in the statewide Community Advocacy Coalition to educate leaders about the impacts of cuts and crisis.
We will also work alongside partners in other coalitions to monitor proposals that
would cut K-12 education, early learning and childcare, and housing.
So far, proposals that most alarm us are ones from DDA and the Aging and Long-Term Support Administration (ALTSA), which also serves many people with developmental disabilities. Because people with disabilities are over-represented in food and housing instability, foster care and justice systems, the DD community could be disproportionately impacted
across agencies.
This week, the Office of Financial Management will post details of
what each agency sent in for the 15 percent cut exercise.
Some ideas would require
legislative action to implement; others might require labor agreements; and still others rulemaking.
Rulemaking is a process where agencies post proposed changes to the Washington
Administrative Code, hold a public hearing, and then issue a decision. No
legislative action is needed in rulemaking.
It’s important to note that OFM's budget cutting exercise is the
start of a process that will last through next spring, and possibly longer if the
legislature cannot come to an agreement during its regular session. In the Great
Recession, the legislature considered both cuts and new sources of revenue, but
relied heavily on cuts.
Here is a general timeline:
- Revenue forecast June 17: The state will know then whether immediate cuts are necessary
- Supplemental budget:
If needed, the state will draft and vote on a supplemental budget for current
spending. The budget is voted on by the state legislature; the governor has
veto power. If a supplemental budget is needed, the legislature could convene
for a special session. Or they could make budget adjustments at the start of
the next general session.
- Next biennium budget: Over the summer, agencies will work on budget requests for the
2021-22 state budget. They submit those to the governor in September.
- November 2020 revenue and caseload forecast: The governor’s staff builds a budget proposal.
- January 2021: The state legislature
convenes. The budget writing committees will host public hearings on the
governor’s plan, but the actual budget will be passed by the legislature; the
governor has veto authority
- February/March 2021:
Quarterly revenue and caseload forecasts come out and inform the legislature’s
budget proposal
- April 2021: The legislature
passes its budget (in theory)
- April/May 2021: The Office of
Financial Management reviews; the governor signs or vetoes
- June/July 2021: Agencies submit detailed spending plans. The new biennial budget takes effect July 1, 2021
Options put forth
Unfortunately, we don't have any more detail than what is provided here. This information came from letters DSHS administrators shared with the community. When we know more, we will share out.
NEW! Cuts proposed by DSHS (Opens spread sheet)
NEW! Cost savings proposed by all departments (Opens webpage)
NEW! Cuts proposed by DSHS (Opens spread sheet)
NEW! Cost savings proposed by all departments (Opens webpage)
DDA options
- Staffing
costs: Options include unpaid furlough
days. ($8.3M GF-S; $14.8M total funds)
- Delay
expansion or eliminate client service programs: Includes eliminating the
Community Crisis Stabilization and Adult Family Home Meaningful Day programs
and reducing Medicaid waiver capacity. ($26.6M GF-S; $48.8M Total Funds)
- Residential Habilitation Center cuts: Options include reducing staff positions,
consolidating cottages and closing Rainier School entirely. Closing Rainier and
transitioning all the clients actually costs more in FY21, but leads to savings
in the next biennium. ($5.5M GF-S; $11.5M Total Funds)
- Provider
Rates: Savings is achieved by a rate cut for in-home providers, Adult
Residential Care, Adult Family Homes, and employment and community integration
providers capturing the additional 6.2 percent of enhanced Medicaid matching
funds from July through September as savings. ($24.2M GF-S; $33.4M total funds)
- Client Eligibility: Changing the level of ICF/IID in Washington’s Medicaid state plan to increase functional eligibility requirements will end services for thousands of Medicaid clients in home and community residential settings and RHCs; and a corresponding reduction of DDA staff. ($75M.3 GF-S; $150.5M total funds)
ALTSA options
- Cut client
eligibility: Elimination of the optional Medicaid Personal Care (MPC) state
plan program. Increasing the level of functional need required to meet Nursing
Facility Level of Care in Washington’s Medicaid state plan and waivers will
decrease the number of Medicaid clients in home and community residential
settings by approximately 20,500 people; nursing home clients by approximately
680 people; and a corresponding reduction of a significant number of ALTSA
staff and AAA full-time equivalent positions. ($129.8M GF-S; $282.3M total
funds)
- Eliminate
client service programs: Includes eliminating state funded non-citizens and
Senior Drug Education programs, Medicaid funded Adult Day Health and Day Care
services, reducing Adult Family Home Meaningful Day programs. ($15.5M GF-S)
- Provide rental
subsidies to assist nursing home clients who request transitions: To assist
clients in nursing homes to transition to their own residence with in-home care
supports, ALTSA proposes paying for rental subsidies so that clients can afford
to relocate to their own home. Even though the subsidy is state-only funding,
the cost is still less than paying half of a nursing home rate, thus saving
money. ($1.0M GF-S)
-
Cut provider
rates: Savings is achieved by assuming an across–the-board three percent rate reduction
for all ALTSA providers, including those who collectively bargain wages and
benefits and capturing the additional 6.2 percent of Medicaid matching from
July through September as savings. ($60.6M GF-S; $9.4M total funds)
- Staffing costs: Including unpaid furlough days. ($15.0M GF-S; $25.8M Total Funds)
