Resources, and a few more details
This is a follow-up to an online discussion and materials posted earlier. There are cuts being considered by the governor that would take away long-term Medicaid support for thousands and permanently shrink the state's caseload by making it harder to qualify for services.
These include cuts to services administered through the Developmental Disabilities Administration (DDA) and the Aging and Long-Term Support Administration (ALTSA).
At this stage, there are two actions you should take.
1. Learn about the situation and alert others who could lose their long-term support
1. Learn about the situation and alert others who could lose their long-term support
- Many people still may not be aware of what's at stake. As of last July, the DDA counted 6,474 children and 6,173 adults in King County as clients; 9,362 are getting a paid service, while 3,284 are on the No Paid Services list. We have not reached anywhere near those numbers, yet, through our communications. Please, share resources
- Tell them what loss of service (or continued denial of service) would mean to you
- For those of you who will be electing new state representatives, contact the candidates
- See Resources to Engage, below. The easiest way is to sign up with The Arc of Washington's Action Center
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Budget details - Forecast is worse
This means the state does not have the money to pay for the current budget. This is worse than the situation just last week, when the shortfall was estimated to be $2 billion to $3 billion. For people with intellectual and developmental disabilities, this means the 14,089 people on the No Paid Services list will continue to go without services; and the 1,069 who have a waiver but were denied support due to capacity will continue to go under-served and risk crisis. It also means thousands who have services are at risk of being cut off, permanently.Knowing there would be a shortfall, the governor asked the departments he oversees to share cost-saving options. You can find the proposals on the web page linked to, above. We gave an overview of the DDA and ALTSA plans here.
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Plans from departments that people with I/DD most interact with
- Department of Social and Health Services (DSHS) – Includes the Developmental Disabilities Administration; Aging and Long-Term Support Administration, Division of Vocational Rehabilitation, and the Behavior Health Administration
- Health Care Authority Medical Assistance and Health Benefits Exchange
- Department of Children, Youth, and Families
- Commerce - Housing and Essential Needs (HEN) and other critical supports are channeled through Commerce
We encourage you to review the different cost-saving proposals so you can consider how they might affect you or a loved one. Changing eligibility for care is not the only proposal we are concerned about; but it is the one we are most alarmed and disturbed by.
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What we know about changing eligibility requirements
Both the DDA and ALTSA proposals mean fewer people would qualify and receive long-term support. The DDA is projecting several thousand would lose services.It also means that going forward a significantly smaller pool of people would qualify for habilitative support, personal care, or respite, and thus likely increase use of emergency services as individuals and families fall into crisis.
- Habilitative support is a service that helps you keep, learn, or improve skills and functioning needed for daily living. Speech, occupational and other therapies are all examples of habilitative supports. So is employment support
- Personal care includes assistance with dressing, feeding, washing and toileting, as well as advice,
encouragement and emotional and psychological support
- Respite services offer relief to a person's family caregiver; often respite doubles as access to day programs, including stimulating arts and recreational opportunities
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Background
Most services provided by the DDA are funded though Medicaid home- and community-based services (HCBS) waivers. The waivers are designed for specific groups. The “waiver” involved is an agreement to receive services in a home or community setting, as opposed to an institutional or facility setting. About 99 percent of the state's DDA clients are supported in the community. The current DDA waivers include:
• Individual and Family Services Waiver
• Basic-Plus Waiver
• Core Waiver
• Children’s Intensive In-home Behavioral Supports Waiver
• Community Protection Waiver
In order to qualify for an HCBS waiver administrated through the DDA, a person with an intellectual or developmental disability must meet “ICF/DD Level of Care” as defined in WAC 388.828.4400 (for adults) and WAC 388.828.3040 (for children).
• Individual and Family Services Waiver
• Basic-Plus Waiver
• Core Waiver
• Children’s Intensive In-home Behavioral Supports Waiver
• Community Protection Waiver
In order to qualify for an HCBS waiver administrated through the DDA, a person with an intellectual or developmental disability must meet “ICF/DD Level of Care” as defined in WAC 388.828.4400 (for adults) and WAC 388.828.3040 (for children).
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What would change
Because there is a complex algorithm attached to the waiver assessment, the DDA says it cannot explain exactly what would change, just that it would become harder to meet the ICF/DD Level of Care criteria.
The DDA projects that several thousand clients would lose their supports. This applies across all the DDA waivers and would impact individuals in a range of living environments, including living with family members, using community-based residential programs (e.g. Supported Living and Adult Family Homes), or residing in Residential Habilitation Centers.
Separately, the Aging and Long-Term Support Administration (ALTSA) has also put forward reducing eligibility as its main cost-cutting suggestion. Many people with I/DD receive supports through ALTSA.
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No legislative action required
The DDA confirmed that changing the WAC does not require legislation. The eligibility change can be made through an administrative rule change. For matters of civic engagement, this means less public scrutiny and no vote by your elected leaders. The public can weigh in, but the secretary of DSHS – a governor appointee – would make decisions about eligibility and who is no longer deemed vulnerable enough to receive long-term support.Ultimately, the decision to do far less for people with intellectual and developmental disabilities is the governor’s, through his administrative staff, unless the legislature chooses to intervene with a policy change to the Revised Code of Washington, or make a funding change.
If the proposal to change eligibility is approved, the DDA projects changes could take effect January 2021. The state legislature does not convene for its next general session until January 11, 2021. So this change could happen before the legislature re-convenes.-
Did you know?
People with intellectual and developmental disabilities are four times more likely to contract COVID-19, and twice as likely to die from it. This article looks at a recent study. Now is an especially difficult time to cut support.People with cognitive and behavioral disabilities face deepest poverty in Washington. 17 percent are in deep poverty; 32% are in poverty or deep poverty; and 54% are low income, in poverty or in deep poverty. (Source: DSHS/Economic Services Administration Analysis of 5-Year American Community Survey data 2013-2017. See page 10 of 10-year plan, Jan 2020, Poverty Reduction Work Group)
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Resources to engage:
ACTION CENTER: We are encouraging people to contact their state legislators. The Arc of Washington has an action alert center. If you are interested, you can access it here:
There is a petition to the governor posted, as well as an action alert for state legislators.
CONNECT DIRECTLY: Or, you can email your legislators directly.
You can find your district number and state representatives and senators here:
CONNECT DIRECTLY: Or, you can email your legislators directly.
You can find your district number and state representatives and senators here:
- Enter address; your legislative district number and the names of your state reps will come up
- Click on the name of a legislator to get contact info for them
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If you don't know your state legislative district, use the district finder tool
- Click here for a Developmental Disabilities Budget Crisis Advocacy Toolkit, assembled by advocates from across the state
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Resources to share or learn from:
- Overview of proposed cuts and budget timeline (This links to another post in our Voice blog)
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To wrap up:
This is a lot to take in. Mainly:- The threat of cuts is real
- The cuts would be dire to people with intellectual and developmental disabilities and their families
- You should keep informed (we will do our best to keep you up to date)
- Please contact your legislators and the governor. Tell them what loss of services means to you
- We can share the numbers and big picture stuff; only YOU have the power of your story.
