Florida’s Medicaid waiver program for persons with disabilities, iBudget Florida, has hit multiple snags and as many lawsuits in its slow implementation since being created by the Legislature in 2010.
The program was intended to give clients better access and more choices in the services they receive, providing the potential to lower spending, and thus creating an opportunity to reduce the number of people on a wait list who go without resources. Yet, as is the case with many programs that seek budget predictability or make changes to service structures, not everyone ends up happy or cared for as necessary; and with iBudget just the same.
Under the program, about 40 percent of current clients could see cuts to their allocations by an average of about $7,000, according to a News-Journal report. These cuts are reviewed case-by-case by the Agency for Persons with Disabilities, yet many clients have little faith in the metrics the agency uses to make these decisions.
For some, these cuts mean losing adult day training, in which skills are learned a social setting, or lose essential transportation to these venues. Although according to APD, only about 10 percent of people who have transitioned to the iBudget have appealed — a rate they consider to be “very successful”.
Some are dubious of the low rate of appeals.
Craig Byrd, president and CEO of UCP/WORC in Flagler and Volusia Counties, said, “I believe the reasons for the small percentage of appeals are that individuals with disabilities and their families fear an appeal will cause a further reduction of their funding or they have been told by APD representatives to not waste their time.”
Others are not quiet with their dissatisfaction: a federal lawsuit filed by 10 plaintiffs with disabilities who faced reductions say that clients are not receiving adequate notice or are not given reasons why cuts are being made.
For an agency that has faced deficits as high as $100 million, spending control is necessary. But the Legislature had lost faith in APD’s ability to control its own budget; and has seemingly transferred, through iBudget, these burdens onto families. Under iBudget, clients are forced to choose which services they continue on limited resources, a daunting process that has far-reaching consequences.
The economic impacts of these changes may be felt beyond the families directly affected. Take for example, the mother of Chad Russell — who at 25 needs help with bathing, dressing and medical treatments and communicates with his team at UCP/WORC using sign language they have learned alongside him — may lose her job working on condo sales if Chad loses his access to adult day training. While she already pays for the majority of his services as well as medical supplies and diapers, he no longer receives speech, physical or occupational therapy due to cuts.
“Adult day training is the most effective cost-saving method there is,” said Jim Freyvogel, president and CEO of the MacDonald Training Center, Inc. “These services enable family members to keep their own jobs rather than being home as unpaid caregivers, and prevent people with disabilities from being forced to live outside their own homes. This is a huge cost saver. If Chad is forced to move into a group home it will cost the taxpayers of Florida an additional $45,000 to $50,000 for his care.”
Florida has worked hard to promote and maintain home and community based care; but many fear that changes under iBudget could erode this progress.
“The method in which APD is implementing iBudgets is undermining the system of natural supports which is the cornerstone of the service delivery system in Florida,” said Freyvogel, whose MacDonald Training Center supplements about 22 percent of the actual cost of care, saving taxpayers what he estimates to be about $1.3 million each year.
Freyvogel’s experience is not uncommon.
Byrd says various adult day training programs at UCP/WORC have seen significant drops in clients and a decrease of about $384,000 in combined state, local and federal funding.
Byrd’s concerns with iBudget also hit upon various administrative issues. Prior to iBudget, clients and service providers would receive an authorization for services for one year, providing the ability to plan and budget accordingly. Yet under iBudget, authorizations are required quarterly.
“This means perpetual uncertainty for clients and their families, and from a provider standpoint it is an administrative nightmare,” said Byrd. “iBudget is a wolf in sheep’s clothing. Consumer choice is only the PR piece to make the reductions more palatable. It is nothing more than a cost containment system for the state without regard to the needs of Floridian’s with disabilities.”