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Monthly Archives: August 2012

The Legislative Appropriations Request (LAR) for the Department of Aging and Disability Services (DADS) in Texas has been published.  The full document can be found here: http://cfoweb.dads.state.tx.us/lar/default.asp.  In Texas, the way the budget process works is that it is done by biennium (this is because the Legislature meets every two years).  So, during the summer of the even-numbered years the various agencies submit their LAR.  This is what they want their budgets to be given instructions and limitations provided by the state’s leadership.  This goes to a hearing before representatives of the Governor’s office, the Legislature, and the Legislative Budget Board (LBB).  The LBB then makes recommendations based upon this to the Legislature, who prepares and votes for the budget which the Governor then signs (or vetoes).  The actual budget that the agency receives for the biennium may or may not reflect what they submit via their LAR.

 

The current biennium is FY2012 (the current year, which ends August 31) and FY2013.  The LAR that has been submitted will cover FY2014 and FY2015.  So in this blog I’ll compare FY2012 to FY2014.  I’m only going to focus this post on DADS’ goal of providing long-term services and supports.  I won’t post anything about their regulation/outreach and indirect administration goals.  The long-term services and support goal has several objectives and supporting strategies.  These include intake/access, waivers, entitlements, community services, nursing facility payments, promoting independence, ICF’s, and state supported living centers.

 

The current fiscal year (2012) has approximately $6.4 billion budgeted for these.  DADS is requesting $6.15 billion for fiscal year 2014 (the first year of this LAR), a 3.5% decrease.  Much of this is due to the roll out of STAR+PLUS and services being absorbed by STAR+PLUS.  This decrease is primarily coming from the following areas:

  • Primary home care: this is the providing of non-skilled personal care services.  This is seeing a major reduction (FY12 to FY14) due to STAR+PLUS, which will eventually see this strategy be eliminated.
  • Day activity and health services:  This refers to adult day care services and is another being impacted (and eventually eliminated) by STAR+PLUS.
  • Community based alternatives: This is a service designed to help keep people out of facilities, it’s another that is impacted by STAR+PLUS and will eventually be eliminated.
  • ID community services: The intellectual disability services are seeing a reduction of approximately 14% comparing FY2012 to FY2014.  This is due to the administrative expenses being transferred elsewhere and to some of the individuals receiving services being transferred to the Texas Home Living Waiver (see below).
  • Promoting independence by providing community-based services: This service is designed to help get people out of residential facilities and back into the community.  It is seeing a reduction due to STAR+PLUS.
  • State supported living centers: The state supported living centers are seeing a strange funding pattern.  From FY2012 to FY2013, they are losing 1.3% of their funding.  From FY2013 to FY2014, they will see a 0.6% increase in funding, partially restoring some of what was lost. 

 

The following areas are actually seeing an increase in this LAR:

  • Community attendant services: This increase seems to be balancing out the reduction in primary home care.
  • Home and community-based services (HCS Waiver): Compared to 2012 HCS is seeing a large increase in funding (roughly 4%).  But this is fairly flat compared to FY2013’s funding.
  • Texas Home Living Waiver: Compared to 2012 this is seeing a large increase in funding (roughly 41%), but this is flat compared to FY2013’s funding.  This increase over FY2013 represents instructions from the current appropriation’s act to provide services to more individuals via this waiver.
  • ICF’s: Intermediate care facilities for an individual with an intellectual disability are seeing an approximately 1.3% increase in funding from FY2012 to FY2014. 

 

Now, DADS also has eight exceptional items which will impact many of the areas highlighted above.  The amounts shown reflect all funding sources for FY2014 only:

  • Maintain caseloads: approximately $11.4 million.  The instructions that DADS received on this LAR were essentially no new growth in their baseline request.  If that is done, by 2014 they will not be able to maintain 2013’s caseload levels – which means reducing the number of people serviced.  This exceptional item is meant to keep that from happening.
  • Cost trends: approximately $90 million.  DADS was instructed to show cost increases, rate increases, etc. as exceptional items.  DADS points out that they have no ability to control these cost increases and failing to fund this will reduce services.
  • Promoting independence: approximately $20 million.  This exceptional item is meant to get a number of individuals out of residential centers and to provide crisis services to individuals in immediate risk of institutionalization.
  • Community expansion: approximately $131 million.  This item would increase community services for individuals on interest lists.  For example, it would serve 20% of the eligible individuals on HCS and CLASS interest lists.
  • Protecting vulnerable Texans: approximately $12 million.  This would add staff and help upgrade IT systems in areas like guardianship, ombudsmen, adult protective services, etc.
  • Improving support for SSLC residents: approximately $112 million.  These are infrastructure improvements to the state supported living centers.  Things like furniture, computers, IT upgrades, vehicles, repairs/renovations, etc.
  • Streamlining service systems: approximately $9 million.  This is primarily an information technology initiative.
  • PACE expansion: $1 million.  This would add additional PACE slots and fund new sites.

 

All of these exceptional items total about $385 million for FY2014, of that $258 million would be from Federal funds or other funds, only $127 million from the state.  In FY2015, these exceptional items would expand to over a billion dollars.  This is primarily from the following:

  • Cost trends: expands to $195 million
  • Promoting independence: expands to $60 million
  • Community expansion: expands to $765 million
  • PACE expansion: expands to almost $11 million

 

Of this billion dollars, $337 million would be from the state with the rest from Federal and other funds.

 

How will this LAR potentially impact Texans with disabilities?  First, it demonstrates that Medicaid recipients are going to be rolled into managed care, which has pro’s and con’s.  Second, it’s renewing the commitment to the state supported living centers and the ICF’s.  Third, there is never going to be enough money to fund the number of waiver slots needed, combined with the increase in costs.  Finally, in my opinion the exceptional items should be called “Things We Need  To Do Just To Hang On,” if they are viewed as superfluous by the state’s decision makers then this will end up hurting the elderly and disabled in Texas.

The Department of Assistive and Rehabilitative Services (DARS) in Texas published its Legislative Appropriations Request (LAR) on its website yesterday.  To view this document in its entirety click here:   .  This is where the agency makes its request to the Legislature, Governor, and Legislative Budget Board for its funding for 2014 and 2015.  This will be followed by a hearing before those bodies on September 10, 2012 in Austin where DARS will present this request.  I’m going to write a little bit about the background behind this request, the consequences of the background, and discuss how the current request impacts Early Childhood Intervention (ECI).

First, as background ECI had its funding cut by 14% for 2012 and 2013 (the current biennium).  As a result, DARS had to make some tough decisions to continue to offer services with such a reduced budget.  These decisions were:

  1. Narrow the eligibility requirements of who gets ECI services.  This means that fewer kids are receiving services today.
  2. Implement a family cost share, which means that as a family’s income level increases they pay for a greater share of the ECI services that their child receives.
  3. Require ECI providers to directly bill Medicaid to be reimbursed.  This is was not a skill set that many of these providers possessed.

The effect of these cuts has been dramatic.  In 2011, 3.62% of children under the age of three were served by ECI.  This number will drop to 2.96% in 2014.  In 2011, the number of children enrolled in ECI declined by 6.1%.  This will decline by a further 17.1% in 2012 and is forecasted to be flat (i.e. zero growth) in 2014.  The DARS LAR has ECI services suffering a 12% reduction in funding from 2011 to 2014. 

There are a number of complications.  First, the population of Texas is increasing.  Just because of this the number of children needing ECI services will increase.  Second, while narrowing the eligibility decreased the number of children receiving ECI it also had another effect, it meant that those children receiving ECI were more significantly delayed and required more services.  The combination of these two mean that keeping funding flat (i.e. the proposed LAR) will result in another narrowing of eligibility because the current funds cannot fund the future demands even with the changes that have been put into place.

As a result of this, DARS has two exceptional items that they are requesting funding for with regards to ECI.  The first requests approximately $8 million in 2014 and $16.5 million from all funds to fund the anticipated growth in the number of children who will qualify for ECI even under the current narrowed eligibility criteria.  The second requests approximately $8.7 million in 2014 and $9.2 million in 2015 to maintain the level of service to children (this refers to hours/week) due to the fact that children with more severe delays (which is the result of narrowed eligibility criteria) require more services.

If ECI does not receive the exceptional item funding that it is requesting, then it will have to narrow the eligibility requirements still further. This will mean that fewer children with needs will receive services.  These needs won’t go away, they will be transferred to the public schools because they are not addressed early.  This may impact children’s success in school, their success in employment, and the amount of public assistance they are going to require in school and in their post-school lives.