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Monthly Archives: September 2012

Below is a copy of my written testimony for Texas’ Department of Aging and Disability Services’ Legislative Appropriations Request hearing, which is scheduled for September 11, 2012. The full document of the LAR is located here: and this represents the first round of hearings for what will be the department’s 2014 and 2015 budgets:

I want to thank the Legislative Budget Board and the Legislature for the opportunity to comment on the Legislative Appropriations Request (LAR) for the Department of Aging and Disability Services (DADS). I am the parent of a five year old with Down’s Syndrome who will one day be an adult with Down’s Syndrome, so I am very interested in the services offered by the state of Texas. In addition to being a parent, I also serve as an appointed parent representative on the Children’s Policy Council, the Task Force for Children with Special Needs, and the Early Childhood Intervention Committee. In this letter, I’d like to ask the LBB and the Legislature to consider several items that were in DADS’ LAR as well as several items that were not.

With regards to items that were in the LAR:
• This LAR reflects a shift over to managed care. It is also reflecting the fact that whether we like it or not, costs increase and this must be accounted for via appropriations. If it is not, then the only way to balance things out is to reduce services. DADS is attempting to do this via two of their special items; maintaining caseloads and cost trends. These items represent approximately $101 million in FY14. If these special items are not funded then DADS will have to reduce services to Texans.
• If the state of Texas is committed to maintaining the State Supported Living Center (SSLC) system, then funds must be made available to keep them modern and well-staffed so that they are able to provide the best services possible to the residents. With that in mind, then the special item dealing with this (approximately $112 million in FY14) must be funded.
• It is in the best interests of Texas, and the individuals affected, to have people move from residential facilities to the community. In the community there are fewer risks of abuse, better opportunities for work, and an ability for people to thrive. Two of the special items (promoting independence and community expansion) that total approximately $151 million in FY14 deal with this and should be funded.

There were several items that were not in the LAR that I’d like to ask the LBB and the Legislature to consider:
• Health Management Associates issued a report in October of 2010 recommending establishing a pilot program using a non-capitated enhanced care management model for individuals with intellectual and developmental disabilities. The idea being that this can result in cost savings, open up additional waiver slots, and eventually (hopefully) lead Texas down the road to these services becoming entitlements like in other states. DADS should include this in the LAR (and in associated budget presentations) to get this pilot program funded for the biennium and lay the groundwork for possible future expansion of the program.
• Prior to the 2011 Legislative session, the Legislative Budget Board issued their report calling for a number of changes to the state supported living centers. Their recommendations were to include a rider in the general appropriates bill directing DADS to close at least one SSLC; to include a rider requiring DADS to submit a closure plan; to include a rider to authorize DADS to reclassify one FTE position to direct the closure process; and to amend the Health and Safety Code to establish a realignment/closure commission (for SSLCs). These recommendations did not go anywhere in 2011. DADS and the LBB need to provide leadership on this matter and resubmit these recommendations to the Legislature in order to give DADS the flexibility to modernize its services in this area. The fact of the matter is that the SSLCs are not sustainable and the most fundamental issue with them is the fact that there simply is not enough money to hire and retain the caliber of front-line staff, keep the facilities and services modern, and provide the residents the opportunity to thrive.

• It is important that future planning with regards to health care, Medicaid, and the improvement of services for individuals with special needs must be integrated. Often, these planning efforts are disconnected or driven by whim and this ensures that they will fail. Committees can draft reports, they can develop plans, but if they are not integrated and supported by the state agency strategic plan and the Legislative Appropriation Request then they are doomed to failure.

Thank you again for the opportunity to comment on this important matter. Thank you for your service in these difficult times.