No easy choices for disabled after big budget cuts

No easy choices for disabled after big budget cuts

published: Friday, October 17, 2008

l First of two parts


By CHRISTOPHER TUFFLEY

christopher.tuffley@newssun.com

AVON PARK -- When State Representative Denise Grimsley was recently asked what the biggest issue facing the Legislature was, she replied, "Florida will again be faced with preparing a balanced budget with an unprecedented reduction in revenue."

This story illustrates that problem by following an abstract choice made in Tallahassee to the very real effects that choice is having on individuals all over the state.

Caught in the middle is the state agency charged with the responsibility of carrying out the Legislature's wishes.

In October 2004, the Agency for Persons With Disabilities separated from the Department of Children and Families to stand on its own. Before then it was known as the Developmental Disabilities Program.

According to its Web site, "The agency supports persons with developmental disabilities in living, learning, and working in their community."

The goal is to maximize self sufficiency and increase independence, while insuring individual well being and safety.

The agency serves people with a range of conditions that interfere with ability to function in everyday activities.

Chapter 393 of the Florida statutes define developmental disabilities as spina bifida, autism, cerebral palsy and mental retardation.

According to Melanie Etters, the agency's communications director, the agency has run a deficit every year of its existence. "As long as a service was deemed necessary (for a client)," she said, "the client got it regardless of whether or not the agency had the money."

There were no spending caps and the state was spending approximately $1 billion a year and reaching 31,000 clients. Another 17,000 were on waiting lists.

But the running deficits meant the agency was breaking the law.

In the spring of 2007, when the state began to feel the effect of falling tax revenue, the legislature mandated a new policy, beginning with a cutback in funding to about $880 million.

With the cutback came the concepts of spending caps and apportionment.

The Legislature had the agency create four new Medicaid developmental disability waivers -- actually tiers in an ascending system. The Legislature then established the criteria for each tier based on an individual's needed level of service, current living situation and other characteristics.

Three of the tiers are capped, meaning there are financial limits. Put simply, the fourth tier, or bottom tier, is for individuals who live at home with families and have moderate disabilities. Spending tops out at $14,792.

The third tier, for individuals with moderate disabilities and who live by themselves or in group homes, spending tops out at $35,000.

The second tier, for individuals with more complicated issues living in group homes, tops out at $55,000, and the first tier, for individuals with intense disabilities, has no spending cap.

This new system went into effect Wednesday.

The practical result has been a cutback in services to many of the developmentally disabled. In an effort to be fair and give the clients a voice, Etters said, the clients themselves were given the responsibility of choosing what services they were willing to cut out of those they received.

Clients were also given the right to appeal the choice of tier the agency had made for them.

Out of the roughly 7,500 disabled people who are facing cutbacks in service, 4,550 of them have filed appeals. It is an extraordinary number, Etters said.


Part two will focus on the tiered funding pays for and talks to three individuals whose lives have been impacted by the new policy.








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