The Agency for Persons with Disabilities recently got itself back on sound financial footing after nearly a decade of budget deficits that had agency officials under a legislative and gubernatorial microscope. Now the agency is facing two lawsuits challenging its budgeting process, and the outcome of those legal challenges has the potential to throw the agency’s future, and those of the more than 30,000 disabled Floridians it serves, into doubt.
For years, APD has struggled with a basic economic problem: Too many demands, and not enough supply. At one point, the agency’s budget deficit was more than $100 million. To control costs, the agency first cut the amount of money it paid providers to take care of the needs of more than 30,000 disabled, mostly adult, Floridians.
“What I told the attorney’s at APD, I guarantee you, you would not wipe a grown man’s butt for $7.50 an hour," said Ken LaRoe, a Central Florida banker who is a party to at least two lawsuits against APD.
LaRoe's 26-year-old son is disabled and lives in a group home and requires 24 hour care. In the past few years, LaRoe says he’s seen first-hand how budget cuts have impacted the people who provide that care—everything from late arrivals, to days when there’s no food, or his son’s teeth don’t get brushed because there’s no one there to do it.
A year ago, the LaRoe family was notified the agency was cutting the Medicaid funding used to pay for his son’s care by more than $8,000, around 20 percent of the overall allocation. The reason: the agency had a new way of divvying up those Medicaid dollars, called the ibudget.
“It’s pretty easy to see what they’re trying to pull. Someone sat around a conference table and said, ‘well let’s gut the funding.’ Figure out how to do it and do it. And the only way to do it was through shenanigans...because, it was such a shoe-string budget to begin with.”
One lawsuit against APD alleges the agency didn’t provide proper notification to families about why their budgets were being reduced. And Ken says that was true for him. He also pushes back against the agencies claims it allows challenges—and says the 10 day challenge period after notification isn’t long enough. But it’s the second lawsuit—the challenging the rules used to implement the ibudget-- that has APD officials really nervous.
“It has so much of a margin of error, It’s a bit like throwing darts at a wall of numbers,” said Gigi Rollini, an attorney with the firm Holland and Knight, who represents four people who say the mathematical formula the agency is using to determine awards, is wrong.
Rollini says under the ibudget, some people are getting too little funding, while others are getting too much. Furthermore, Rollini argues the Agency for Persons with Disabilities violated the state’s rulemaking process when it rolled out the system before there were firm rules governing the program in place:
“We’re talking about a program that’s probably here to stay in Florida. And allowing a broken system to continue for years to come, can’t be the answer.”
But Barbara Palmer, APD's director, says a perfect formula is impossible, because even if people have similar disabilities, their needs can be, and often are, completely different.
“There is no way an algorithm, and any kind of formula can be developed where 30-thousand people can go through it and it be perfect. It’s impossible.”
Palmer is credited with getting the agency back on sound financial footing. She says APD has been transparent about its budgeting process, and points to internal figures showing most people who receive budget cuts, don’t challenge them:
“About 90 percent of the people did not challenge. How’s that? 10 percent of the people did".
Palmer says all the allocations went through reviews by case managers hired by the families. More money was added when those families didn’t agree, and if a deal still couldn’t be reached, the case was bumped up to regional offices and ultimately a hearing. She says no budget was reduced while it was being challenged. The lawsuits against the agency don’t sit well with Palmer, who questions the motives, and the timing of the rule-challenge lawsuit, after nearly two years of hearings on the ibudget and its governing rules:
“This challenge was done the very last day the rule was going to be finalized. What is the reason for it? That’s the question we want someone to answer for us. Why did they wait so long? Why didn’t they do it when we could have corrected whatever it was that was problematic and what was the motive behind this?”
Palmer says she believes part of the impetus behind the lawsuits is a drive to privatize the waiver program. Both groups backing the lawsuits against the agency deny that. There is precedent for privatizing social service programs in Florida. The state has done so with the health insurance part of Medicaid for low-income Floridians in an effort to control costs. Some state prisons and some prison services have been privatized and an effort to do the same. And state lawmakers raised the possibility of privatizing APD as they hammered the agency over its budget problems.
The Medicaid funding flowing through the ibudget is nearly a billion dollars. The legislature put another $36 million into the agency’s budget this year, enough to provide services for more than 700 people on a waiting list. But people like Ken LaRoe, who have been watching the agency struggle with funding, say it’s still not good enough:
“It’s a hellhole. It’s a social services hellhole. And I’m a lifelong Republican. This is a business issue. It’s not a liberal, touchy-feely giveaway thing. Someone who has a handicapped child and they can’t work—they aren’t contributing to the tax base...it’s not business-friendly.”
Florida ranks near the bottom of states when it comes to providing care for that population. If the agency loses the lawsuits, it could be required to reverse many of the payment cuts made in the past two years. That could push the APD back into the red. But if the plaintiffs prevail in their challenges, they may be able to get back vital services that for some mean the difference between between living independently, or being institutionalized. And the end of the day, there are still 20,000 thousand more people on a waiting list, getting nothing at all.
