The program supporting thousands of Floridians with developmental and intellectual disabilities is likely in for an overhaul this year. Advocates had been relying on the Senate to save the ibudget program from being taken over by private companies. But some say Republican Senator Aaron Bean’s proposal might be worse.
For more than a decade now, Florida’s Agency for Persons with Disabilities has been running way over budget. The agency’s ibudget formula is used to decide how much money people receive for services that allow them to live independently. When it was first rolled out the idea was to give people less money in exchange for more flexibility in how they spend it. That hasn’t quite worked out. Last year, the agency was more than $100 million over its billion-dollar budget, something Bean says jeopardizes its survival.
“To the public and everyone who’s on this waiver (program)," he told the people gathered in the hearing room, "if we don’t make changes, the whole thing is going to collapse under its weight. We can’t continue to deficit spend.’’
Bean’s plan to fix the issue requires the people who do work directly with families—support coordinators—to be contracted out and hired by at least two or more vendors in each region of the state. He says that would provide greater professionalism and consistency. The plan also shifts responsibility for reviewing budgets and billing for people with significant additional needs from APD, to the Agency for Healthcare Administration. But AHCA wouldn’t do those reviews itself. It too will have to contract with outside vendors and appeals would stay with APD. Bean says his proposed system will be faster and better.
But APD Secretary Barbara Palmer has concerns. “I feel like moving it to other agency just adds another layer of complication to how the legal process would work and some other things," she said.
Palmer supportive of the overall bill, but is concerned about multiple agencies and outside vendors being tasked with budgeting and billing.
Many of the people who recently spoke about the proposal say they like Bean personally and that his heart is in the right place. But they fear what happens if the proposal passes with the outsourcing language. Florida Developmental Disabilities Council Executive Director Valerie Breen says there are organizations that could handle the outsourcing of the coordinators. What’s more concerning to her is outsourcing of budget reviews.
“There is a major company that’s doing it for Medicaid managed care. So there probably are. But will they have the knowledge base, the sensitivity…to deal with our ill funded system to meet the needs of our population? No. I don’t think that’s going to solve it. I think it’s going to create what it did in the past. More headaches," she said.
Still, she acknowledges the alternative: what the House will do if there’s no solution to APD’s budget overages. Disability advocates worry the House could privatize the program and cut its budget the same way it did with the state’s Medicaid program for low-income Floridians.
“So this deficit issue with APD has been an ongoing issue for the House. And so I think they’re...waiting to see what the Senate does to be able to push through issues more that they’re used to, with moving the plans over to managed care," Breen said.
Bean says that’s a real possibility.
“Before we spend the first dollar on anything…we’re going to spend $107 million on the deficit APD is running. That will not continue. The rest of the legislature says we’re going to end this. You know what they’re going to do? Where we’re headed if we do nothing—managed care is the only default solution there is.”
More than 34,000 Floridians are receiving services through the ibudget program that help them live independently and stay out of more expensive institutions. Another 21,000 people are on a waiting list.
Bean’s plan does NOT include what’s been a major ask—more money. A separate proposal would require the state’s social services estimating conference to calculate and form better estimates for what APD needs. The Legislature is likely to approve changes to the ibudget program this year: advocates want make sure they can mold those changes into something everyone can live with.