By Lynn Hatter
http://stream.publicbroadcasting.net/production/mp3/wfsu/local-wfsu-989306.mp3
Tallahassee, FL – The agency that supports people with disabilities has been running in the red for years. Now lawmakers are calling for it to get its budget together--or else. But as Lynn Hatter reports, some observers say the agency's budget problems were created by the legislature, and they say lawmakers are bluffing on their threats. Meanwhile, the people who actually provide the services are trying to keep their doors open.
These are Tallahassee's Pyramid Players. A theatre group made up of people with disabilities. And every year they perform to packed audiences at one of the city's main entertainment venues. Bill Fuller is the founder of Pyramid Studios, which provides adult day training services.
"It used to be that our students came four-to-five days a week, now it's about two, to three. That means they're sitting home twice as much. It's forced them to give up jobs to supervise their adult children. From our standpoint, it also represents a huge waste of potential that people with talents and abilities are sitting at home with nothing to do, and that is a human dignity issue."
Providers like Pyramid have seen their reimbursement rates cut by almost 25-percent in the last few years. That money comes through the Agency for Persons with Disabilities through the Medicaid program. For the last several years, the legislature has cut provider rates in order to try and balance the agency's budget. Last year APD ended the year 170-million dollars in the red. This year it's looking at a 55-million dollar deficit. Melanie Mowry Etters is the agency's spokeswoman.
"One of the complaints that legislators have with our Medicaid waiver currently is that year after year we continue to spend more than what is appropriated."
The agency has been running budget deficits for the past several years. And that has lawmakers frustrated and fed up. In a committee meeting with APD's director Michael Hansen, State Representative Matt Hudson issued this warning:
"There are an awful lot of dollars at stake here. A lot of dollars that have to go to people who genuinely truly need them, and we have to make sure it's managed well. I challenge you and your agency to tackle the massive project in front of you, but know that we will be watching with a very scrutinizing eye."
APD's Hansen says a lot of the agency's budget problems are out of its control. And there's not a lot of places it can cut.
"We are required by law to admit people to the waiver or increase plans if people are in crisis. There's also legal challenges if we try to reduce someone's cost plan they have to have an opportunity go before a hearing officer to make their case, and we cannot reduce their cost plans one dollar until the challenge is resolved."
Hansen also says APD has becomes a go-to place for other agencies looking to reduce their own costs.
"Let me give you an example: someone is dual diagnosed if they have a mental condition and a developmental condition we end up paying for their care."
Lawmakers have said if the agency can't solve its budget problems, its programs will be swept under the state's Medicaid managed-care program. No one is quite sure what that would look like, but Agency Spokeswoman Melanie Mowry Etters says APD is working hard to address the problems. One solution the agency is hedging its bets on is called the I-Budget. It would allow families and individuals to spend their money in any way they want up to a certain limit.
"One of the benefits of I-budgets is, you know what your appropriation is, and everyone on the waiver will get an amount that's within our total appropriation."
But not everyone is convinced the system is a silver-bullet. Pyramid Studio's director Bill Fuller, an agency provider, says the program will result in a decrease in funding to families. He also says the legislature is partly to blame for the agency's budget woes. Around 2004 the legislature cleared the agency's waiting list and started giving benefits to an additional five-thousand people. But no one budgeted for the increase.
"We knew then that a deficit was inevitable. Their answer was consistently that this was a result of greedy parents, incompetent support coordinators, greedy providers. I would challenge them to prove that statement."
Last year, APD spent 930-million dollars. This year, lawmakers gave it 810-million, putting it on track to wind up with yet another deficit. Even with the money it has now, there are still 20-thousand people on the agency's waiting-list for services. And Fuller says if the state and agency were to fully fund everyone who is entitled to benefits, the true cost of the program could be in the billions.