APD's Legislative Digest | Agency for Persons with Disabilities

The Senate Health and Human Services Appropriations Committee met on Thursday, January 24, 2008, and began with opening remarks from the Staff Director Elaine Peters about the budget prospects. She said the Legislative Office of Economic and Demographic Research reports the state's revenue has continued to decline from earlier projections and is approximately $100 million less and the downturn will continue into the FY 2008-09 base budget. It was reported that a budget shortfall of $1.6 billion is projected. The House is proposing cuts to the budget of approximately $2 billion. She said there will be another revenue estimating conference in March and appropriations committees will have a better idea of how to adjust needs for next year's budget. Senator Frederica Wilson (D-Miami) asked if anyone is looking for alternative funding solutions since the outlook is so bleak. Committee Chair Senator Durell Peaden, Jr., (R-Crestview) responded that this would be a question for the Senate Finance and Tax Committee.

APD Director Jane E. Johnson then gave a follow up presentation to the committee about the agency's crisis enrollment process and the wait list. An earlier issue arose about an individual who was homeless and in need of services. The committee had the impression the person in question was left without services for 60 days while waiting to become eligible and enrolled in the waiver. Director Johnson explained that, like with anyone with immediate crisis type needs, this individual was immediately helped with finding an emergency shelter and other non-waiver services while waiting for waiver enrollment.

She thanked the Department of Children and Family Services for helping APD expedite the Medicaid eligibility process and said that most of these determinations were made within 14 days or less. Improvements include APD employees being trained in the Medicaid application process so they are better able to assist families. A Medicaid eligibility expert is being assigned to APD to consult with the crisis committee and to assist with complex issues.

Director Johnson said APD has General Revenue funds it uses for emergencies until individuals can be enrolled on the waiver. Last year, the agency spent $5.3 million in General Revenue and has spent $2.2 million this year for individuals who are on the wait list. Director Johnson said per legislative direction, crisis enrollment is currently funded through attrition that occurs within the waivers. APD enrolled 298 approved crisis applicants last year and processes about 19 per month. The agency has also streamlined the financial eligibility and waiver application processes. Individuals can be enrolled within 45 - 90 days. She said individuals are being encouraged to enroll in Medicaid before they are assigned to the waiver to expedite the approval process.

Based upon recommendations from the OPPAGA report, which was discussed in the previous committee meeting, APD is looking to re-categorize the wait list as follows: Individuals in crisis; children in foster care; Brown v. Bush; and individuals with valid court orders. The agency will also assess immediate service needs within 6 months. To comply with concerns raised by both the Senate Children, Families, and Elder Affairs and HHS Appropriators Committee members, APD is breaking the wait list up into categories such as services needed within 7-24 months; aging out of Medicaid State plan within 2 years; transitioning from school within 2 years; and anticipated loss of caregiver within 2 years. A planning list will be maintained that will identify services needed within the next 2-5 years. The Senate Appropriations Committee encouraged the director to continue the efforts.

There was mention of redesigning the APD system and Director Johnson responded by saying SB 1124 was a radical redesign with the service reductions and eliminations and the unknown impact of implementing the tiers. "No one wants to get in the black more than I do," she said.

Matt Claps, APD Senior Management Analyst for the Operations Division, gave an update on foster children on the APD wait list. In FY 2006-07, a total of 337 waiver offers were made to DCF/CBC children and 529 have been added to the waiver. APD was subsequently directed by the Legislature to limit enrollment to only people in crisis through attrition and CBC children were the next priority. APD had collaborated with DCF to develop an operating procedure for the identification and enrollment of these children and has developed a process to give these children priority consideration on the wait list when the agency is able start new enrollment. However, these children are not excluded from applying for the waiver through the crisis process. Waiver expenditures for DCF/CBC children through mid-December were $6.29 million, with estimated projected FY 2007-08 total expenditures of $13.72 million, a 12 percent increase over FY 2006-07.

Senator Rich expressed concerns that the CBCs are using their money to pay for APD services and wanted to know about placing them on the Family and Supported Living (FSL) waiver. Claps said that their needs are assessed to determine appropriate placement and the FSL is intended for family-like settings and most of the CBC children are placed in residential settings due to their needs. He said expanding the FSL to include this service would be very expensive. Senator Rich asked why APD had not used the surplus in the FSL to serve these children and Claps explained that the Legislature has given APD authority to use this money to offset its deficit and any change in that will only serve to increase the deficit.

Don Winstead, Deputy Secretary for Department of Children and Family Services, was called to the podium to answer questions about the CBC spending issue. He told the committee that as Director Johnson and Claps had indicated, they are all working closely together on these pressing issues and have provided some recommendations, but "to take one resource-starved group and give it to another resource-starved group is not the answer." He said everyone is working together to find a solution.

Senator Wilson said there is not any money to serve anybody on the wait list and the Legislature and Executive branches need to make a commitment to the needs of the state, or the debate will continue. Margaret Hooper, Policy Coordinator for the Florida Developmental Disabilities Council told the members that her group has been working with APD with the federal funds they get to identify community resources while people are waiting for enrollment services. She said FDDC opposes some of the managed care models that have been floating around in reference to presentations that were made to House and Senate Committee staff during the regular session and the possibility that it will surface again during the 2008 Legislative Session. She said the Council is pleased with the direction taken by Director Johnson, who also sits on their board, because "she listens!" "We feel the agency has quickly implemented the changes imposed by the Legislature - we've asked them to slow down, "she said.

Ann Millan with the Family Care Council Florida presented their 2008 legislative platform. She said a contributing factor to APD being over budget is that sister agencies neglect, or are not held accountable, to cover services under their program which "passes the buck" to APD to cover necessary services such as PCA under Medicaid State Plan. The council requests legislation that would give a person on the wait list not receiving any waiver services up to $2,000 a year for specified needs. FCCF opposes any proposal that moves APD and the waiver services into a managed care program, including people on the wait list. The FCCF also opposes any move of APD to AHCA or another similar agency. "We believe they (APD) will meet their fiscal responsibilities given the opportunity.

"The APD has been rebuilt, she said, and the affects from the previous APD fiduciary administration should not be put upon the new agency which continues to support and respond aptly to the Legislature's mandates."

Dr. Thomas Buckley, Executive Director of UPARC, Pinellas County, told members he came to the meeting with reservations, but felt much better after having heard the testimony. He gave examples of the severity of the individuals his organization serves; many of whom come to him through a crisis placement. He said the citizens of Florida with developmental disabilities deserve better and the state needs to do more for people on the wait list. He encouraged the committee to "stop the redesign of the redesign of the redesign."

Judging from the crowd of nearly 450 attendees and comments made throughout the day, the Unity in the Developmental Disabilities Community Summit was a huge success! The meeting, sponsored by the Agency for Persons with Disabilities (APD), was held on January 17, 2008, at the Downtown Convention Center in Tampa, Florida, and began with welcoming remarks from Tampa Mayor Pam Iorio. Mayor Iorio told the standing-room-only audience that she has a full-time Disabilities Coordinator on her staff to address issues of accessibility, transportation, housing, and the general needs of the disability community. In recognition of funding shortfalls, she said the needs of the disabled should go to the top of the list. The purpose of the summit was to hear firsthand from the Legislature's leading budget expert and legislators about the future of the state's economy and its impact on funding for developmental disabilities services. Attendees were asked to bring suggestions and solutions that APD and the Florida Legislature can use to bring about a more equitable service delivery system based on funding levels.

The first panel presentation, "Working with the Florida Legislature - What's Ahead," was moderated by Lance Block, Chairman of the Governor's Commission on Disabilities. Block commented that the "fantastic turnout" was because a lot of people across the state care about people with disabilities. He said the disabilities community has been in a "civil war" for many years, divided by philosophical and funding issues, and this meeting was an opportunity to put these differences aside for the good of those in need of services.

Panelist Amy Baker, Coordinator for the Legislative Office of Economic and Demographic Research, explained why the state is facing a recession, along with the rest of the country, and as a result she said there will be a $2.5 billion shortfall in general revenue needed to fund state-run programs. She said they anticipate this projection will get worse soon. Fellow panelist Senator Nan Rich (D-Sunrise), who serves as Vice-Chair of the Senate Health and Human Services Appropriations Committee, and is also a member of the Senate Children, Families and Elder Affairs Committee, thanked everyone for attending the meeting and said it is her goal to protect the state's most vulnerable people. She said she is not sure if the legislation passed in the 2007 Session (SB 1124) to help address the APD budget deficit will have the impact on the budget shortfall that was anticipated by the Legislature, and that "tiers" in the bill need to be readdressed. This concept was also echoed later in the day by Florida ARF CEO Terry Farmer. Senator Rich said the relationship between the Community Based Care agencies (CBCs) serving children in the child welfare system with developmental disabilities and APD should be further addressed, as well as the current structure of the APD service delivery system to make it more efficient, including looking at co-payments for services.

Senator Ronda Storms (R-Brandon), Chairman of the Senate Children, Families and Elder Affairs Committee, also participated on the panel. Senator Storms spoke to the audience from the heart and told everyone about her nephew who is profoundly disabled with cerebral palsy, her in-laws who run a group home, and her sister-in-law who teaches children with developmental disablities. She said she understands what consumers, families, and providers are going through and wants to find solutions. She said, "I am extremely pained by the cuts and the 'tiering' of the system." She also stated the wait list for services must be addressed in order for the agency to be able to better project needs and costs. "The system is not equitable and we need to provide as much service as possible for those who have proven medically necessity," she added.

After a healthy and very informative debate between the two senators about the use of sales tax exemptions to raise additional state revenue, questions were taken from the floor. The next panel was an APD overview of where the agency has been, where it is, and what the future holds. The panel was moderated by Bill Palmer, Director for the Division of Vocational Rehabilitation, Department of Education. APD Director Jane Johnson said, while she has only been at APD a short time, it is evident that a lot of the existing policy came from responding to lawsuits and crises, and may not have led to good long-term decisions. She said the agency has made significant progress in reducing its deficit with the help of the Florida Legislature and its members, like Senators Rich and Storms. She cited a University of South Florida study which notes the growing DD population, coupled with aging caregivers and revenue shortfalls, which all point to the need for careful planning. Director Johnson said she was "humbled" by the dedication and professionalism of APD staff and introduced the agency's Deputy Director of Budget and Planning, Mr. DeBeaugrine.

Jim Debeaugrine gave an overview of how the DD budget and services have grown over the past 19 years and that 80 percent of the budget goes to waiver services. "More people are being served with more services and more people are being added to the wait list daily," he said. He told the audience that APD has reduced the previous deficit by 80 percent and great accomplishments have been made in the nine months since Director Johnson joined the agency. He added it will take a huge infusion of cash from the Legislature, at a time when we are hearing it will not be available, or further service reductions will be needed to bring the budget into full compliance with state law. He encouraged everyone to work together to help the agency find solutions that will have the least impact on the people APD serves.

The panel concluded with an update from Mac McCoy, APD Deputy Director of Operations, on the implementation of SB 1124, enacted to assist the agency with the budget deficit. He thanked the Legislature and the legislators in attendance for their assistance with funding efforts. He said over half of the 75 positions the Legislature funded have been filled to conduct customer needs assessments with a new assessment tool. The agency is also conducting in-depth quality assurance reviews of group homes to ensure client safety. He also recognized the APD Area Administrators and DSI Superintendents in the audience and encouraged people to talk to them about any issues they might be having. The day wrapped up with a "roundtable" panel representing a cross section of stakeholders such as consumers, families, advocacy groups, and providers. Common themes arose quickly, including seeking passage of legislation that will allow people with disabilities to work without loosing their benefits; opposition to an HMO delivering DD services; opposition to moving APD to another agency; support for a dedicated funding stream for DD services; and elimination of the service "tiers" mandated in SB 1124. To show how diverse the panelists were, some individuals spoke in favor of keeping the Developmental Service Institutions open, and others urged reducing the number of people living in them to free up more dollars for waiver services.

Following the roundtable discussion, over 30 people went up to the microphone and gave their views on issues of the day. Many comments were reflective of the roundtable discussion, but the one common thread seemed to be the need for the DD community to work together and unify into one voice and be heard in the legislative process. The event was a huge success and APD was asked to continue the dialogue and consider having another event with more time for workgroups and recommendations. Thanks again to everyone who participated!

The Florida Channel taped the event in its entirety and a schedule of telecasts is posted on its web site at www.wfsu.org/tfc/tfc-schedule.html. APD will also be posting comments and the white papers from the roundtable discussion on its web site at www.apd.myflorida.com.

APD's Area Administrators, Developmental Services Institution Superintendents and key staff met on Janaury 15 and 16 to discuss priority issues for the agency. The state of the economy and its impact on budgets and services influenced much of the discussion at the Leadership Team meeting held in Tampa in conjunction with the Unity Summit. From the implementation of new residential rehabilitation rates to the launch of the new needs assessment tool, initiatives to reduce the projected deficit in the Home and Community-Based Medicaid Waiver budget continue to dominate attention. Cost-saving measures have brought down the projected $156 million deficit for the current fiscal year to approximately $19 million. More action, however, may be necessary if the economy fails to improve.

APD Director Jane Johnson has made exploring any and every means possible to stay within budget a priority. While applauding Area Office and Developmental Services Center administrators for their Herculean efforts in implementing spending controls, Johnson encouraged them to continue looking both within and "out of the box" for ideas to save money. As managers of the agency's day-to-day operations, local administrators are informed by contact with thousands of people daily and are a valuable resource for suggestions.

As in the presentation by Deputy Director Mac McCoy at the "Unity in the Developmental Community Summit" the following day, there were updates on Senate Bill 1124's Medicaid Waiver service reductions, limitations and the tier system. The new assessment process is being prioritized to collect information about the needs of people on the wait list for services. The agency also is launching a statewide quality review of residential services in February.

The Leadership Team discussed their expectations of a quality assurance review in relation to residential services and the negotiation of a new quality assurance contract. The Delmarva Foundation has performed this function for non-residential services since APD's inception. APD has been reviewing all contracts in the effort to maximize efficiency.

The Leadership Team also reviewed suggestions for quality services, systems and infrastructure that have been incorporated in the agency's draft strategic plan. The draft represents the suggestions of over 300 people who attended the recent strategic plan regional workshops. A final workshop is scheduled for February 1st in Tallahassee for Central Office staff.

met on January 22, 2008, and considered HB 333 by Representative Peter Nehr. This bill requires APD to notify the residents and guardians if APD or Legislature proposes to close or reduce the resident population of the Marianna Sunland or the Tacachale Developmental Disabilities Institutions by 20 percent or more. The bill would also require the submission of a plan to the Governor and the Legislature detailing agency action. After consideration of the plan and input from the Legislature, the Governor must approve or disapprove the action. APD would be required to provide quarterly reports. The bill passed favorably and was referred to the House Healthcare Council.

The House Healthcare Council met on Tuesday, January 8, 2008. Council Chairman Aaron Bean commented on the fiscal outlook of the state's economy and its impact on budget allocations. He indicated that in all likelihood there will not be new money. House Speaker Marco Rubio has also instructed Council chairmen to prepare for budget reductions that he expects legislators to approve upon convening for the 2008 regular session.

Jim DeBeaugrine, APD Deputy Director for Planning and Budget, gave a presentation to the Council regarding the status of the agency's budget deficit and implementation of SB 1124 and SB 2C to assist the agency in reducing the deficit. DeBeaugrine told members that most of the agency budget -80 percent- is allocated to waiver services and there are currently 16,000 individuals waiting for services. The deficit is occurring in the Home and Community Based Services waiver where the majority of services are provided. He showed members a chart of waiver expenditure growth which has largely gone to the increasing cost of serving existing recipients while the wait list for services continues to grow.

He told members that unless utilization growth moderates or substantial financial investments are made, they can expect continued deficits and growth on the wait list. He said if current trends continue the Legislature will need to provide roughly $100 million per year to continue services to existing enrollees. An additional $60 million would be necessary to keep the wait list from growing larger based on current average expenditure amounts for the HCBS and FSL waivers and current average growth of the wait list. An additional $320 million would be necessary to service the remaining individuals on the wait list assuming all wait list individuals accept enrollment offers.

He said some utilization growth is expected since the waiver serves a very stable cohort of individuals who are getting older along with their caregivers. SB 1124 provides for freezing cost plans and implementation of a four-tier system with expenditure caps. During the special session, the Legislature approved the use of state employees to conduct needs assessments which will assist with planning and budgeting and identifying future trends. The agency is planning to use individual budgets based on the new needs assessment as an additional means of controlling utilization. Despite the policy changes implemented pursuant to SB 1124, deficits are projected for FY 2007-08, 2008-09, and 2009-10.

On Wednesday, January 9, 2008, the Office of Program Policy Analysis and Government Accountability (OPPAGA), an office of the Florida Legislature, a July 2006 report regarding improvements to the APD wait list for planning and budgeting purposes. The report indicated the wait list is not a valid indicator of need for waiver services. The report stated that information on individuals on the wait list is often out of date and does not reflect current or potential service needs, making it difficult to determine the level of funding needed to serve eligible persons.

The report recommended that the agency should obtain more current information on the location and status of individuals on the wait list and add a feature on its website to allow for updating of contact information. It was also recommended that APD adopt a policy to contact individuals on the wait list at the beginning of each fiscal year who are most likely to be offered services during the year to ensure that contact and support plan information are correct.

The report further indicated APD should maintain better information on the expected need for waiver services by clearly determining the number of individuals who have declined a previous offer of waiver services but remain on the wait list, and the number of individuals on the list who are currently receiving services from other programs. This information is to be reported in the Agency's Quarterly Report. A full copy of the report may be found at OPPAGA's web site www.oppaga.state.fl.us.

Committee Chairman, Senator Ronda Storms said the wait list does not measure immediate need, medical necessity, and is not an accurate budgeting tool for future planning. Committee members were also concerned that some individuals are "place holding" for services with no immediate need while others are waiting in a crisis mode.

Denise Arnold, APD's Bureau Chief of Community Development, gave a report on the status of the agency's implementation of the OPPAGA recommendations and addressed the members' concerns. Arnold gave an overview of eligibility for waiver wait list services and the process for wait list placement, which uses the date of eligibility determination as the start date. She said some of the reasons for the wait list include families wanting to ensure a place on the list when a child exits the school system and needs services from APD so there will be a smooth transition. There are approximately 10,000 children under the age of 18 on the wait list. Other reasons are funding for wait list services is not available so people must wait to be enrolled and family income may be above the Medicaid eligibly level at the time. She said individuals meeting crisis criteria - homeless, threat to self or others, or caregiver cannot provide care, are moved to the front of the list along with foster children in the child welfare system who are developmentally disabled as mandated by statute.

Arnold said the agency has complied with many of the OPPAGA recommendations including capturing wait list data in its Quarterly Report, which shows disposition of waiver offers, services received while waiting and length of wait for waiver services. She said the agency has also developed a contact policy and method to remove individuals it can no longer find who had applied for services.
A wait list analysis has been planned that will assist with budgeting and planning activities. These activities include the following:

The survey and random sample will assist the agency in projecting budget needs to serve individuals on the wait list. A multi-year plan will be developed to serve the wait list and develop future costs of the program. Members felt very strongly that the individuals on the wait list should be "triaged" much like in the medical field to determine their need and only serve those who have an immediate need that must be addressed within a six month or one-year time frame. Senator Storms will be working with committee members on a bill to address the agency's wait list issues.

The Senate Health and Human Services Appropriations Committee met on Thursday, January 10, 2007, and also heard the OPPAGA and APD presentations on the wait list. Committee members expressed similar concerns as the Senate Children, Families and Elder Affairs Committee. Senator Don Gaetz recommended abolishing the existing wait list and starting over with a new data collection process. Senator Nan Rich said conducting needs assessments on the entire wait list would help. She also wants to make sure children are properly assessed and that the Community Based Care providers are not paying for services for DD children who are in the child welfare system while they are on the wait list. Committee Chairman Durell Peaden, Jr., asked Senator Rich, who is also a member of the Senate Children, Families and Elder Affairs Committee to take the lead for the Appropriations committee on this issue. Senator Peaden also asked that APD Director Jane Johnson give an update at the next meeting.

January 25, 2008	5p.m. deadline for submitting requests for drafts of general bills, including requests for companion bills
February 29, 2008	5p.m. deadline for submitting final drafts of general bills,including companion bills
March 4, 2008	Regular Session Convenes Noon deadline for filing bills for introduction
April 22, 2008	50th day - last day for regularly scheduled committee Meetings
April 28, 2008	All bills are immediately certified Conference Committee Reports require only one reading
May 2, 2008	60th day - last day of Regular Session

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APD Testifies in Senate Health and Human Services Appropriations Committee

Unity Summit a Huge Success!

January 2008 APD Leadership Meeting

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