DeSantis, Florida lawmakers ponder disabilities program


TALLAHASSEE, Fla. – Gov. Ron DeSantis said Tuesday he's "very open" about steps the state should take to rein in costs of caring for people with developmental and intellectual disabilities.

The Florida Agency for Persons with Disabilities and the Agency for Health Care Administration last month suggested a number of options for the state to pursue to bring greater budget predictability in the so-called iBudget program, which is part of Medicaid.

Enrolling people in Medicaid managed-care programs, though, was not one of the recommendations by the agencies in the legislatively mandated review.

But at an annual Associated Press pre-session event Tuesday at the Capitol, DeSantis left the door open to the possibility that managed care could be the answer.

"I think it's been a tough issue fiscally, but I think it's an issue where some of these folks are in pretty bad shape. And we have a responsibility to do what we can," DeSantis said when asked why the agencies didn't recommend rolling the iBudget program into a state requirement that most Medicaid beneficiaries enroll in managed care. "I'm very open about the best way forward. I'm not saying one or the other, but the way it's gone, it's not necessarily going in a good direction." 

DeSantis' comments came the same day that the Florida Developmental Disabilities Council launched a statewide media campaign to "save" the iBudget. The iBudget program provides services to about 35,000 people with developmental and intellectual disabilities, while another 21,000 are on a waiting list.

The iBudget serves people who have been diagnosed with intellectual disabilities or other disorders, such as autism, spina bifida, cerebral palsy or Down syndrome. In the program, participants have individual budgets to spend on the services they require. Instead of traditional health-care services, people on the iBudget are able to get assistance with activities of daily living such as eating and bathing. Budgets are determined using a complex algorithm.

The Legislature last session directed the agencies to work jointly on a redesign of the $1.4 billion iBudget program. The report, which was submitted to legislative leaders on Sept. 30, recommended limitations on "life services," such as companion services, employment services and adult day training services.

Another recommendation was to place a $205,000 individual cap on services in the iBudget program. People who spend more than that would need to reduce their waiver expenditures to come within the cap or seek institutional care. 

The report did not recommend that the Legislature scrap the iBudget program in favor of a managed-care approach. Most of the 3.8 million Medicaid beneficiaries in Florida are required to enroll in managed-care plans to get their care. People with developmental and intellectual disabilities are exempt from that mandate.

Valerie Breen, executive director of the Florida Developmental Disabilities Council, said it was "totally coincidental" that the campaign was launched following DeSantis's remarks.

Breen told The News Service of Florida that initially the goal of the campaign was to "preserve" the iBudget. But she said that the emphasis was switched from "preserve" to "save" to underscore the importance of the program to the people who rely on it.

"Preserve makes it sound like a fiscal issue," Breen said. "And that's why we are using ‘save.' It is saving lives. These are the services that keep people living in their community. Those are the services that nobody covers but the state. And they are critical."

Senate President Bill Galvano, R-Bradenton, said he had gone through the recommendations advanced by the agencies and that the Senate would thoroughly "vet" the issues before acting.

"We have not developed a plan at this point," Galvano said.

Galvano said that the Legislature could focus on making changes to the Agency for Persons with Disabilities, which administers the iBudget.

"I am first and foremost concerned about the level of service that the individuals who interact with this agency get," Galvano said. "If that means that our funding is at an even greater level, then that is something that can potentially happen."