TALLAHASSEE, Fla. – The Senate health-care spending chairman said Tuesday he will unveil a proposed budget that would funnel close to $100 million in additional funding to a Medicaid program that provides community-based services to people with developmental and intellectual disabilities.
Health and Human Services Appropriations Chairman Sen. Aaron Bean, R-Fernandina Beach, made the comments after his panel approved a bill that would redesign the “iBudget” program after hearing more than an hour of testimony on the proposal (SB 82).
“It’s close, very close to $100 million,” Bean told The News Service of Florida. “Boom.”
Before moving the bill along, though, the panel approved an amendment that removed a section of the original version. That section would have required the state to hire an outside organization to determine whether people’s iBudgets should be increased because of “significant additional needs.”
Currently, the Agency for Persons with Disabilities, which administers the iBudget program, makes those determinations.
The amendment would allow the agency to continue to make those determinations but would put parameters in place, including a requirement that people who receive increases must have one or more significant additional needs that cannot be accommodated within their existing iBudget allocations.
Moreover, the people could not have access to any other “resources, support or services” to meet those significant additional needs. Also, the Agency for Persons with Disabilities would be required to centralize the appeals process to “ensure consistent application of medical necessity criteria.”
While the appeals process would not be conducted by a private vendor, the amended bill would continue to require the state to contract with organizations to provide support coordination services. Currently, people with iBudgets can work with support coordinators who are independent contractors.
The amendment, though, put some requirements on the entities that would provide the services, including that they employ four or more support coordinators.
That’s problematic for some people on the iBudget who traveled to Tallahassee to testify on the change, including Jacksonville resident Alonzo Jefferson.
Jefferson told members of the Senate panel that he has worked with an individual support coordinator as well as a coordinator who worked for an agency.
“There’s a lot of fear and trepidation going into making those choices,” Jefferson said.
The iBudget program is designed, in part, to help people live as independently as possible in their homes or in their communities. Each person has an individual budget to spend on services they require. A person’s budget is determined using a complex algorithm.
The agency has spent more money providing services to the 34,000 people in the iBudget program than what the state has agreed to spend, which has spurred lawmakers to take a closer look at how the program operates. Also, the program has a waiting list of nearly 22,000 people seeking services, Bean said.
While Autism Society Florida President Ven Sequenzia thanked Bean, he said that the bill does nothing to address an underlying problem of inadequate funding for the Agency for Persons with Disabilities.
“The problem isn’t APD’s overspending. It’s that the Legislature would rather give sales-tax holidays for pencils and generators, only charge Nestle a $115 permit fee to pump 1 million gallons of water out of our springs every da, or give $500 million in tax cuts to some of the wealthiest corporations in the state,” Sequenzia said. “Let’s face it, if the state wanted to take care of this population, we have the money.”
In addition to addressing iBudgets, the revised bill contains a “certificate of need” regulatory exemption for the construction of new intermediate care facilities for people with developmental disabilities -- so-called ICFDDs.
To qualify for an exemption, an ICFDD provider would need at least 10 years of experience serving people with severe maladaptive behaviors. Also, the provider would have to be willing to dedicate two-thirds of the beds on their campuses to residents “with severe maladaptive behaviors.”
The certificate of need language in the amendment tracked stand-alone bills (SB 1344 and HB 1163), filed by Sen. Gayle Harrell, R-Stuart, and Rep. Colleen Burton, R-Lakeland.
Mark A. Swain, executive director of the ARC of Alachua County, noted that Florida has tried to move away from institutional care for people with developmental and intellectual disabilities.
As of Tuesday afternoon, the House had not filed a version of the Senate bill. But the House is interested in moving ahead with changes, Speaker Jose Oliva, R-Miami Lakes, said last week.
Oliva said making changes to the iBudget can be difficult, with the optics being that the Legislature doesn't care about people with disabilities. But, he said, that isn’t the case.
“What it means,” Oliva said of legislative interest, “is there’s a massive waiting list. And we’d like to be able to spread that (the funding) out a bit better. So I am anxious to see what the Senate is putting forth.”