Claim: “Florida’s Medicaid waiver program for persons with disabilities, iBudget Florida, has hit multiple snags and as many lawsuits in its slow implementation since being created by the Legislature in 2010.”
Fact: The Agency for Persons with Disabilities (APD) formed a stakeholder workgroup to design and plan the implementation of the iBudget Florida waiver and these meetings occurred over a two year period. Jim Freyvogel, president and CEO of the MacDonald Training Center, Inc., was a member of the stakeholder workgroup. The iBudget waiver began in April 2012 and will be completed on July 1, 2013. The agency implementation requires significant training for agency employees, families, waiver support coordinators, and service providers. Therefore, the implementation was not intended to be completed statewide in one quick process. The agency also conducted reviews for any individual who may have received a reduction in funding. These reviews take time and are critical to ensure the health and safety needs of the person are met.
Claim: “For some, these cuts mean losing adult day training, in which skills are learned a social setting, or lose essential transportation to these venues. Although according to APD, only about 10 percent of people who have transitioned to the iBudget have appealed — a rate they consider to be ‘very successful’.”
Fact: Adult day training was specifically included in the extraordinary need calculation for all APD customers during the iBudget transition, as were many other services that are needed to provide for the health and safety of the APD customer in the community. The right to an appeal is always honored by APD. The 10 percent rate of appeals is below the rate of appeals the agency experienced when implementing the tiers.
Claim: Craig Byrd, president and CEO of UCP/WORC in Flagler and Volusia Counties, said, “I believe the reasons for the small percentage of appeals are that individuals with disabilities and their families fear an appeal will cause a further reduction of their funding or they have been told by APD representatives to not waste their time.”
Fact: The agency honors all appeals for due process. No one from APD has indicated otherwise. The iBudget process includes an individual review with each person to discuss the potential reduction and to determine how to best meet the person’s needs using all available resources.
Claim: The economic impacts of these changes may be felt beyond the families directly affected. Take for example, the mother of Chad Russell — who at 25 needs help with bathing, dressing and medical treatments and communicates with his team at UCP/WORC using sign language they have learned alongside him — may lose her job working on condo sales if Chad loses his access to adult day training. While she already pays for the majority of his services as well as medical supplies and diapers, he no longer receives speech, physical or occupational therapy due to cuts.
Fact: The individual review process takes into account the need for adult day training and therapy services. All services are available under the iBudget waiver and the individual has complete flexibility to use their funding from iBudget to meet their needs.
Claim: “Adult day training is the most effective cost-saving method there is,” said Jim Freyvogel, president and CEO of the MacDonald Training Center, Inc. “These services enable family members to keep their own jobs rather than being home as unpaid caregivers, and prevent people with disabilities from being forced to live outside their own homes. This is a huge cost saver. If Chad is forced to move into a group home it will cost the taxpayers of Florida an additional $45,000 to $50,000 for his care.”
Fact: The agency fully supports the need for adult day training and has recognized its importance in the iBudget funding process.
Claim: Florida has worked hard to promote and maintain home and community based care; but many fear that changes under iBudget could erode this progress.
Fact: Home and community-based care remains the highest priority for APD.
Claim: “The method in which APD is implementing iBudgets is undermining the system of natural supports which is the cornerstone of the service delivery system in Florida,” said Freyvogel, whose MacDonald Training Center supplements about 22 percent of the actual cost of care, saving taxpayers what he estimates to be about $1.3 million each year.
Fact: The iBudget recognizes the critical services and supports families and natural or community supports provide. The iBudget provides funding that is to be used as a last resort to pay for services. iBudget provides all individuals services that they may have not been able to access under the tier system, such as dental services and therapy services.
Claim: Byrd’s concerns with iBudget also hit upon various administrative issues. Prior to iBudget, clients and service providers would receive an authorization for services for one year, providing the ability to plan and budget accordingly. Yet under iBudget, authorizations are required quarterly.
Fact: iBudget allows full flexibility for individuals to use the iBudget funding to meet their needs. The iBudget system helps the family in tracking the funding by issuing quarterly service authorizations based on the services that the individual has requested. Quarterly service authorizations allow families to move unspent monies from quarter to quarter allowing individuals to meet their changing needs.
Claim: “This means perpetual uncertainty for clients and their families, and from a provider standpoint it is an administrative nightmare,” said Byrd. “iBudget is a wolf in sheep’s clothing. Consumer choice is only the PR piece to make the reductions more palatable. It is nothing more than a cost containment system for the state without regard to the needs of Floridian’s with disabilities.”
Fact: The iBudget waiver gives individuals choices on how to spend their taxpayer funding for community services and also provides immediate access to change services as needs change. This is the essence of the iBudget Florida waiver.
APD annually serves more than 50,000 Floridians with the developmental disabilities of autism, cerebral palsy, Down syndrome, intellectual disabilities, spina bifida, and Prader-Willi syndrome. To learn more about the agency, call 1-866-APD-CARES (1-866-273-2273) or visit APDcares.org.