The 2016-17 biennial budget represents the most significant influx of new money in the history of the Department, and invests $316 million over two years in developmental disabilities system redesign. The Administration’s investment in new and improved opportunities for Ohioans with developmental disabilities is historic, and is the most significant health and human services investment in the Executive Budget.
Governor John Kasich today announced a budget that will build on the positive momentum begun by the previous state budget, and continue Ohio’s economic progress over the 2016-17 biennium. The budget takes into consideration the needs of all Ohioans, and provides funding for initiatives designed to help people of all abilities live, work, and learn in their communities.
In state dollars, the DODD portion of the budget is increased by $45 million in year one, and $102 million in year two, over FY2015 levels. Director Martin noted,
The funding for Home and Community-Based Services (waivers) goes from $184 million (FY2015) to $279 million (FY2017) in support of those receiving – and those waiting for – waivers. That’s an increase of $95 million in funding in this area, and will move forward the statewide efforts to provide more choices for Ohioans with developmental disabilities, including downsizing institutional care settings, and building into the system more opportunities for community inclusion at home and at work. It is a historic demonstration of support, and makes a down-payment on the recommendations made by the Strategic Planning Leadership Group (SPLG).”
How the Money Will Be Used – Additional Waiver Services
Additional waivers will increase support to people on the waiting list, or who choose to leave Intermediate Care Facility (ICF) settings:
- Adding approximately 2,000 new IO waivers and 1,000 Self Empowered Life Funding (SELF) waivers over the biennium to assist people on the waiting list, and those that choose to leave an ICF.
- Adding 2,890 more IO waivers by converting the Transitions DD (TDD) waivers, thereby providing enhanced payments and day services, reducing the types of waivers from four to three, and simplifying the system.
How the Money Will Be Used – Strengthening Waiver Services
The budget continues to prioritize funding to reflect the growing demand for Home and Community-Based Services. Funding will allow DODD to:
- Add nursing services to the IO waiver to serve people with medical needs who live in community settings.
- Increase waiver rates by 6 percent to provide for increased wages for direct care staff.
- Increase the availability of add-on services for individuals with complex needs and behavioral challenges.
- Provide training for those who receive, plan, and deliver waiver services.
- Strengthen oversight and quality assurance efforts so the person-centered plan is delivering meaningful outcomes.
- Develop a daily rate to decrease administrative complexity.
During the budget development process, the Governor’s Office of Health Transformation looked holistically at the budget impact on waiver services and observed,
The scale of change is transformational, not incremental.”
How the Money Will Be Used – Employment and Day Services
The budget includes nearly $3 million for each of the two years. Funds will be used to create new service models that promote community employment and integrated day services. Individuals will transition from workshops and other facility-based day settings to community-based alternatives over an extended timeframe.
Additional funds for community employment are earmarked for ongoing support of DODD’s partnership with Opportunities for Ohioans with Disabilities (OOD) to assist in the cost of transitioning to integrated day services and supported employment, and to inform and assist individuals and families, as well as those who develop person-centered plans, regarding the options available to them.
How the Money Will Be Used – System Infrastructure Improvements
Director Martin noted that statewide system infrastructure improvements have been built into the budget plans so that a foundation of excellence in service can be encouraged and supported. He stated, “We will have approximately $8 million per year to provide training to the statewide DD services workforce to better equip them to provide community services, while covering some of the costs associated with system transformation efforts. We also will provide some rental assistance to support community living, strengthen employment and day service integration, and help some providers transition from Intermediate Care Facilities to waiver services.”
How the Money Will Be Used – ICF Program
Continuing the community-based services direction in the previous two budgets, DODD will move forward with the modernization of the ICF program in line with the vision outlined in the ICF white paper three years ago. It included plans for smaller facilities, conversions to waivers, and a focus on services to individuals with the most intense needs. DODD will honor the choice of individuals who want to stay in ICFs, while encouraging and supporting the choice of those who want to leave. This budget will include the following initiatives to accomplish that. DODD will:
- Remove the grandfather clause that permits more than two people in a bedroom. This will be accomplished by requiring a downsizing plan that brings the provider into compliance within ten years, and restricting admission to facilities that do not meet the two-persons-per-bedroom standard.
- Include a modest increase in funds in the ICF line item to accommodate downsizing. When coupled with a flat rate for people in acuity assessment categories five and six, it will provide more funds for people with high acuity.
- Contract to redesign the ICF reimbursement system to reward quality measures.
- Request a recommendation from a County Board of DD prior to a person entering a large ICF. The County Board and DODD must determine that admission to the large ICF is the least restrictive environment for that person, while leaving the final decision to that person.
- Deem persons in ICFs as a priority on the waiver waiting list. Persons in ICFs on the waiver waiting list will receive options counseling, and be contacted by someone not affiliated with the ICF to determine their interest in community options.
- Allow funding to follow a person who chooses to leave a large ICF.
- Include money for bed buy-back and, for the first time, offer rental assistance for people leaving ICFs.
- Permit providers to file cost reports with quicker adjustments for the Individual Assessment Form (IAF) changes, franchise fee adjustments, and accommodations for capital costs that exceed the current ceiling, due to downsizing.
- Consider debt forgiveness for those large ICFs exiting the business that have a liability for state grants.
DODD is very appreciative of the Kasich Administration’s additional investments in community-based services for Ohioans with developmental disabilities, supporting the trend away from large, institutional settings, and workshop-based employment, and reflecting recommendations developed by the SPLG (See SPLG Report). We understand that the budget just announced is a complex construct with many moving parts. DODD will actively engage the statewide developmental disabilities community to review and explore the options now available to the system. We look forward to working with our partners to continue modernizing the system.
If you have questions about the budget, call the DODD Budget Hotline at 855-611-6446 (Toll-Free in Ohio) or 614-728-5311. Look for additional budget information in future issues of Pipeline.