Disability program changes draw concerns

by | Jan 15, 2020

A Senate panel on Wednesday took the first steps toward overhauling a complicated and expensive program designed to help thousands of Florida residents with developmental and intellectual disabilities.

The proposal (SB 82), sponsored by Sen. Aaron Bean, R-Fernandina Beach, would represent a significant change to what is known as the iBudget program, which receives state and federal money to provide an array of Medicaid services so people with disabilities can live at home and outside of institutions.

The legislation drew passionate testimony in opposition. But Bean tried to assuage detractors, contending that his bill would not result in reductions in services.

“The demise of this bill would occur should we make reductions in people’s lifelines, so that’s not where we’re going,” Bean told members of the Senate Children, Families and Elder Affairs Committee.

But Bean’s bill would revamp how people with disabilities get access to support coordinators and how they appeal decisions related to the amounts of money they are allocated, two issues that advocates say are critical.

Republicans are pushing for changes in the wake of perennial deficits in the program.

“To the public and everyone who’s on this waiver (program) … if we don’t make changes, the whole thing is going to collapse under its weight,’’ Bean said.

Currently, families and people with disabilities can choose from 1,082 support coordinators across the state. The coordinators are on call for clients around the clock and help them obtain services needed to live in the community.

Bean’s bill would have the state competitively bid those services and ultimately award contracts to two or more organizations. The competitive procurement would have to be initiated by Oct. 1.

Laura Mohesky, chair of the Support Coordination Association of Florida, told senators the bill “just doesn’t sit well” with her.

“This looks like managed care of support coordinators,” she said.

Agency for Persons with Disabilities Director Barbara Palmer said she was concerned that the proposal would move “significant additional needs reviews” from her agency to the Agency for Health Care Administration. But AHCA wouldn’t conduct the reviews, which are used to determine whether people’s iBudgets should be increased because of additional needs.

Instead, the bill would direct AHCA to contract with a vendor to conduct the reviews.

Palmer told committee members she thinks “our agency is very equipped to deal with it” and added that moving the process to a different agency “adds another layer of complication.”

The Senate committee voted 5-2 to approve the bill, with Sen. Kevin Rader, D-Delray Beach, and Sen. Victor Torres, D-Orlando, in opposition.

In the iBudget program, each person has an individual budget to spend on services they require. A person’s budget is determined using a complex algorithm.

For several years, Florida officials have struggled to figure out how much should be spent on the program, which offers services to roughly 34,000 people with disabilities.

Bean, who chairs the Senate Health and Human Services Appropriations Subcommittee, said his first spending priority for the upcoming year is to plug a $107 million deficit that has occurred because the Agency for Persons with Disabilities has spent more on the iBudget program than what the Legislature agreed to allocate.

In addition to the deficit, the program has a waiting list of 21,000 people seeking services.

“Unless we make changes, we don’t have the resources to handle everybody,” Bean said.


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