Budget Struggles, Complying with Federal Rules, Adjusting to New Methods Will Require Leadership & Cooperation
As the Baker Administration begins drafting its FY 2018 budget recommendations, there will be several challenges including:
Ensuring that people enrolled in employment and day programs are actually able to work or have meaningful day activities
Compliance with federal regulations, including HCBS Community Settings for residential and employment programs
Keeping current with best practice and Massachusetts record of quality and high performance
Governor Baker and Lt. Governor Politio have a long record of supporting disability issues. Click here and ask the Administration to make developmental disability issues a top priority in next year's FY 2018 Budget.
ADDP FY 18 Budget Request to Governor Baker & Sec. Sudders
In anticipation of the Governor's effort to put together his FY 2018 Budget, ADDP met with EOHHS Secretary Marylou Sudders and shared ADDP's priority budget requests for the coming legislative session.
ADDP FY 18 Budget Request:
Line Item 5920-2025 DDS Day and Employment
Fund at $233 million to reflect increased costs associated with closing sheltered workshops and moving people into more staff intensive community based day supports and supported employment
Fulfill Blueprint Implementation Recommendations
Line Item 5920-5000
DDS Turning 22
Fund at $22 million addressing significant size of graduating class
Line Item 5920-2000
DDS Residential
Fund DDS Residential at $1.3 B to maintain FFP, provide participants with privacy and security, and promote Shared Living
Cost Share with providers the designation and employment of Community Integration Specialists
FY 17 Day and Employment Cuts Jeopardizes Current Services
Last year's FY 2017 Budget outcome remains a headache for DDS Day and Employment providers who were handed a 5% contract cut to their 2017 programs.
The irony and unrealistic challenge of the 5% cut is that effective July 1, 2016, the state ended its funding of sheltered workshops, moving those individuals into "more inclusive" Community Based Day Support programs and Supported Employment Services. Sadly for many this "inclusive movement" has been more an illusion than reality.
To provide inclusion or community based programming, CBDS providers need additional staff and transportation dollars to take people out to jobs or into the community.
Sheltered workshops were funded on a 1 staff to 8-10 participants. CBDS would require a 1 staff to 4 staffing ratio; however the FY 17 Budget cut the budget of these programs, thus negating the hope and promise of more inclusive settings.
ADDP has spoken with EOHHS, the Governor and key legislators asking for an FY 17 Supplemental Budget appropriation of $5 million to correct this dilemma. To date, there is no positive action to report on this request.
Federal Rules Require Greater Focus on Inclusive Practices
Beginning in 2014, with the adoption of the CMS Rule on Community Settings, states have been on notice to ensure that all HCBS programs are inclusion based, ensuring that Home and Community Based Service programs are used to provide outcomes that assure privacy, tenant rights, protection from isolation and the opportunity for inclusive based day/employment opportunities.
States are required to meet this standard on or before March 2019 or risk the loss of HCBS Federal Matching Medicaid dollars.
The HCBS rule does not prohibit congregate living or non-inclusive employment programs. Residential programs, not Final Rule compliant would be able to qualify for more restrictive Intermediate Care Facility (ICF) funding after March 2019, however such funding would impose a more restrictive medical test for program eligibility.
Helping current programs modify their delivery system to meet HCBS standards will require additional state investments. ADDP estimates these costs to be in the vicinity of $30 million for both residential and employment program compliance. Compliance will help the state maintain federal funding, keep Massachusetts reputation as a leader in the disability field and provide participants with dignity and respect.
Governor Baker and Lt. Governor Politio have a long record of supporting disability issues. 
