Florida’s Agency for Persons with Disabilities’ (APD) Fiscal Year 2021 request seeks $50 million to plug a budget shortfall in its current fiscal year budget, $41.1 million more for home- and community-based services, and $21.7 million for iBudget, a Medicaid program that provides home and community-based services.
Gov. Ron DeSantis’ administration offered lukewarm support for APD’s budget request, recommending lawmakers fully fund the Medicaid “waiver” program for people with developmental and intellectual disabilities but analyze how the iBudget program works and consider imposing annual caps on services individuals can receive at home.
The iBudget review is among 11 recommendations forwarded by the DeSantis administration to legislative leaders within a report compiled by the Agency for Persons with Disabilities (APD) and the Agency for Health Care Administration (AHCA).
The APD, with a $1.4 billion annual budget, has come under criticism for recurring deficits, particularly in exceeding appropriations for the iBudget program since it was implemented in 2014.
The iBudget program serves people diagnosed with intellectual disabilities, severe forms of autism, spina bifida, cerebral palsy or Down syndrome through the Medicaid home- and community-based waiver program. It served 34,500 Floridians with a waiting list of 21,900 people in January.
Many advocates and iBudget enrollees fear the state will scrap the Medicaid “waiver” program and, instead, require people enroll in managed-care plans, but that is not among the fiscal year 2021 policy recommendations from the DeSantis administration.
In fact, in its 2021 budget proposal, the APD is seeking about $115 million in new general revenue allocations, primarily for home/community-based iBudget services.
That fear stems from a directive issued by lawmakers during the 2019 legislative session requiring the APD and AHCA present them with an “alternative delivery model” of home- and community-based services.
The Legislature also asked the agencies to identify services essential for client health and safety, and to recommend elimination of services should funding be reduced under a "mandated general revenue reduction scenario.”
While APD’s proposed fiscal 2021 budget request asks for $115 million in increased spending, it also identifies $57.3 million in spending cuts to home- and community-based services.
Those enrolled in the iBudget program have individual accounts to spend on selected required services. Among changes included in the administration’s report to the Legislature:
• Limitations on “life services” now provided 1,557 Floridians under the waiver program, including companion services, employment services, adult day training services.
According to the report, the state would save at least $2.6 million annually by limiting services to 48 weeks a year, 30 hours a week. According to the report, about people would be affected by the change.
• Imposing a $205,000 individual cap on iBudget program services would save APD about $20 million, transfers about $17 million off those costs to the AHCA, resulting is a taxpayer savings of about $2.4 million a year.
Those who exceed the $205,000 individual cap will be encouraged to seek institutional care.
“If the costs of an individual’s waiver services exceeds this amount, then the community may not be the most appropriate setting for them to receive their services,” the report reads.
• Require state Social Services Estimating Conference economists analyze spending and enrollment trends for iBudget as they do for other Medicaid programs.