Developmental Disabilities and Long-Term Care

* Indicates cut the Governor proposes to prevent with new revenue.

** Restores $4 million

Reduce community residential provider rates - $11.6 million

Cuts rates by approximately 6.5 percent for developmental disability community residential providers, who serve 3,800 clients each month. Support ranges from a few hours per month to around-the-clock, one-on-one assistance each day.

Eliminate state-only employment and day services - $9.2 million

Terminates supported employment services, such as job coaching, for 488 clients with developmental disabilities who have not been placed in a Medicaid waiver program. This reduction will affect the ability of these individuals to obtain job training and placement services.

Reduce home care agency reimbursement rates - $8.8 million *

Cuts reimbursement rates for home care agency providers from $19.72 to $18.72 per hour. Home care agencies assist more than 12,000 clients per month with activities such as bathing, dressing, eating, meal preparation and housework in the client’s home.

Suspend Individual and Family Service program - $8.4 million *

Suspends services to nearly 1,000 families for respite care, therapies and other activities which help them keep loved ones with developmental disabilities in their homes.

Reduce eligibility for services - $8.3 million *

Requires clients with developmental disabilities and long-term care clients receiving personal care services to meet the same level-of-care standard as nursing facility clients. This eligibility change will result in 1,300 of the least acute long-term care and developmental disability clients losing personal care services. In addition, eligibility for developmental disability institution and Medicaid waiver services is restricted, which will cause approximately 330 clients to lose services.

Reform developmental disability waivers - $6.3 million **

Merges the Basic and Basic Plus federal Medicaid waivers into a single waiver with an average lower cost based on a flexible model instead of the current service allocation model. About 7,000 clients will be authorized to spend a pre-determined amount on services at an aggregate level rather than by the specific service. Clients can select their own mix of services within the determined amount.

Close one residential habilitation center - $6.1 million

Closes the Rainier School residential habilitation center through the use of federal grants and one-time funding to transition approximately 350 clients to community-based settings or other residential habilitation centers. Because the average monthly cost in an institution is more than $15,000 per client, significant future biennia savings are expected.

Eliminate Adult Day Health program - $4.1 million *

Eliminates services to nearly 1,000 individuals with developmental disabilities or in long-term care who now receive assistance through adult day health centers with medication management, cognitive and physical therapies, and group interactions.

Reduce instructional and support hours by 2 percent - $2.3 million

Cuts community residential services to 3,800 individuals in supported living placements. Services are built around the person’s needs and may include assistance with maintaining the home, paying bills, preparing meals and personal tasks.

Eliminate rate add-on for assisted living - $1.9 million

Stops the rate add-on given to assisted living providers to take more Medicaid clients. Assisted living facilities serve more than 4,500 individuals per month.

Reduce Senior Citizens Services Act funding by 20 percent - $1.6 million *

Cuts funding to the Area Agencies on Aging, which provide case management services and other services, such as Meals on Wheels, to elderly individuals to help them remain in their homes.

Investments

Include funding for Initiative 1163 - $15.2 million

Meets requirements of Initiative 1163 for increased mandatory training, additional background checks and certification for long-term care workers beginning Jan. 7, 2012. The initiative also requires performance audits and more fraud investigators.

Increase community resources - $4.3 million

Captures savings from the elimination of the Housing and Essential Needs program and redirects them for housing support and services for 258 long-term care and developmental disability clients who would lose their current residential placement as a result of proposed personal care and developmental disability program eligibility changes.

Enhance Family Caregiver Support program - $1.8 million

Adds specialized caregiver support for people with Alzheimer’s disease. This program is available to unpaid caregivers of adults who need care. Providing these caregivers with information and connecting them to other resources may help 2,200 clients remain in their homes and delay entry into more costly long-term care services.

Increase crisis stabilization - $1.5 million

Provides additional community capacity to address the needs of clients with developmental disabilities who are in crisis or in need of respite. This investment in new community facilities will strengthen the home and community-based system and allow more individuals to be better served.

Provide critical community placements - $1.3 million

Funds 35 out-of-home community residential placements for individuals with developmental disabilities. These individuals are in crisis and have been identified as aging out of the Children’s Administration or being released from a state institution.

Support transitioning high school clients - $376,000

Funds a supported employment program for an estimated 161 young adults with developmental disabilities on a Medicaid waiver turning 21 and graduating from high school this year.

Governor Gregoire’s Revenue Options

Recognizing that these cuts would do serious damage to the state’s safety net and jeopardize our students’ future, Gregoire also asked the public and the Legislature to consider several revenue options for “Building a Better Future.” She recommended the Legislature allow voters to decide whether to approve a temporary one-half cent sales tax increase. If approved, the increase would raise $494 million through June 30, 2013, and expire July 1, 2015. The additional revenue would prevent cuts to critical services in three specific areas.

Invest in education

• • Stop a $100 million cut that would shorten the K-12 school year from 180 to 176 days;
• • Stop a $152 million reduction to the state’s levy equalization program, which provides financial support to school districts in property poor counties; and
• • Stop a $160 million reduction in state support for the state’s six public four-year colleges and universities, and 34 community and technical colleges.

Protect public safety

• • Stop the early release of offenders assessed at low to moderate risk of reoffending, including sex offenders; and
• • Maintain the length of post-prison community supervision for all offenders.

Preserve developmental disability and long-term care services

• • Prevent 1,300 individuals from losing all personal care services and restore service hours for some of the most vulnerable clients whose care hours have been reduced over the past three years;
• • Restore more than $13 million in home care and residential provider rates; and
• • Invest more than $15 million in programs that keep elderly and developmentally disabled individuals in their own homes and with their families.