2010-2011 Budget Presentation
Good afternoon, I am Debra Payne and I am currently serving as the Interim Deputy Commissioner for the Department of Intellectual and Developmental Disabilities. To my left is Fred Hix, Assistant Commissioner for Administration and to my right is Melinda Lanza, the Division’s Budget Director. I will present the budget overview and Mr. Hix will present budget detail.
Our Division is the state agency responsible for serving Tennesseans with intellectual disabilities. Programs offered by the Division are primarily funded by state dollars which are used to leverage federal Medicaid matching funds in a 34 to 66% ratio. The Division provides services directly or through contracts with providers in a variety of settings including Home and Community Based Waiver Services and to much lesser extent, institutional care in state developmental centers.
Governor, we understand that we must do our part to assist you in managing our state responsibly through the most difficult economic crisis since the Great Depression. While we are now at a fork in the road due to the current fiscal climate and are forced to make some hard decisions, it should not go unnoticed that this administration has allowed us to enhance the quality of services and serve more people than ever before. The Division is currently serving 8,300 individuals and this is almost 3,000 more people than prior to you taking office. We also understand that given these fiscally challenging times that there has to be a limit.
As a 34 year veteran serving individuals with intellectual disabilities I found that putting these budget recommendations together was one of the greatest challenges I’ve faced. I do understand, however, that they are necessary.
We have taken great consideration to ensure that Tennessee’s most vulnerable citizens continue to receive services that meet their basic needs. Consideration was given to preserving the most essential supports and to the impact that the budget would have on the people we serve, their families, as well as providers. We also had to ensure that we could meet state and federal requirements that are necessary to continue receiving federal Medicaid matching funds while also complying with the requirements of any federal court orders. What we are trying to achieve with this budget is a mechanism to continue providing essential supports to Tennesseans with intellectual disabilities during a time of limited fiscal resources.
Before I present an overview of our proposed budget, let me say that the Division’s recurring base budget was reduced by 14.7 percent. Some of the items identified for reduction were bought back in the current fiscal year with one-time American Recovery & Reinvestment Act funds. The items are as follows:
- Developmental Center Respites, (short term training stays for usually 30)
- State funded Wrap Around Services: (hospital attendant, transportation, household establishment, dental anesthesia)
- The Harold Jordan Center (This is a forensic service program that supports our judicial system. It evaluates competency to stand trial for a felony offense given that the person has an intellectual disability.)
- And the Family Support Program (This program was established in Title 33 to assist people with developmental disabilities and their families to remain together in their homes and communities. It is a critical service that helps preserve the family unit and lessens pressures that might lead to institutionalization, divorce, neglect or abuse)
(The total funding for these items is approximately 41.1 million state dollars.)
The Family Support Program and all other programs bought back in the current year with Recovery Funds will be reduced or eliminated in the 2010-2011 budgets. As you are aware, the Family Support Program is one of our most valued programs as it serves over 4,000 people with developmental disabilities and currently has a waiting list of 6300. This program is widely recognized as one of the most successful services in TN. The consequences of eliminating this program will create tremendous hardship for thousands of Tennessee’s most vulnerable individuals and their families. This will be one of the most difficult cuts.
In regards to the Harold Jordan Center, the Division has begun transition planning for the 16 people who reside there. 94 staff positions at this facility were already scheduled to be eliminated as they were funded with non-recurring ARRA funds.
I will now go over the necessary actions that will need to be taken in the 2010-2011 budget to meet the requested reductions:
- The Brown Waiting List Lawsuit required the Division to disburse 5 million state dollars annually to individuals on the waiting list for services. These disbursements will end on December 31, 2009 resulting in a savings of 5 million state dollars.
- Arlington Developmental Center will close on or before June 30, 2010. Individuals currently residing there will transition to ICF/MR facilities or to the community waiver program. Savings are estimated at a little over 2.5 million dollars.
- We have adjusted the operational budget for the West Tennessee Community Homes while ensuring that the adjustments maintain the safety and well being of those supported. This will reduce budgeted cost for the operation of these homes by 27 percent.
- The Division proposes limiting Personal Assistant Services to 50 hours per week. This will result in savings of 5.2 million state dollars.
- The Division proposes limiting Nursing Services to 12 hours per day except in Medical Residential homes. This will result in a savings of 4.9 million state dollars.
- The Division proposes to adjust residential rates for Level of Needs 1-4. This will result in a savings of 5.8 million state dollars.
- The Division proposes to close Clover Bottom Developmental Center by transitioning the 108 people who live there to either private ICF/MR facilities, Greene Valley Developmental Center or the community waiver program. The 2010 recurring budget operating cost is 38.6 million dollars. This center has been in operation since the 1920’s and has a number of environmental challenges regarding the age and upkeep of the facility. The Division will be meeting with the Parent Guardian Leadership early next week to seek their assistance in building strategies to safely transition all persons who reside there. There are 612 state employees who work at Clover Bottom Developmental Center. The Division’s office of Human Resources will work with the employees to assist with job placement where possible. This closure will help reduce the state appropriation needed for this Division’s programs by 3.8%.
As you see in the proposed budget summary, we have listed three improvements. These improvements do not require supplemental funding and will be funded by previously mentioned reductions.
- The first improvement totals approximately 758,000 state dollars. The Agreed Order which allowed Greene Valley Developmental Center to exit the People First vs Clover Bottom Developmental Center lawsuit requires the state to develop 16 four-person homes in the geographic area served by Greene Valley Developmental Center. The fiscal year 2009-2010 budget includes funding for 8 of these homes. The improvement includes 6 months funding for the next 4 homes which should be ready for occupancy in January 2011.
- The second improvement amounts to 5.6 million state dollars and it will address projected shortfalls in the statewide waiver based on the current enrollment and after the Division implements the above mentioned Waiver amendments.
- The last improvement item is for 4.6 million state dollars and it will allow the Division to serve an additional 108 people per year through the Home and Community Based Services Waivers.
Finally, I would like to share some of the actions we have taken in the areas of management and accountability.
- TennCare, the Attorney General’s office and the Division obtained a Court order granting the state’s motion to cease its contract with Community Services Network. The court’s ruling will allow us to provide benefits thru a TennCare MCO that would cover all persons in services instead of just the 848 members of the Arlington Plaintiff Class. The Division will transfer 12.1 million dollars to TennCare so that federal match can be achieved for this important initiative.
- We are utilizing the TennCare approved medical necessity protocols to ensure better consistency in authorizing waiver services.
- We have reorganized Arlington Developmental Center and the state operated community homes under the West Tennessee Regional Office which will result in a more cohesive continuum of care for persons transitioning into the community.
- In the spring of 2009, we opened the first three state operated 4-bed ICF/MR homes in West Tennessee. The remaining homes are scheduled to open on or before June 2010.
The Division has reviewed services that are funded with pure state dollars and recognize that this cannot be sustained. On an individual basis, the Division will be working with the Circles of Support to discuss options for those persons receiving services funded with pure state dollars.
The high cost in Tennessee’s Statewide and Arlington waivers is attributable at least in part to the inordinate number of persons who currently receive residential services in single person placements. Residential services comprise 65% of the Division’s waiver budget.
Over the past 15 months the Division has worked diligently to reduce the number of single person homes for about 300 people. However, there are approximately 297 individuals who remain in costly single person placements, many of whom could enjoy the benefits of a shared home. The Division can no longer afford to support people in single person placements without significant justification that their needs cannot be met in shared residential settings. Moving forward, the Division will require transition, where appropriate.
In closing, the Division is prepared to work with persons supported, families, conservators and providers as needed, to ensure that everyone’s essential needs are met. It is our mission to make certain that no person is placed at risk as a result of budgetary modifications. Governor, this concludes my presentation. Our staff and I will be glad to answer any questions you may have.
Governor Bill Haslam
