As lawmakers weigh disability program redesign, DeSantis and Galvano provide few specifics

“It’s been a tough issue fiscally, but I think it’s an issue where some of these folks are in pretty bad shape and we have a responsibility to do what we can,” DeSantis said.
The Florida Capitol. Scott Keeler
The Florida Capitol. Scott Keeler [ Times (2019) ]
Published Oct. 29, 2019|Updated Oct. 29, 2019

Florida lawmakers are expected to vote early next year on how to modify a troubled statewide Medicaid program that serves tens of thousands of people with disabilities, but some of the state’s top leaders say they are still undecided on what those changes should be.

The outcome could change how much the program, known as “iBudget,” provides for about 34,500 Floridians through the state Agency for Persons with Disabilities, as well as another 21,900 more on a waiting list to join the program.

Both Gov. Ron DeSantis and Senate President Bill Galvano said Tuesday at the annual “AP Day” press session for reporters that how to redesign the Medicaid waiver program is still under review. But they did not commit to recommendations made by APD and its sister health agency calling for more funding to the program as well as changes to better predict its future costs.

House Speaker José Oliva, R-Miami Lakes, who leads the legislative chamber that has historically pushed efforts to change the agency, declined to appear at the session.

“It’s been a tough issue fiscally, but I think it’s an issue where some of these folks are in pretty bad shape and we have a responsibility to do what we can,” DeSantis acknowledged. But he added he remained “very open about the best way forward.”

“I’m not saying one or the other, but I think the way it’s gone, it’s not necessarily going in a good direction,” he said.

Galvano said the Senate’s goal was “to see if we can help achieve that efficiency but not at the cost of reducing services” and that the agency’s report submitted last month needed “a thorough review.”

“It’s going to be something that has to be vetted through our committees and through the Health Appropriations committee before we decide where we ultimately get to,” he said.

The program, which operates under a federal waiver to give the state more flexibility in providing services, has been the target of legislative blame for years. Lawmakers, who set APD’s budget, have criticized it for overspending its appropriations — including more than $150 million in the last two years alone.

But APD has said it is torn between federal requirements that it must pay for clients’ services — even if they spill over the agency’s budget — and the increasing costs of caring for aging Floridians with also aging caregivers. State disability administrators have also complained the program’s costs are not included in a state review usually by economists to project the upcoming year’s expenditures, meaning they cannot project upcoming expenses.

After lawmakers ordered APD, in conjunction with the state Agency for Health Care Administration, to review changes to the program, they released a report last month recommending that the Legislature reconsider how it sets aside money for vulnerable disabled people.

They recommended some cuts — like limits on programs that provide in-home caregivers, job training and coaching for people with the capacity to work, as well as “adult day training” centers — and capping services to people outside institutions at $205,000 annually.

But they also urged lawmakers to allocate “appropriate funding sufficient to provide medically necessary services in the most appropriate setting” for everyone in the program and to include the Medicaid program in that annual review, which would inform a budget that more closely matches its actual expenses.

Galvano did suggest some funding for the agency could increase, though the Legislature’s mandate earlier this year directed the agency to find ways to trim costs.

“The idea of cutting costs doesn’t necessarily mean we’re gonna reduce funding, if we look at how we can reform this agency,” he said. “I am first and foremost concerned about the level of service that the individuals who interact with this agency get.”

But asked if he believed lawmakers should know ahead of time how much the agency’s costs might be, Galvano declined to commit to doing so.

“We’re trying to figure that out,” he said.

Advocates are planning to contest the cuts that have been proposed to the Medicaid program and urge funding to the program remain whole.

As Galvano and DeSantis delivered their remarks, the Florida Developmental Disabilities Council, a private nonprofit advisory council with members appointed by the governor, launched a campaign to “save the iBudget waiver,” urging people with disabilities to “educate the Florida Legislature on why preserving this program means preserving thousands of lives.”