Proposed Medicaid changes could hurt those with disabilities, advocates say

TALLAHASSEE — Florida lawmakers are proposing changes to a Medicaid program for people with disabilities this year that would contract out some of its functions and support services, the latest in a years-long effort to restrain state spending on some of its most vulnerable Floridians. Advocates for people in the program say they fear the move could hurt the care they receive and add bureaucratic red-tape to an already convoluted process.

A bill to make those changes cleared its first committee stop in the Senate Wednesday by a 5-2 vote, though it is likely to become entangled in the complicated calculus surrounding the state’s massive healthcare budget this session. The fight is one of the central healthcare conundrums facing state lawmakers during this year’s legislative session: what to do for the nearly 35,000 Floridians currently being served by the state Agency for Persons with Disabilities and the 21,900 more on a waiting list for its services.

Lawmakers are expected to determine some kind of redesign for the agency in the next two months, after criticizing the agency for running a deficit every year for the past few years. Advocates and agency officials, who say that the costs of providing care have risen because of aging clients and the additional services they need, have countered that the Legislature controls the Agency for Persons with Disabilities’ budget and should give it more funding. The agency is required to pay for clients’ services even if it exceeds what lawmakers allot.

“It’s almost akin to a family that’s got five children and you take on another five and you still have the same grocery budget to feed them,” said Valerie Breen, executive director of the Florida Developmental Disabilities Council. “You’re trying to shorten and redo things and you get down to just potatoes and bread.”

But bill sponsor Sen. Aaron Bean, R-Fernandina Beach, said changes to how the program is run had to be made. “If we don’t make changes the whole thing will collapse under its weight,” he said. “We can’t continue to deficit spend.”

SB 82 would direct the state to contract out parts of the Medicaid program known as iBudget, which operates under a federal “waiver” that gives it more flexibility to provide services. That would include consolidating support-coordination services into contracts with two organizations across the state — services that are currently delivered by agencies and individuals throughout Florida that bill directly to Medicaid.

It would also require state officials to find an outside group to evaluate whether or not people’s funds provided through iBudget should be increased, in a process meant to determine “significant additional needs.” The Agency for Persons with Disabilities currently oversees that process.

Some caps would also be put in place under the current iteration of the bill, which directs state officials to change contracts and ask the federal government to amend the “waiver” the program operates under. Those caps include some for personal care assistance and some for residential habilitation and supported living coaching services.

Bean, who chairs the Senate’s health care budget committee, told fellow lawmakers Wednesday that he saw the bill as a way to forestall shifting the entire program to managed care, where private contractors manage patients’ care and control what services they can receive.

Advocates have loudly criticized any shift for the disabilities program to that system, which almost all of the state’s other Medicaid services are now run through, saying that it is poorly suited for people with disabilities whose lifelong conditions are not short-term diseases that can be managed. A joint report from the Agency for Persons with Disabilities and the Agency For Health Care Administration last year also recommended against shifting the program’s model to managed care.

“If we do nothing, I do know this: managed care is the only default solution there is,” Bean said. “They’re going to move the whole thing to managed care and say good luck,” he said. “Right now, we can make changes to the solution.”

But many of those testifying on the bill told Bean and his colleagues they considered the proposed changes a slippery slope to a managed-care future, not an alternative.

“This looks like managed care of support coordination,” said Laura Mohetsky, a waiver support coordinator from Brevard County. “And I think once you manage the support coordination, then all the other services will continue to feel that effect.”

“To change from one program to another, and the consequences of moving them to two or three agencies, the state will have some effects that will be devastating to some of our folks,” she added. “I don’t understand why we think the lowest bidder of a few agencies are going to provide better support coordination than what we have.”

“I don’t want to be a number to someone,” added Amanda Baker, 39, an advocate with cerebral palsy. Baker, who moved from Panama City to Tallahassee after Hurricane Michael in 2018, added that her own support coordinator in the city had been invaluable in finding her the resources she needed. “I want to be able to still have their cellphone number and still be able to call them if I have an emergency.”

Bean said after the vote Wednesday that he expects to see amendments to the bill in its next committee stops, including a recommendation allowing the program to be considered in state economists’ forecasts to better project its future costs. He added that he expected to talk again with Barbara Palmer, the agency’s director, who said Wednesday that that she wanted Bean reconsider the proposal to outsource evaluating significant additional needs.

But Bean ruled out doing nothing: “We already know the ink is red,” he said. “We need to paint a picture of how we can get to black ink in the future.”