Advocates are cautiously optimistic that a proposed plan for reforming state assistance to the disabled includes no broad call for cuts in services. If anything, the report is a thoughtful look at the inescapable factors driving the cost of the program. And it offers a robust case for fuller funding of these services for the benefit of clients, their families and taxpayers alike.
In a report to legislative leaders last week, the Agency for Persons with Disabilities and the Agency for Health Care Administration outlined a redesign of the iBudget waiver program. The program provides services to more than 34,500 people with intellectual or developmental disabilities, helping them to live at home or work in their communities as an alternative to institutional care.
Lawmakers have complained for years that the program outspends its budget, and their order for a redesign had advocates fearing deep cuts in services. The recommendations do include some small caps on services like companion care, which could impact about 1,600 people. But the report also suggests shifting some expenses to other areas of Florida’s health care budget, which could save the disability program tens of millions of dollars. One sensible idea for avoiding budget surprises is to have economists from the Legislature and the governor’s office more closely monitor expenses on a regular basis.
But the overriding message is that state lawmakers need to acknowledge reality. Over the last several decades, Florida joined other states in offering supportive services to allow the disabled to remain at home instead of moving into institutional settings. That has enabled tens of thousands of the most vulnerable Floridians to lead happier, more fulfilling lives. More than two-thirds of those enrolled live independently or with their families, compared with 29 percent in licensed residential facilities. And the average cost of home care ($35,000 per person annually) is far cheaper than residential placement ($135,000).
Costs are rising, the report notes, not because of fraud, mismanagement or waste - but because aging clients are requiring more help and their aging caregivers are no longer able to handle the job. A 46-year-old man with cerebral palsy, the report notes, was forced to sit in a dirty diaper until his caregiver arrived in the evenings because his 84-year-old mother could no longer lift him from his wheelchair. And that gap will only increase. Florida is home to more caregivers over age 60 who deal with the disabled than any other state in the country. More families are moving to Florida, and life expectancy is rising along with the number of people with disabilities. Already, more than 21,000 people are on the program’s waiting list.
The budget problem is clear: the state simply isn’t spending enough. Florida ranks 50th out of 51 in the nation (including the District of Columbia), the report notes, in spending on these services as a percentage of statewide personal income. Yet too many lawmakers are looking to cut costs instead of invest more in programs that work, treat the disabled with dignity and save money in the long run. It’s great that this program may avoid deep cuts that would significantly harm families, but Florida should aim higher.
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