iBudget Waiver Provider Rate Crisis

2 What is the iBudget Waiver? The iBudget Waiver is how Florida pays for community-based services for people with developmental disabilities (DD).

3 Two critical issues that affect iBudget services! Provider rates are below the level they were in 2003! There are not many providers that can live off low pay rates for their work. The Department of Labor (DOL) In-home care Rule may put supported living, personal supports, and companion service providers out of business.

4 How did the DOL issue happen? Let’s look more closely at the DOL Home Care Rule: The Department of Labor in Washington, DC ruled that Medicaid reimbursable service providers have to be paid at least minimum hourly wage and not at a daily rate. For some services, Florida pays providers a daily rate that works out to be lower than minimum wage!

5 How does this affect me? If iBudget rates are not adjusted, individuals with intellectual/developmental disabilities who are living independently in their own homes may no longer have staff to provide their needed supports and will have fewer options! Many will likely require placement in more costly residential group homes, or institutions.

6 What is the solution for DOL? The additional costs to resolve the DOL hour-for- hour issue would be about $12 million in General Revenue and about $18 million in Medicaid Matching Funds, for a total cost of about $30 million for those who are receiving daily rate supports. Based on APD historical surpluses the program should be able to absorb this impact within existing appropriations. Other impacts of the DOL rule costs are included as rate increases.

7 Back to the provider rate issue... Provider rates are below the level they were in 2003! iBudget rates are on average 14% lower than they were in Florida’s minimum wage increased by 56% and providers have to pay this increase to staff with this lower rate. Direct Care staff turnover rate is about 40%. This leads to an unstable workforce and constant training. Providers spend about percent of their budgets on direct care staff, so rates need to be adequate to hire good staff.

8 How did this happen? Overall, provider rates were reduced as a result of the Great Recession and have not been returned to their previous level! Florida ranks 50 out of 51 (States plus D.C.) on fiscal effort for individuals with intellectual and developmental disabilities.

9 How does this affect me? Remaining on the current path will continue the deterioration of a network that serves Florida’s most vulnerable citizens. Florida has seen a 35% drop in number of providers since 2008, meaning individuals have fewer providers to choose from and a less stable provider system to count on.

10 What can be done? Fund a provider rate increase over the next two years for three (3) critical iBudget services (Personal Supports, Adult Day Training, and Residential Habilitation). Year one will cost $29 million in GR and generate $44 million in federal Medicaid Match.

11 What do we do now? Communicate your concerns to your lawmakers!

12 Talk to People Local organizations and advocacy groups. Legislators: – Find your Representative at : es/myrepresentative.aspx es/myrepresentative.aspx – Find your Senator at :

13 Talk to People cont’d The Florida Developmental Disabilities Council and the Florida ARF will be asking for $30 million dollars to increase provider rates and $12 million dollars from surplus funds to receive at least minimum wage for companion services and in-home support services.

14 How to Reach Your Legislator Legislators have local offices and offices in Tallahassee. Contact your legislator’s office. Make an appointment to visit their office. Ask to speak to them on the phone. Send them a letter or .

Be Polite Make an appointment. Arrive on time. Be brief (15 minutes or less). Limit your group to five people or less. 15

16 Tell Them What You Know People remember best what they hear first and last, so: Tell them your main point first. Explain why this point is so important. Tell them your main point again at the end.

17 What to Add Introduce your issue. –“I’m here to talk to you about the iBudget Waiver Provider Rate Crisis” Give an example of how this problem affects you or someone you care about. Talk about how this problem makes you feel.

18 Before you Leave Ask, “Do we have your support for this issue?” o If yes, then thank them for their support. o If not, still thank them for their time. Ask, “Is there any additional information I can provide?”

Why Advocates Work Together TEAMwork- Together Everyone Achieves More! No one can do everything; but everyone can do something. Focus on what you CAN do. 19

20 Who else can we do? For more information on issues and advocacy go to:

21 Who to Contact Contact: Margaret J. Hooper Florida Developmental Disabilities Council Public Policy Coordinator 124 Marriot Drive, Suite 203 * Tallahassee, FL Toll Free #: Address: Address: Web Site: Web Site:

22 Who to Contact cont’d Contact: Suzanne Sewell Florida ARF CEO/President 2475 Apalachee Parkway, Suite 205 * Tallahassee, FL Switchboard #: (#123) Address: Address: Web Site: Web Site:

23 Who to Contact cont’d Aaron Nangle WaiverProvider.com SupportCoordinators.com MedicaidWaiver.org Office: Fax: FloridaUnites.com - WaiverInfo.com - FloridaSupports.com FloridaGroupHome.com - FloridaAutisum.org - FloridaGuardianship.com