Michael P. Hansen Director Rick Scott Governor Public Meeting December 9, 2011

Overall iBudget Goals Customer self-direction and choice Equitable distribution of appropriated Medicaid waiver funds Business process efficiencies using technology 2

iBudget Background 2009 General Appropriations Act (GAA) required plan by February 2010 –APD researched other states’ systems and best practices –APD worked with iBudget Florida Stakeholders’ Group to design plan iBudget implementation authorized in s , Florida Statutes, in

QSI ASSESSMENT 1) Functional Score 2) Behavioral Score 3) Ability to: Transfer, Self-Protect, and Maintain Hygiene AGE LIVING SETTING Determines Individual Budgets 4 iBudget Allocation Formula

LEAST FLEXIBLE: Residential Services Therapeutic Supports and Wellness MOST FLEXIBLE: Life Skills Development Supplies and Equipment Personal Supports Support Coordination Transportation Dental Services CONSUMER CHOICE (12,196 Combinations of Services) 5 Consumer Flexibility in Spending

Create Overall Plan Technical/Process Finalize Deployment Strategy Implement in Phases Statewide Transition Areas 1 & 2 In Progress iBudget Phase-In Plan In Progress 6

The results of the initial proposed model would likely lead to about 2/3 of people getting reductions with many of these having large reductions (over 40% reduction in cost plan compared to current cost plan). The initial proposed model could result in about 45% of people not having enough in their budgets to fund their current core services. iBudget Implementation Challenges and Impacts 7

Non-Core and Core Services 8 8 Core ServicesAmount Behavior Services$51,826,726 Consumable Medical Supplies$15,706,045 Durable Medical Equipment$125,541 In-Home Supports$112,798,827 Nursing Services$26,276,542 Occupational Therapy$3,881,908 Personal Care Assistance (PCA)$84,876,522 Physical Therapy$8,030,342 Residential Habilitation$375,049,588 Respiratory Therapy$624,467 Special Medical Home Care$2,081,789 Supported Employment$9,955,184 Supported Living Coaching$30,531,145 Waiver Support Coordination$41,862,739 Portion of Personal Supports (based on In-Home Support and PCA) $10,794,055 SUBTOTAL - CORE$774,421,419 Non-Core ServicesAmount Adult Day Training$84,667,539 Companion Services$41,473,432 Dental Services$3,598,353 Dietician Services$297,508 Environmental Adaptations$210,378 Specialized Mental Health Services $3,025 Respite Care$22,160,859 Speech Therapy$5,061,633 Transportation$38,339,635 Portion of Personal Supports (based on Companion and Respite) $5,992,966 SUBTOTAL - NON-CORE$201,805,327 8

Models’ Impact on Individuals 9 Note: The initial proposed model would set aside about $100 million for extraordinary needs as well as other required costs not in the algorithm such as waiver support coordination.

Uses current cost plan and initial proposed iBudget amount as starting point. Does not increase any cost plan. Does not decrease any cost plan more than 50%. Uses core services to approximate “extraordinary needs.” Additional savings from other cost-containment strategies and individual cost plan reviews would continue. Model A Key Features 10

Example 1 11

Example 2 12

Example 3 13

Example 4 14

Example 5 15

Example 6 16

Example 7 17

Example 8 18

Example 9 19

Percentage of Individuals by Funding Approach 20

Thank You! Please comments by 12/16/11 to 21