1. Something new is on the horizon…
…for individuals
receiving waiver services.

2. The Waive(r) of the Future
Budget Florida
Describe comment card process
The Waive(r) of the Future

3. What’s wrong with the present?
You said:
“There’s waaaay too much paperwork”
“I have to wait for decisions”
“Services my son needs are denied”
“We can do things better ourselves”
“Give us access to a wider set of services”
“I’m tired of so much change”

4. How we got to this point Managing APD funding is difficult . . .
Which has led to deficits
Since APD must stay within the budget the Legislature sets . . .
It leads to cost control measures like tiers, rebasing, and prior service authorization . . .
Which increases bureaucracy and limits consumer control and . . .
Keeps us from serving the waiting list.

5. What does the waiver of the future look like?
The Answer: iBudget Florida
More self-direction
More simplicity – less “red tape”
Greater equity
More stable, sustainable system

6. Why iBudgets? Other options raise concerns Managed care
Greater institutionalization
Continued deficits, growing waiting list, awkward legislative cost-control measures
Legislature told us to develop a plan by February 2010—then passed a law requiring APD to implement it.

7. The Waive(r) of the future
is almost here
Initial implementation of iBudgets is in late Fall 2010 in one area of the state
Need federal government approval first
Wider phase-in begins late 2011 or 2012

8. How did APD make the iBudget plan?
Did a lot of research
Other states have similar systems - Georgia, Minnesota, Connecticut
Got a lot of stakeholder input
16 dedicated self-advocates, family members, WSCs, providers, state agency representatives, and advocates on Stakeholder Group
Got help from consultants
Listened to consumers, families, and providers in public meetings and via our Web site

9. What’s different about iBudget?
Current System
Services decided first
Complex system:
WSC writes plan
PSA review
Rebasing affects
Tiers affect
Change in services often requires new PSA review
iBudget Florida
Funding decided first using formula
Simpler, flexible system:
Can spend up to individual iBudget limit
Limited service review process
More choice in services
Pro:
Very individualized
“High touch”—personal discussions w/ WSC
Cons:
Not equitable (was a rationality, but not fully equitable; now some have had drastic cuts from tiers)
Lots of bureaucracy—means far away people make decisions, not as responsive to changes in need
Administratively complex—uses lots of resources (staff time, funding, delays in services)
Not controlling costs well, and involves problems for people
Can’t predict cost of serving wait list

10. Features of iBudget
You have more control over your services—can get your priority services faster and make changes easier
You’ll know your budget for services up front to help you plan
Wider array of services available to all
Prior service authorization ended as we know it
Greater support for you
WSCs will have less paperwork to do
You’ll have training and tools to self-direct if you want

11. Features of iBudget Stronger quality assurance and quality improvement
APD and QA contractor will review for health and safety, provider manipulation, and fraud
More stable system
Would phase-in gradually

12. Sounds great, but how does all this work?
Uses a statistically validated formula or algorithm
Considers consumer age, living setting, QSI subsection sum of scores, some QSI questions
People with similar needs receive similar funding
People with greater needs receive greater funding
Total of iBudgets + funds for exceptional/ changed/one-time needs = total APD waiver funding
Still tweaking the algorithm & analyzing its impact but these are elements.
QSI subsections are Behavioral & Functional
QSI questions are Q18 (Transfer) Q20 (Hygiene) Q23 (self-protection)
Living setting explains about 46% of the variance;
Age about 11%;
QSI subscale scores about 13%
QSI individual questions about 6%
Together (because there is some interaction; for instance, children primarily live in family homes, so those correlate stronger) explain about 62% of variance—very good!

13. What else should I know?
Initially, some budgets would increase, others decrease, and some stay about the same
Will phase-in gradually—over a few years
Exceptional need process if critical health and safety needs are unmet with budget
Expect more system stability after initial phase-in
Consumers may need to prioritize use of APD funding
Waiver is intended to work with other resources
WSCs freed to help get more community resources

14. What if my iBudget isn’t enough?
Exceptional need funding available if critical health and safety risk
Temporary and permanent increase for significantly changed needs that current iBudget can’t accommodate
One-time funding available—durable medical, environmental modifications, nonroutine dental
Thorough review of requests for more funding

15. Service Review
The process as we know it would go away—minimized or eliminated as much as possible while meeting federal requirements
Streamlined paperwork
More flexibility
Review spread among areas, Central Office, and contracted experts
More review for unusual situations, less (or no) review for routine decisions

16. Services Design of service array
Services grouped in 8 service families
Can switch among services within service family usually with minimal or no outside service review
Easier to meet changing needs over time
Broader services
Personal support and day activities
One worker can do a broader set of tasks
Allow to meet changing needs day-to-day
. .

17. Waiver Support Coordination
• Waiver Support Coordinator’s role will shift to more of a facilitator and guide
• Will be seeking to reduce paperwork
Allow more customized level of service
Most will have more flexibility to choose support coordination level (limited, full, or enhanced)
More meaningful distinction between levels (for example: more limited support in limited WSC service)

18. Consumer and Family Control
Training would be provided to consumers and families on iBudget policies and choice-making
Unless in CDC+, must use Medicaid-enrolled providers
Could negotiate some rates up to maximum

19. What the Future Holds Greater control over your lives
Less delay in getting services
Services better tailored to meet your needs
WSC freed up to help you more
Greater equity in funding
Reduced bureaucracy and “red tape”
More stable system

20. Budget Florida apdcares.org Get the latest info and provide
Describe comment card process
Get the latest info and provide
additional input via APD’s Web site
apdcares.org