RD216 - Plan for the Elimination of Waiting Lists under Medicaid: Intellectual Disabilities and Individual and Family Developmental Disabilities Supports Waivers


Executive Summary:
Chapters 228 and 303 of the 2009 Virginia Acts of Assembly express the intent of the General Assembly to eliminate the waiting lists for the Medicaid Intellectual Disabilities (formerly “Mental Retardation”) Waiver and the Individual and Family Developmental Disabilities Supports Waiver. The language further requires the Department of Medical Assistance Services to collaborate with the Department of Planning and Budget to increase the number of funded waiver slots at a minimum of 67 slots for the Individual and Family Developmental Disabilities Supports waiver and 400 slots for the Intellectual Disabilities waiver per year, until the waiting lists are eliminated. Finally, the language directs the Governor to develop a plan to eliminate the waiting lists for these waivers by the 2018-2020 Biennium. This document is intended to meet the requirements for such a plan.

Growth in the number of individuals in need of services through these two Medicaid waivers has been and is expected to remain substantial. Utilizing the expected rate of growth in the waiting lists, the Department of Medical Assistance Services has determined that the minimum slot allocations required in the legislation are insufficient to meet the stated intent of eliminating these waiting lists. Beginning in state fiscal year 2011, an annual allocation of approximately 220 new Individual and Family Developmental Disabilities Supports waiver slots and approximately 1,110 new Intellectual Disabilities waiver slots will be required to eliminate these waivers’ waiting lists by the end of state fiscal year 2020 (these estimated slot needs are inclusive, not in addition to, the stated minimum new slot allocations). Over the course of the 11 years required, these additional slots are expected to cost approximately $2.4 billion in General Funds ($4.9 billion in total funds). These costs will be on-going in perpetuity and additional slots will be required each year thereafter as needed under the non-capped waiver programs. This additional cost could impact the Commonwealth’s ability to fund other programs both within the Health and Human Resources Secretariat and across other State programs.

In addition to the General Fund cost to eliminate the waiting lists, the Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS) will require additional administrative support to adequately administer the waiver programs. DMAS and DBHDS have estimated an additional $82 million in General Funds ($139 million in total funds) to support the administration of the added waiver slots over the course of the elimination plan. As with the medical costs, these costs will be on-going. Finally, there are significant concerns with provider capacity, both public and private, to serve the increased population.

The following document represents the legislatively required plan to eliminate these two waiver waiting lists through the addition of slot capacity to the existing waivers. The plan is presented independent of the upcoming Executive Budget development, as well as future biennial budget proposals. To the extent the adopted budgets modify implementation of this plan, the targets and expenses presented herein will need modification to meet the elimination goal by the end of state fiscal year 2020. In light of the fiscal impact of this plan, DMAS and DBHDS are recommending further long-term study to examine alternate service delivery options (i.e., waiver modifications/development) to achieve the coverage goals outlined by Chapters 228 and 303 in a more cost effective manner. It is envisioned that this study would be conducted over the next biennium, with significant involvement from relevant stakeholders, to be considered in the development to of the 2012-2014 Biennial Budget.