RD599 - Developmental Disability Waiver Wait List Report – November 1, 2021

Executive Summary:

*This report was replaced in its entirety by the Department of Behavioral Health and Developmental Services on November 30, 2021.

The 2021 Appropriations Act mandated the creation of a workgroup to review the existing Developmental Disabilities (DD) waivers’ reimbursement rates and devise recommendations to reduce the current DD waivers’ waiting list. The current rates are based on a rate study conducted prior to the DD waivers’ redesign in 2016. It is typical for rates to be “rebased" (revised based on an updated study of costs and new assumptions) every five years. Similarly, two existing waiver waiting lists were combined in 2016 to create a single, three-part waiting list for individuals to whom DD waiver slots are assigned based on their urgency of need. This waiting list has grown exponentially over the years and now hovers at more than 14,000 persons.

The recommendations of the waiting list reduction workgroup are three-pronged. The group felt that the most important step towards meaningfully reducing the waiting list is to fund a large number of DD waiver slots over the course of the next five fiscal years. In order to permit a system hobbled by the effects of COVID and inadequate reimbursement rates to catch up, assuming that the rate increases recommendations are accepted, the desired slot infusion is back-loaded towards the end of this period.

Second, the group recommended exploration of and future investment in innovative practices and services. There is the desire to move away from bricks and mortar services and towards services in families’ and individuals’ own homes and larger community settings. These more integrated services are also highly supported by the commonwealth’s Settlement Agreement with the US Department of Justice. Further discussions about this recommendation and exploration of its costs will need to take place with key stakeholders and state staff in order to bring it to full operationalization.

The final recommendation is for the Departments of Medical Assistance Services’ (DMAS) and Behavioral Health and Developmental Services’ (DBHDS) staff to explore and prepare a report for the General Assembly regarding a “core services" waiver, which would include a very limited number of services, but which would be available to individuals currently on the waiting list. The provision of some home-based services will enable many individuals and their families to maintain their place in their present setting, potentially move off the waiting list, and certainly delay the need for the more costly, current DD waivers.

The cost of adding 4,665 slots over the course of five years to significantly reduce the Priority 1 portion of the waiting list totals $143,585,812 in General Funds ($287,171,621 in total funds). These costs will be ongoing in perpetuity and will not fully eliminate the waiting list. In addition to the General Fund cost to support the slots needed to reduce the waiting list significantly, DMAS and DBHDS will require additional administrative support to administer the waivers and carry out necessary safeguards for the individuals supported by them. These costs total $1,329,995 in General Fund ($1,923,138 in total funds) over the course of the five years spanned by the recommendations of this report. The total cost of all proposed actions is $144,915,806 in General Fund ($289,094,761 in total funds). Additional, as yet unidentified, costs may be incurred as recommendations #2 and #3 are explored and if the decision is made to pursue their implementation.