- Recent Budget Cuts
The state of Florida has made steep cuts to the Agency For Persons With Disabilities Medicaid Waiver Program. These cuts include the elimination of six services. Provider rates are constantly being slashed; you can read the history below. The legislation also mandated a four tier system, and three of the four tiers will have spending caps for services.
- Contact Your Legislators. Tell Them That Providers Can Not Afford Any More Rate Cuts.
Please write to WaiverInfo@aol.com if you know of any other resources.
History of Changes to the HCBS Waiver Program
In July 2003, the State of Florida adopted the Mercer Rate system for services funded by the Home and Community Based Services Waiver. Transportation, Special Medical Homes and Intensive Behavior services continued to have negotiated rates.
In November 2003, the Agency reduced Residential Habilitation rates by 14.3% and Live In Residential Habilitation by 7%. Also, billable days were limited to 350 per year for homes having more than 3 individuals. ADT rates were reduced by about 9.5%.
In 2004, the Agency implemented a residential habilitation matrix approach which limited billings by looking more at the number of hours needed per home to adequately staff it.
In 2006, agencies received a 2.81 % Cost of Living Adjustment that applied to all waiver services.
During the 2007 Legislative Session, the Florida Legislature mandated changes in Senate Bill 1124 that resulted in limitations and eliminations of Developmental Services Home and Community Based Services Waiver services funded through the Medicaid program. Chore, Non-residential Support Services, and Homemaker Services were eliminated. However, the definition of In-Home Support Services has been expanded to include some activities previously provided in the eliminated services. Massage Therapy and IQ testing (Psychological Assessments) services were eliminated.
APD will be implementing a uniform rate for individuals with intense needs but a date for implementation has yet to be set. Supported Living Coaching has been limited to no more than 20 hours a month for persons who also receive in-home support services.
Excerpts from The Association of Rehabilitation Facilities (Florida ARF) paper titled "History of APD Medicaid Waiver Cuts: The DO System Needs Stability." Prepared December 2008, Updated March 2011.
March 31, 2011 HSBC Waiver Program Review Support Coordination to all persons under the age of 18 who live in the family home are limited to Limited Support Coordination which is 50% of the adult rate. Personal Care Assistance (PCA) services have been limited to 180 hours a month unless the person has intensive needs and all rate modifiers have been eliminated. Additional hours may be authorized if there is a substantial change in circumstances. APD and AHCA have reached an agreement which allows for people under the age of 21 to receive more than 180 hours of PCA, if medically necessary. The Medicaid State plan is to cover the cost of the additional hours.
In December 2007, residential habilitation rates were collapsed and reduced overall by 7%, however, a settlement agreement reduced the reductions to 4.25%.
As a result of the 2007 legislation, AHCA in consultation with APD sought and obtained federal approval for two additional waivers to implement a four-tiered waiver system. The tiers were implemented in the fall of 2008. Tier 1 -Current DD Waiver with No Monetary Cap: Limited to individuals with intensive medical, behavioral, and adaptive needs that cannot be met in other tiers. Tier 2 -Capped at $55,000: Limited to clients whose service needs include support in a licensed residential facility and at least minimal moderate levels of residential habilitation with behavior focus services as well as clients in supported living who receive more than six hours of in-home services. This tier applies only to individuals who receive residential habilitation or supported living and in-home support services. Tier 3 -Capped at $35,000: Includes all individuals who do not fall into Tier 1 or Tier 2. Tier 4 -Current FSL Waiver with a Cap of $14,792: Includes most families with children under 21 who are to receive Personal Care Assistance services via the Medicaid State Plan.
In May 2008, proviso language passed that implemented a $43 million across the board rate cut for waiver services that was implemented in July 1, 2008. Residential Habilitation and Support Coordination received a 3% cut effective July 1, 2008, and other waiver services received a 7.21 % reduction in rates. Other changes included: May 2008, legislation passed reducing the rate paid to Personal Care Assistants by 4%. Support coordinator's case loads can increase to 43 people per month, up from 36. March 31, 2011 HSBC Waiver Program Review In July 2008, South Florida providers had geographic rate differentials reduced for residential habilitation services by 2.5% in Broward, Palm Beach, and Date Counties. Monroe County realized a 5% reduction.
In January 2009, during a Special Session the Florida Legislature approved a 3% rate reduction for DD waiver services. However, the rate reduction was vetoed by the Governor (Crist) and was not implemented. Per the 2009 Legislature, effective October 1, 2009, Medication Administration Review services will be eliminated as a waiver service.
The 2010 Legislature decreased the overall funding level for the waiver by $43.8 million, and did not continue anticipated federal stimulus (FMAP) dollars. The proviso language approved by the 2010 legislature included $16,811,989 for a 2.5% provider rate reduction for most waiver services excluding: Support Coordination, transportation, personal care assistance, durable medical equipment, consumable medical supplies, and environmental and home accessibility services are specifically excluded from this reduction target. Governor Crist vetoes the rate cut language but did not reinstate the dollars.
The following services are no longer covered under the medicaid waiver program.
- Massage Therapy
- Non-Residential Supports and Services (NRSS)
- Psychological Assessment
- Medication Review
Supported Living Services Reduced to a Maximum of 20 hours per month.
Prior to the budget cuts, Supported Living Services were provided based on need.
People who also get in home supports services, are now only allowed 20 hours per month of supported living services.
PCA Rate Reduced To a Flat $15 per Hour. Also, Medicaid Takes Over PCA for People Under 21.
Prior to the budget cuts, Personal Care Assistance rates were slightly higher for clients with more intense needs. Now there is a standard rate of $15 per hour.
It is expected that by December of 2008, that the medicaid waiver will no longer pay for PCA for people under the age of 21. Providers who would like to continue working with their clients under the age of 21 need to get enrolled with ACHA.
Four Tiers (Reduced As of January 1, 2011)
Many people will soon be forced to give up services due to a new Tier System. Almost everyone will have spending caps.
Tier 4 $14,422.
(old cap was $14,792)
(Most Kids and People Who Only Have The FSL Waiver)
- Right Now Has- The FSL/ Florida Supported Living Waiver.
- Is under 22, AND lives in a family home.
- Is a dependent child who lives in a group home setting.
*** Most kids will be in this tier. See other tiers for intensive behavior and/or medical needs. ****
Tier 3 $34,125
(Old Cap Was $35,000)
Is 21 or Older AND (must meet one)
-Lives in a group home setting.
-Gets in home supports in their OWN HOME. (supported living environment)
- Gets Personal Care Assistance (PCA) at the MODERATE rate.
- Gets Skilled or Private Duty Nursing.
- Gets A Therapy Service (Occupational Therapy, Physical Therapy, Speech Therapy, or Respitory Therapy.
- Gets Behavior Analyst and/or behavior assistant service and is 22 or older.
- Gets More than 60 hours a month of behavior analyst and/ or behavior assistant service.
Tier 2 $53,625
(Old Cap Was $55,000)
- Gets Residential Habilitation services at the moderate rate.
- Gets Supported Living AND over 6 hours per day of in home supports.
Tier 1 No Cap At This Time
NEEDS CAN NOT BE MET IN OTHER TIERS! (essential for avoiding institutionalization)
Behavioral Needs That exceed what can be met in the other tiers. (A substantial risk of harm to themselves or others.)
Residential Habilitation At:
- Behavior Intensive
- Behavior Focus
- Standard at Extensive 1 or Higher
- Special Medical Home Care