Public Policy

One of the misguided changes made to Idaho Medicaid benefits in order to cut the budget, is the refusal to allow a person who has both a psychiatric illness and a developmental disability (DD) from receiving both developmental skill building services and psychosocial rehabilitation.  People who have both diagnoses are expected to give up treatment for one or the other. This makes no more sense than asking a person with both diabetes and heart disease to pick which one they want to receive treatment for. There are about 600 Idahoans on Medicaid who have a developmental disability (such as autism, … Continue reading Psychosocial Rehabilitation (PSR) is NOT the same as Developmental Therapy.

The Idaho Department of Health and Welfare (IDHW) has implemented the new “blended” reimbursement rates for adult developmental programs. “Blended” rates were suggested by DD service providers and endorsed by the Department as a way to cut costs for Fiscal Year 2012. The suggestion was embraced by the Legislature in H 260 (see the previous post for information on H260). Developmental therapy is teaching new skills and behavior patterns to people with developmental disabilities, such as, intellectual disabilities, autism or cerebral palsy.  This might be basic self care skills like dressing, grooming, bathing or going to the bathroom, or independence … Continue reading “Blended Rates” for Medicaid Developmental Therapy is Very Bad News for People with Disabilities in Idaho.

My last blog was posted in the middle of the Idaho legislative session and chronicled the terrible effects  H221 would have on Medicaid services for people with disabilities.  I am pleased to report that H221 was held in committee and did not pass.  Unfortunately, it was replaced H260 which dropped some of the worst parts of the first bill, but still has enough harmful features to qualify as a disaster. H260 passed easily, was signed by the Governor and is now law. Fortunately, H260 does not include the elimination of developmental therapy for some adults.  It does not include the … Continue reading Community Based Disability Services Will Be Seriously Hurt by H 260.

The most egregious problems with H221 are the elimination of developmental services for people who are not eligible for waiver services and for all people over the age of 45 (p. 10 lines 43-46). 1.       People with developmental disabilities who do not meet institutional level of care will lose all developmental supports and services.  a.       Who are these Idahoans? -They are 524 people who have a severe, lifelong disability occurring at birth or in childhood.  The disability must cause significant limitations in at least three major areas of life activity, and it must, by definition, require lifelong services and supports … Continue reading H221 violates federal law and deprives vulnerable adults of essential safety net services.

Liberty and Disability The preamble to the Constitution of the United States says “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”(spelling and capitalizations are in the original, emphasis is added).  The framers and drafters of our Constitution clearly intended that the national government should be committed to protecting the liberty of its citizens and actively securing … Continue reading Liberty and Disability

Of course the Idaho Legislature faces some tough decisions.  The projected revenue (whether accurate or not) is far short of the cost of running the state government for 2012. Medicaid is a very large part of the cost and so it is a natural target for cuts.  But, like any enterprise, you can’t always balance the budget by cutting the largest cost centers. A retailer can’t recover by closing its most profitable stores. A family can’t make ends meet by eliminating food from the budget, or selling the car that takes them to work.  Medicaid is the largest single source … Continue reading Medicaid- When Are Cuts NOT Savings?

Few, if any, volunteers have the training or skills to provide Developmental Therapy.  According to the Idaho Administrative Rules (IDAPA 16.04.11.10.14) “Developmental therapy is the use of therapeutic intervention and positive behavioral techniques that result in measurable skill acquisition or prevent regression …”   Most volunteers from the community have no training or education in “therapeutic intervention” or “positive behavioral techniques” and volunteers will not have professional supervision. Currently, developmental therapy (DT) requires supervision by a “developmental specialist” with specific qualifications and experience, on a weekly basis. Without this supervision and training the therapy is unlikely to have the desired … Continue reading Families and Volunteers Cannot Replace Developmental Disability Agency Services or Psycho-social Rehabilitation

On January 17th, The Idaho Department of Health and Welfare (DHW) presented their budget to the huge joint meeting of the Finance, Appropriations, and Senate and House Health and Welfare committees.  It is not a pretty picture.  Based on the Governor’s proposed budget, DHW is expected to cut $25,000,000 in state funds from the amount they need to maintain services at the current level. This will result in the loss of about $59,000,000 in Federal matching funds, for a total cut in services of about $84,000,000 for 2012.DHW Director, Dick Armstrong, said that he believed that we could replace current … Continue reading Medicaid Budget Threatens Developmental Disability and Mental Health Services

How Optional Medicaid Services Save Idaho Taxpayers Money. Medicaid is a state and federal program created in 1965 which provides federal funding for medical care for people who cannot afford it, and a range of services for poor people with disabilities which allow them to live safely in their homes. The State of Idaho provides about 30% of the cost of this care and the federal government provides about 70% of the cost. For the last three fiscal years the federal share was increased to about 80% due to a provision in the American Recovery and Reinvestment Act (ARRA).  In … Continue reading How Optional Medicaid Services Save Idaho Taxpayers Money

Public Policy Watch Children’s DD Services II-School Services The recently proposed Medicaid rules for Children’s Developmental Disability (DD) services will apparently have very serious consequences for schools and students who have been receiving developmental therapy through their school districts. My understanding from the Department of Health and Welfare is that Medicaid will no longer allow schools to bill Medicaid for developmental therapy or the new “intervention” service, if the rules are adopted. When Schools bill Idaho Medicaid for developmental therapy, the school district pays the state’s share of the costs (typically about 30%, though it has been higher for the … Continue reading Children’s DD Services II-School Services