The State of Indiana is in the process of submitting a re-written Developmental Disabilities Waiver to the Federal government for approval, and we have serious concerns.  The Developmental Disabilities Waiver is one of the main sources of financial support for day services to clients.  We have also been told that if the Federal government accepts the revised DD waiver, the other waivers (Autism Waiver and Support Services Waiver) may be re-written along the same lines.
 
Some of you may recall that about a year ago, we sent out an alert because we thought that services would be capped at 12 months. That was held off, and it appeared that those services would be reviewed, not necessarily capped, at 12 months.
 
The State of Indiana is not sharing the draft of the re-write with us, so the information we have comes from sources close to those completing the re-write. 

 

It appears the cap is back on the table. It appears that Pre-Vocational services (services in our workshops) may be capped at a lifetime limit of 12 months, and that SEFA (Supported Employment Follow-Along services to help a person keep their job elsewhere in the community) may be capped at a lifetime limit of 18 months.
 
WHAT DOES THIS MEAN?
 
It means that the individuals who have worked in our workshops for 5-10-20-30 years may no longer receive funding for that service.  They can move into jobs elsewhere in the community through Employment Services, but after a year and a half, support services to help them keep the job may cease.
 
WHAT ARE SOME OTHER CHANGES?
 
Rates may change because services may change. We can now bill at $4.85 per hour per person for Pre-Vocational services (workshop.)  If the twelve-month cap is approved, we may no longer be able to bill for that service once a consumer hits the twelve-month limit.  

The State of Indiana is not saying that organizations cannot operate workshops; rather, they are saying they will only pay for that service for a limited time. 

The State of Indiana is recommending as a part of the waiver re-write a new non-goal directed day service that will be reimbursed at the rate of $1.85 an hour per person, based on a 1:16 ratio. This is a service that might be used to support workshop services, but we do not know if the combination of income from contract work and the $1.85/hour rate will cover the cost of operation.

 

If we cannot cover the cost of operation for a service, then we cannot continue providing it, so while the State of Indiana cannot close a workshop by direct order, it can do so indirectly by how it channels the money for services. 

 

Importantly, since we have not seen an official definition of this proposed service, we do not know if paid work will be allowed or if there will be an hours-per-day limitation.  We also do not know if we can successfully supervise clients at a 1:16 ratio while performing paid work.

 

We believe that this direction is wrong because it will ultimately have the effect of limiting client choice.
 
WHAT ELSE IS HAPPENING?
 
Like many agencies, we are finding that other regulatory changes are forcing us to consider spending additional money on clerical support, rather than being able to hire support staff for client services.