By Gina Macris 

Rhode Island’s developmental disability budget for the next fiscal year includes assurances that aa total of $9.1 million in Medicaid money will be spent to raise pay for direct support workers and to begin transforming the state’s system of services for those with intellectual challenges.

Shortly after 1:30 am on Saturday, June 18, The Senate approved total developmental disability funding of $246.2 million beginning July 1 in concurrence with the House vote taken Wednesday. That total, almost all of it state and federal Medicaid funds, is nearly $15.4 million more than the General Assembly approved last year at this time for the current budget, which closes on June 30.

New budget language ensures that $4.5 million in state revenue earmarked for worker raises and performance-based contracts can’t be used for anything else in the overall appropriation of the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) in the fiscal year that begins July 1.

The language is significant. In the recent past, as much $9 million has been budgeted in a single year to raise the wages of some 4,000 workers who provide direct support services, but the money has gone instead to help close deficits in the BHDDH budget.

The workers make an average of about $11.50 an hour, often less than the clients they support in jobs in fast food restaurants. Many of the direct support staff receive public assistance,  according to testimony presented to the House and Senate finance committees during the current legislative session.

The big difference between this year and past legislative sessions has been a federal court case aimed at enforcing a 2014 consent decree in which Rhode Island agreed to transform sheltered workshops and segregated day programs into a community-based system of services over a 10-year period. The decree settled a U.S. Department of Justice investigation that found the sheltered workshops violated the integration mandate of the Americans with Disabilities Act and the 1999 so-called Olmstead decision of the U.S. Supreme Court which clarified that requirement.

In late January of this year, Judge John J. McConnell, Jr. of U.S. District Court became actively involved in monitoring the state’s compliance with the consent decree. In May, he issued an order putting the state at risk for contempt if it does not meet any one of nearly two dozen specific goals.

One of the requirements in the order is that the state adopt increased funding sought by Governor Gina Raimondo for developmental disabilities in the next fiscal year “in order to fund compliance with the Consent Decree.” The order does not mention a specific dollar amount.

Several other requirements in the order collectively set an August 1 deadline for implementing appropriate raises for direct support staff, regular supervision of workers, and a pilot group of performance-based contracts for supported employment services.

It’s not yet clear how much money the raises will add to the workers’ pay, or what the incentives will be in the performance-based contracts.

Initially, Raimondo’s budget proposal included a little more than $5 million for raises of 45 cents an hour, but that sum was not considered enough to provide performance initiatives to the private agencies that provide most of the developmental disability services in Rhode Island. .

After improved state revenue projections in May, Raimondo added another $4 million to wages and other increases to providers. .  

Raimondo sought protective language to segregate state revenue budgeted for pay increases for developmental disability workers, but that wording was eliminated in the budget passed by the House Finance Committee.

Sometime before the June 15 vote on the House floor, however, new and more detailed language was inserted, a House spokesman confirmed Friday night. 

The new language says that $4.5 million of general revenue “shall be expended on private provider direct support staff raises and associated payroll costs to include targeted increases associated with performance-based contracting and system transformation incentives” authorized by BHDDH.

Because funding for developmental disability services is part of the state’s Medicaid program, the $4.5 million in state revenue set aside for raises would be matched by federal funds, for a total of slightly more than $9 million..

Raises also must be approved by the Office of Management and Budget and the Executive Office of Human Services, according to the budget language. Changes in reimbursement methods must be approved by the Governor’s office and OMB.