Rhode Island's BHDDH Makes Streamlining Efforts in DD Application Process But Backlog Persists

By Gina Macris

 At any given time during the past several years, roughly 250 individuals with intellectual or developmental disabilities have been caught in a backlog, waiting for the state to determine whether they are eligible to seek a variety of support services.  

During an interview in late May, Andrew McQuaide, the Chief Transformation Officer at Department of Behavioral Health, Developmental Disabilities and Hospitals (BHDDH), confirmed the size of the backlog. 

 McQuaide said that it’s “troubling” that eligibility workers have not been able to break through the backlog, even though there has been a “fairly consistent inflow and outflow of applications” for the last four years.

 Historically, younger adults have found it difficult to get eligibility decisions much before their 21st birthdays - the age they are no longer eligible for school-based programs in districts throughout the state.  Most of the backlog came from applicants aged 21 and older.

In some cases, according to evidence provided the U.S. District Court in April, delays in screening applicants has led to their turning 21 and sitting at home, waiting for appropriate services to be put in place.

That evidence was significant for two reasons:

  • A two year-old federal consent decree requires meaningful options for integrated work and other community-based activities to be in place by age 18 for individuals who are at risk for segregation once they leave school.
  • State law says individuals with developmental disabilities qualify for adult services at age 18.

In a new report to the U.S. District Court, which is overseeing enforcement of the consent decree, the state says the makeup of the “pending cases” has changed from predominantly older to predominantly younger applicants.

As of mid-April, more than 70 percent of pending applications came from individuals 16 to 21, most of whom are not planning to leave school soon, according to the report.

The report on eligibility issues is included in the state’s new communications plan, which the court ordered to be submitted by July 1. 

 The report on eligibility says that the “former practice and understanding within the community that applications would only be accepted at age 21 has demonstrably changed, mostly due to BHDDH’s engagement and commitment to transition planning for youth.”

 During the last year, the eligibility unit at BHDDH has given priority to deciding cases from transition-age applicants, according to the report.

Nevertheless, a chart with a breakdown of the 125 individuals aged 17 to 24 who were found eligible during the 12 months ending in June shows that 108 of the approvals were made in the 21-24 age group.

Eighty-six are turning 21 this year, and 22 other applicants are turning 22, 23, or 24. Among the younger applicants, 14 are turning 20 and 3 are turning 19.

No 17 or 18 year-olds were found eligible.

The report, while acknowledging that the “number of pending applications has remained relatively consistent,” makes no reference to a backlog. 

Data on the number of applications and the number of eligibility decisions prior to 2012 is hard to come by, McQuaide said, although he understood the number of new cases approved had slowed to a “trickle” from 2008 to 2011. 

McQuaide acknowledged the widespread belief among service providers and families during that period was that BHDDH stalled eligibility decisions in an attempt to reduce spending.

 In 2011, the General Assembly controlled the budget by cutting reimbursements to private service providers by 16 percent. 

“There’s absolutely zero evidence” that eligibility was delayed as a cost-cutting tool, McQuaide said, but “unfortunately, that perception still persists.“ 

McQuaide emphasized that the eligibility unit is working as hard as possible, making 250 to 300 decisions a year.

He said the responsibilities of the three caseworkers and support and supervisory personnel go beyond eligibility determinations to include other tasks associated with applicants transitioning into the service system, such as:

• Attending Individual Education Plan meetings for high school students in special education

• Facilitating applications for individuals’ Medicaid funding to the Department of Human Services

• Coordinating a referral to the BHDDH assessment unit, where the level of funding is decided

• Writing a “referral narrative” that can be used by service providers to better understand the needs of prospective clients.

McQuaide said during the May interview that that one option for addressing the backlog might be to increase the size of the staff for a limited period of time.

The Executive Office of Human Services has not responded to repeated requests for additional information on the backlog and clarification on related issues.

The communications plan says the eligibility unit underwent a continuous improvement, or LEAN exercise, in June that was coordinated by the Office of Management and Budget.

As a result, eligibility workers will begin meeting with potentially eligible high school students and their families 18 months before they anticipate leaving school to make sure they have at least begun the application process for adult services and to encourage them to start learning about potential service providers.

Once an application is received, the eligibility unit will have 30 days to screen it and make a decision as long as no additional information is needed.

 (The document says in one place that applicants have 60 days to submit additional information and in another place that they have a 45-day deadline.)

 Applications that remain incomplete are removed from consideration and the applicant must begin the process again. This practice will prevent incomplete applications from “sitting for extended periods of time, in some cases years, waiting for documentation,” according to the report.

After an eligibility determination, the assessment unit must determine a level of funding for the individual, and an individual service plan must be written before services can begin.