By Gina Macris
Governor Gina Raimondo has sent the General Assembly a budget proposal that adds enough money to developmental disabilities before June 30 to prevent waiting lists or reductions in services but then dramatically reduces funding in the fiscal year beginning July 1.
Raimondo’s amended budget for the current fiscal year, released Jan. 18, would add nearly $10.4 million in state and federal Medicaid funding for reimbursements to private providers of developmental disability services, raising the total from about $228.1 million to nearly $238.5 million.
Beginning July 1, however, the total federal-state Medicaid allocation for developmental disabilities would drop to about $220.1 million. That would mean a reduction of 8 million from the currently enacted bottom line of $228.1 million. Viewed another way, it is $18.3 million less than her revised proposal for the current fiscal year.
In the executive summary to her budget, Raimondo indicates that the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) may begin realizing savings in the next budget from a change in its current fee-for service reimbursement model.
BHDDH is exploring a shift toward some sort of per-capita payment system, including the possibility that provider agencies may become Health Homes under provisions of the federal-state Medicaid program.
Health Homes coordinate all care for some Medicaid-eligible individuals in a way that takes into account the needs of the whole person, including primary and acute medical care, behavioral care, and long-term supports.
During the budget briefing for the media, Rebecca Boss, the BHDDH director, said there is “no clear path” to any one alternate reimbursement model, but the agency is committed to finding one during the coming year.
BHDDH may be able to begin realizing savings from a different payment system in the second half of Fiscal 2019, Boss said. For example, the Medicaid Health Homes model offers an enhanced federal match for certain services, 90 percent instead of the usual 50 to 60 percent.
She said BHDDH wants flexibility for service providers and predictability in costs.
“I think fee for services has been very challenging to providers,” she said. .
After Raimondo submitted her budget to the General Assembly, Sen. Louis DiPalma, D-Middletown, expressed concern about how the administration arrived at the $18.3 million reduction in funding for developmental disabilities beginning July 1.
“We need to look at how we can fund the human services more efficiently and effectively,” he said, “but there needs to be a body of evidence” supporting the numbers.
One of the fundamental principles of Raimondo’s budget plan, according to her executive summary, is to protect Rhode Islanders in need.
DiPalma said he likes the job Raimondo has done as governor, but historically, from the perspective of the General Assembly, “we have not funded BHDDH the way that we should.”
He said he was concerned about the lack a firm plan for implementing an $18.3 million budget reduction without putting vulnerable people “in harm’s way.”
Boss, meanwhile, said a supported employment program for adults with developmental disabilities will continue with $6.8 million that will be embedded in the overall allocation for reimbursements to private service providers in the next fiscal year.
BHDDH did not use $2 million of the initial allocation for the supported employment program, also $6.8 million, but the unspent money will go toward helping to close an existing deficit in developmental disabilities of about $12 million in state dollars.
Raimondo’s budget proposal includes no allowance for raises for direct care staff who work with adults with developmental disabilities, as had been the case in the past two budgets.
But if economic projections look better in May than they did in November at the semi-annual Revenue Estimating Conference, raises would be on the table, Boss said.
Funding for the state-operated group home system, Rhode Island Community Living and Supports (RICLAS), would temporarily increase before turning downward July 1. RICLAS, which cares for about 150 people, is now funded at $28.8 million. Raimondo's plan would raise that total to $33.7 for the current fiscal year. For the next fiscal year, total funding for RICLAS would be nearly $30.7 million.
The full budget, as submitted to the Rhode Island House, is here: http://webserver.rilin.state.ri.us/BillText/BillText18/HouseText18/H7200.pdf