This is an article that came from The Tampa Tribune.  Because Ms. Dolinski said it much better than I could, I’ve reprinted her entire article.

By CATHERINE DOLINSKI | The Tampa Tribune

Published: July 3, 2009

TALLAHASSEE – Last fall, 5,555 Floridians with developmental disabilities and their families appealed spending cuts or other changes to the services they receive through a state Medicaid program.

The state Agency for Persons with Disabilities granted formal hearings in only 771 of those cases. So far, only one family has prevailed in its case.

That worries Yvonne Mason, of Seffner, who is awaiting an August hearing to appeal a 42-percent cut in funding for services and care of her adult son, Sean. “That’s disheartening,” she said. “I would have expected better numbers.”

Sean, Mason’s 39-year-old son who lives with her, has been diagnosed with autism, schizophrenia and intellectual disabilities. His mother, who is 70 and suffered a minor stroke four years ago, said she may not be able to continue caring for him if the state refuses to raise Sean’s spending level.

“I think I have a very good case,  but seeing this, you feel like you can’t fight City Hall,” she said. “I hear they have excellent lawyers.”

From the disability agency’s perspective, the low number of successful appeals only proves it is doing its job.

House and Senate lawmakers directed the agency in 2007 to divide beneficiaries of the Home and Community Based Services program into spending tiers, based on their needs and circumstances. The agency was facing a deficit of about $155 million at the time, and lawmakers passed the tough new reforms in an effort to bring the disability agency’s wallowing budget back into balance. On Thursday, preliminary estimates showed the deficit hovering around $12 million due to a variety of cost-cutting measures.

The 2007 legislation provided for an appeals process for beneficiaries to challenge their tier assignments “ but only to determine whether or not APD implemented the Legislature’s mandate correctly.”

APD director Jim DeBeaugrine said he understands why families may feel discouraged by the low success rate of appeals. “But it’s an indication that we have been very, very careful,” he said. “We have double-checked everywhere there’s even been a hint that there may be something wrong. I told our employees and our legal staff that we’re not going to take anything to a hearing unless we’re completely convinced we’ve done it right.”

That’s cold comfort for parents like Mason, who fear what the agency’s spending cuts mean for their children. But a closer look at the appeals process may offer more hope.

Of the 771 appeals that APD approved for review, 621 have not even reached the Division of Administrative Hearings yet. That’s because APD relies largely on lawyers in the Attorney General’s office to represent them at the hearings, and their capacity to process the requests has been limited. To date, only 60 hearings have been held, and hearing officers have released findings in only 14 of those cases so far.

Meanwhile, APD is preparing to notify 175 beneficiaries that the agency has reassigned them to new spending tiers. The agency expects that many of those families will drop their appeals as a result.

Attorneys for APD also noted that of the initial 5,555 challenges from families, 455 were dropped “ in most cases, prior to the agency determining which merited hearings. APD attorney John Newton said that half of all people who filed appeals would not actually have experienced a cut in services, because their tier assignment actually covered what they were already spending.

Rep. Juan Zapata, who chairs the House Human Services budget committee, blamed the volume of initial appeals largely on “scare tactics” by providers like fearing loss of income. The program covers a wide range of services to help with beneficiaries and families with daily life, from regulating diet and monitoring medication to bathing and housekeeping.

“Every time we put cost containment in the process, we get a lot of pushback from providers; they scare the families,” said Zapata, R-Miami.

But eventually, Zapata said, a more consumer-directed approach may provide a better long-term solution.

At DeBeaugrine’s urging, lawmakers inserted language in the 2009-2010 budget directing APD to devise a new system that would customize individual budgets for each beneficiary, based on his or her particular circumstances. Families, most likely in consultation with a professional support coordinator, would decide for themselves the best way to spend the money. Lawmakers have asked APD to submit the new proposal by Feb.1, 2010.

“We’ll be putting the individual, as much as possible, in charge of their own lives, making their own decisions.” said DeBeaugrine, adding that, In time, it might replace the tier system altogether.

“After putting people through all of this?” Mason asked. “But he’s right, I do think this is the only way to go. It makes perfect sense; anyone can relate to that, customizing it to the person. I think DeBeaugrine is the only person who makes any sense.”

Reporter Catherine Dolinski can be reached at (850) 222-8382.

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