August 2011

This is a long entry but I think you will enjoy it when you are preparing your sermons.

Repost: 20 Scripture Twisting Techniques Up front I will acknowledge that this is a copy and past article I grabbed from the website. Fighting for the FAith/Pirate Christian Radio is a podcast that takes the time to compare what people are saying in the name of God to the word of God. Its an excellent podcast, though I suggest that you come at with some pretty thick skin because it tends to be pretty forthright and unapologetic in its pursuit of proclaiming Bibli … Read More

via Youthguyerik's Blog

When we are met head on by our mistakes, it is sometimes impossible to pick up and resume “just like nothing happened,” especially when we must admit that we have hurt a dear friend.   Even though I deeply hurt a good friend some years back, she was determined to maintain me as a companion.  She went out of her way to see my side.  I was aware that she traveled an extra distance to help me be comfortable and to include me in family gatherings.

That’s grace and it isn’t cheap. It cost my friend a lot.  True grace always costs a price.  We shouldn’t be surprised that it’s the injured party who must not only satisfy the bill but fork over the tip. 

Extravagant mankind has waltzed into the most expensive restaurant in town and ordered the most lavish meal on the menu.  We’ve feasted on appetizers and indulged ourselves with dessert.  But we can’t pay the cashier because we are bankrupt.  We have no cash.  They won’t honor our checks.  Our credit cards have been revoked.  When we realize we can’t pay the bill, we don’t meekly ask for forgiveness.  We yell and make an ugly scene screaming how unfair life is.

No matter how verbal we become, the fact remains.  Someone must pay.  Jesus is our Savior Redeemer.  He is a gracious friend who wants to help and bail us out from our distress.  Making restitution for our thoughtless words and deeds was not easy.  It cost a monumental price.  His life.

I hate cheap grace.  But I shall be eternally grateful to a Savior who didn’t feel it was too hard a price to pay in order to buy me back.  I’m also thankful for my gracious friend who was willing to pay the price to buy back my friendship even though she was the injured party. 

I am equally grateful that 22 years ago the Lord introduced me to the mentally challenged community.  These men and women hold God’s love as a prize to be cherished, and never wasted.   That’s grace.

I hate cheap grace.

A wealthy farmer in a small town in South Carolina bought his son a new red BMW for his sixteenth birthday.  The boy took the car out one night, got drunk and totalled it.

The next day, this father took the errant son to the car dealer and purchased another BMW; but this time made him settle for a black one as punishment.  That’s cheap grace.

A young mother who knew that her daughter became hyper and obnoxious when she ate sugar and sugar products allowed herself to be coerced into buying the five-year old a candy bar because she started to scream in the store.  “I can’t stand to have her cry.  I just love her too much,” the mother told the cashier.  That’s cheap grace.

The Baptist Sunday school teacher proclaimed, “Now that we’ve been saved, we can do anything we want to do.”  That’s cheap grace.

Randy Stonehill, a contemporary songwriter penned,

You’ll be tempted, tried and tested.

There’ll be wars the devil wins,

But God’s love is not a license

To lie down in your sins.

He understands the human heart.

His mercy is complete.

But his grace is not intended

As a place to wipe your feet.

Too often the Church has said by our actions that God’s grace is no longer a valuable commodity but that is a lie.

Several years ago I hurt a close friend by saying some thoughtless remarks in front of others.  While I realized at the time she was wounded, I didn’t comprehend the extent of damage my words had done until several weeks later.  She was deeply hurt by the inappropriate words.  When the extent of the damage was drawn to my attention, I apologized and I tried to go back to make restitution but months had passed. I knew that the opinions of other people had been formed based on my faulty information.  A relationship which had taken 10 years to build was severely damaged by my careless tongue.

While we both resolved to begin again, things were different.  Friendship must be built on mutual trust. When that trust is broken, the two parties have to determine to repair the breach.  Is there an invisible guard up when I was around?  I had to admit that I would have a shield up, if I were she.  I had not valued her friendship enough to watch my tongue.

Knowing that I’ve injured her made me leery of making the same mistake again.  I was not the injured party; yet, I became acutely aware that I was the one who is hindering the openness of our past relationship. I was too careful out of concern for making the same mistake.  At times, I became defensive when it wasn’t necessary. 

She forgave me.  But it took me years to walk through the process of accepting her forgiveness and forgiving myself.

Our relationship with God is much the same.  While the foundation and building stones were mined solely from God’s unmerited favor, His grace, we aren’t given free reign to do as we choose.

There are consequences to each word and deed.  Seeds are sown.  Habits are formed. Cheap grace may exist in the worldly system where we dwell; but God’s grace is never cheap.   His only Son paid a great price for the grace so generously offered to us. 

I have found the mentally challenged community holds grace as a uniquely precious commodity much more precious than diamonds or jewels.  They may not be able to explain what grace is but they are able to embrace God’s grace hungrily, devouring God’s love in the same extravagant way that it is given.  That’s not cheap grace.

This isn’t video week but this is a great video.  Thanks to the folks who send me these gems.

Your Parents are Important In your Life

Ephesians 6:1

The third week in May 2004

Central Theme:  You are to learn to be friends with your parents.

Introduction–A choir member years ago told me that his mother was of the devil because she made him clean the bathroom when he dirtied it.  I told him to call her and apologize.  Have a member read Ephesians 6:1.

       I.     Jesus was a boy but he was God.

          A. His parents didn‘t understand or respect him.

          B. He was patient with them and he helped them to understand him.

      II.     You are in a bad position.  An adult but you live a home.

              A. Seeking independence; but you need special guidance in many things.

              B. Pulled by professionals to GROW UP; but your parents will have to fix any messes you make while learning hard lessons.

    III.     Talk to your parents.

              1.  Always side with them, even against your favorite paid companion.

              2.  You know they don’t know everything; but you also need wisdom to help them understand you.

                   A.      Richard Stimson said that when he became an adult he started talking with his dad and asked about the things that he didn’t understand.   

Conclusion      Parents are to be honored and loved.  We can work to help them understand us.

This is such an important concept.  Would you show this to your members?  Would they understand? Could it be used as part of your sermon or all of it?

“When do we close our  Special Gathering program?” ss a questions that is often asked, even among ourselves.  Because our members are medically fragile as well as mentally challenged, it is a question that needs to be asked.  There are several guidelines that we use:

  1. Has public transportation closed down?  In Brevard County, the SCAT lines close when the winds are 45 mph.  If the pubic transit systems have closed, we close. 
  2. If the winds are 45 mph, we close.
  3. If extreme weather is expected to hit the day of our program, we close.  We don’t usually close, if the electricity is off in many areas.  If the facility or church where we meet is open, then we will meet.
  4. If the facility where we meet is closed or we are requested to not meet, then we will close.  This, however, has never happened.

As you surmise, weather is the main determining factor of when we close.  We have never closed for a death.  Because, health and safety is our primary focus, we will close when it has been determined for one reason or another that our members will be in danger.

Today, I met with two other people who lead ministries in our area.  One leader, Lawrence, has been a staunch proponent of segregated ministries to people who are intellectually disabled.  The other, Susan, came into full-time ministry armed with an inclusion message that she felt was unmovable.

Over the years, her opinion has shifted.  As I often do at meetings where ministry leaders meet, I sat quietly, observing and anxious to learn from this “meeting of the minds.”   Subjects popped up and we raced though them as quickly as driving through a small, one-filling station Georgia town. 

My interest was especially piqued, however, when the subject of philosophy of ministry within the mentally challenged community was broached.  There are two main thought patterns. 

One is that all ministry should be as inclusive as possible.  That is, mentally challenged men and women should be accepted in adult Bible studies and in other ministry situation withou any exceptions.  There should be no regard to their cognitive abilities because they are equal to every other adult.  They should have freedom to move and develop with other believers.  What they do not cognitively understand will be off set by the ethos of the gospel message.

The other train of thought is that people who are mentally challenged deserve to hear the gospel on a cognitive level they can understand.  The gospel should be preach and taught on their functioning level.  Additionally, by allowing them to worship with a group of their peers, they can develop Christian friendships.  However, the most important thing is that they are taught on a level in which they are able to easily grasp and develop in discipleship.  Therefore, a more segregated ministry works best if the goal is effective evangelism and discipleship.

“I came into ministry holding to an inclusive model mindset,”  Susan said, smiling.

“Why and how have you changed?” Lawrence asked.

“Experience showed me that the inclusive model did not meet the practical needs of my members.  I also saw through other ministries that leadership was being developed with the ranks of the mentally challenged community that I wasn’t seeing in my programs.

“After all,” she said, smiling, “men and women have their separate groups everywhere else in the church.  Young mothers and teens are divided.  Why do we think that our members are any different?  Don’t they deserve to learn on their level, with their interests?”

Slowly, we slipped into another stream of conversation and the subject was dismissed; but I felt that Susan had discovered a wonderful principle of ministry that applies to most areas of our lives.  We all desire to learn the scriptures with people who are meaningful to us.  With men and women who walk where we walk and who talk like we talk.   

What do you think are the benefits of a fully inclusive ministry that can’t be found in a segregated ministry?  Or why do you believe that a segregated ministry meets the needs of your members best?

Email received outlines a DRAFT plan of PROPOSED Waiver reductions for people with developmental disabilities.  Because the format of this informational sheet is not compatible with the Weblog and my formatting abilities are extremely limited on the blog, I am reformatting it so that it will fit properly.  There is no website that you can be linked to that contains this information.

1.  Companion ration/limit adjustment–expected savings $18,605,801 

  •  Detailed Description–Allow up to 3 people to be served/Set rate at average of the 1:2 level
  • Action Needed–Handbook change, rate rule change
  • To be completed as of August 1, 2011

2.  Allow IHSS in all tiers in the family home as a less costly option for PCS at lower IHSS rate–expected savings $1,765,277

  • Detailed Description–PCA at 15 per hour versus IHSS at 12 per hour–optional to help reduce cost of services and must always be considered for an increase of services
  • Action Needed–Case Review
  • Started July 1, 2011 with case by case review

3.  Transportation Review and service limitations–expected savings $1,375,000

  • Detailed Description–Ensure transit is funded by waiver only as a last resort and limited number of round trips
  • Action Needed–This requires a county-by county review to ensure cost effectiveness.
  • Reviews to be completed in September 2011 with service limitations effective November 1, 2011. Areas are working with Transportation Disadvantaged Providers to achieve most cost-effective delivery of service.

4.  Pool Respite services for families to draw from and reduce allocation–expected savings $975,042

  • Detailed Description–This initiative primarily reduces unused service authorizations in current cost plans. The actual savings are based on 3% reduction in actual billings with 10 months implementation
  • Action Needed–Currently being implemented and will be completed by October 1, 2011

5.  Move SMH Therapy to MSP (adults)–expected savings $1,395,703

  • Detailed Description–JT to DCF move expenditure from waiver through amendment for the long term because service is provided by DCF/ACHA
  • Action Needed–Handbook change, Rate Rule change, Waiver Amendment
  • While waiting for waiver amendment, case by case transition of services to MSP. Waiver will be amended this FY

6.  Move skilled nursing to MSP (adults)–expected savings $1,615,650

  • Detailed Description–JT from AHCA and remove expenditure from waiver and do waiver amendment for the long term because skilled nursing is provided by MSP
  • Action Needed–Handbook change, Rate Rule change, Waiver Amendment
  • While waiting for waiver amendment, case by case transition of services to MSP. Waiver will be amended this FY

7.  Rate adjustment for all ADT recipients and reduce burdensome regulations–expected savings TBD

  • Detailed Description–Rate adjustment to targeted savings
  • Action Needed–Handbook change, Rate Rule change with reduced paperwork and regulation
  • Prior proposed to consolidate into one ADT rate not well received. Seeking provider input for alternative savings in this category

8.  Eliminate Behavior assistant services with ResHab and ADT–expected savings ?$5,000,000

  • Detailed Description–Elimination of duplicative services occurring in the same settings
  • Action Needed–Handbook change for policy clarification
  • Behavior Assistance services are duplicative of the services and training provided in residential habilitation and adult day training

9.  Agency Rate premium set to a maximum of 20% above solo rates for all services with agency rate–expected savings $3,712,169

  • Detailed Description–Currently there is a range of 5% to 45% over solo rates as an agency premium 
  • Action Needed–Rate Rule change 
  • Current rate premiums vary from 5% to 42% depending on the service category

10.  Behavior Analyst collapse rate from level 1 to level 2–expected saving $2,580,874

  • Detailed Description–Rate for level 2 is $50 per hour for solo and agency is 20% above – based on average
  • Action Needed–Handbook change, Rate Rule change
  • Current behavior analyst rates for level 1 are not directly associated with the client level of need or service outcomes and are based solely on years of experience

11.  Rates reduced to MSP (nursing and therapies and assessments)–expected savings $1,530,476

  • Detailed Description–Use current waiver rate X units – MSP rate X units
  • Action Needed–Rate Rule change
  • Currently in process of including this change in the DD Rate Rule

12.  Res Hab reduce rate levels from 9 to 4–expected savings $21,113087

  • Detailed Description–redefine level of support descriptions and associated rates and revise associated staffing levels in the handbook
  • Action Needed–Handbook change, Rate Rule change
  • Seeking provider input for alternative savings in this category

13.  IHSS collapse quarter-hour above live-in rate–expected savings $2,914,937

  • Detailed Description–Delete use of quarter-hour above the day rate
  • Action Needed–Using QSI 1,2,3 and eliminate IHSS 1/4 hr above day rate
  • Individuals with level of need 1,2,and 3 do not require additional supports beyond a daily rate for in-home supports

14.  Utilization management of behavioral services–expected saving  ?$3,000,000

  • Detailed Description–6 month increment with reapplication and approval required after each increment:  declining hours based on matrix scores
  • Action Needed–none
  • Implementing on-site reviews for continued stay in intensive behavioral programs. Additional utilization reviews ongoing to match services to level of need of client

15.  Publish Standardized 1B rates for future with lower rates retained–expected savings $1,549,764

  • Detailed Description–Standardizing rates based on individual needs rather than negotiated contract
  • Action Needed–Rate Rule promulgation required
  • Rate Matrix in development.  Savings dependent on effective date

16.  Res Hab quarter-hour eliminate since other options are available for in-home supports–expected savings $917,290

  • Detailed Description–Eliminates the quarter-hour unit for this service. Typically used for individuals in their own home and the services is more appropriately provided as in-home support
  • Action Needed–Rate Rule change
  • This would increase IHSS use and reduce service array

17.  Fee collection by residential providers–expected savings *FARF estimate $8,401,147

  • Detailed Description–Create form to calculate recipient responsibility to be deducted from waiver service bills, monthly surplus frozen or swept by service
  • Action Needed–Develop method and procedures to monitor
  • Inplementation strategy and monitoring procedures need to be developed and vetted, late year implementation

18.  12.5% reqd match as state share–expected savings TBD

  • Detailed Description–Would leverage current spending to decrease GR effort
  • Action Needed–Lond term research with AHCA and CMMS
  • Unknown if loca effort is applicable to matching in this context. Variables include in-kind share, local funds, and other sources

19.  Core service models–expected savings TBD

  • Detailed Description–Limit waiver services to only those services considered core to prevent institutionalization
  • Action Needed–Waiver amendment required

20.  Services limits–expected savings TBD

  • Detailed Description–Reduce services limits for each waiver service
  • Services limited to only essential elements within budget

21.  Limit individual cost plan to not greater than average ICF/DD–expected savings $3,300,000

  • Detailed Description–FL ARC estimates 3.3 m based on “limiting most cost plans to $150,000.”
  • Action needed–Waiver amendment required prior to implementation
  • CMMS will require alternative supports for adversely impacted clients.  Data suggest that 17 m in savings could be realized if waivers were limited to individual’s cost of ICF/DD service

One day as I read  the book of Job in the Bible, my heart was struck dumb by the speech given by one of his friends.  ”I agree with what this man is saying.”  I’d always given the speeches of these four men who had come to comfort Joh in his time of distress a cursory over glance; but that morning, I’d become interested with the impassioned passages of scripture. I felt there was truth in what these men had spoken.

I’d often laughed that many times when Job was quoted to prove a point, teachers and preachers chose a read from one of Joh’s friends, not Job.  My curiosity pricked, I reread the book of Job.  The offending friends appeared to be speaking clear truth.

“God,” I prayed, “I don’t understand.  These men spoke truth.  What was wrong with what they said?”

“Their words were not wrong,” I felt the Lord speak to my heart.  ”It was their attitude.  Linda, whenever you approah a brother with an attitude of self-righteousness and condemnation, nothing you say is right.”

It is perhaps why I believe people who are mentally challenged are held so tightly to the heart of God.  Through no fault of their own, they are often maligned and ridiculed because of who they are–not for what they have done.

I find it’s easy to be a Job’s friend; but excruciatingly difficult to be like Paul.  In writing to the Corinthians, the apostle bathed himself with prayer, heaped on love and compassion before he brought correction. When the Corinthian church rejected his first word, he wrote again still balancing his stern admonitions with charity.

God brings to fruition words spoken in love.  However, we learn from the book of Job that God brings His justice and judgment on attitudes of condemnation and self-righteousness.  Job had to pray for his friends before God would forgive them of their sin of condemnation and self-righteousness.

We will always be safe by using Philippians 2 as our pattern: 

Your attitude should be the same as that of Christ Jesus:

Who being in the very nature God,

     did not consider equality with God

              something to be grasped,

but made himself nothing,

     taking the very nature of a servant,

     being made in human likeness.

And being found in appearance as a man,

He humbled himself

And became obedient to death–

     even death on a cross!

The process of emptying ourselves, making ourselves of no reputation, taking the form of a servant assures that our hearts and minds will remain pure.

Do you remember a time that you were corrected with love and assurance of God’s grace?  How did it make you feel?

Read more:

People sometimes ask how I turn my outlines into sermons.  Here is an example of the sermon I would preach from the outline for blog entry for Sunday, August 21, 2011)

When I’m going on a trip, it’s important to know where I am going. It seems pretty fundamental that all of us need to know where we are going. 

In contrast, we love to quote and sing, Proverbs 3:5, “Trust the Lord with all your heart and don’t depend on  your own understanding.”  However, do we actually realize what God is saying?  Most of the time God tells us that we are to go.  Then he does not fill in the blanks.  We end up not knowing exactly where our journey will end.   

We love to reminisce about the great story of Abram and how God sent him away from his homeland, his friends and  family (Genesis 12:1-9).  The romance of the story grips my spirit of adventure and thrills me down to my toe nails.  That is, until God tells me to do something that is a tiny bit out of my comfort zone.

While I don’t like to admit it, I’m convinced that trusting God means actions–not knowledge.  Abram obeyed God.  In like manner, we must choose to obey God and we don‘t have to know everything.

Years ago, I took a lot of time when I was wrapping gifts.   It was a big deal to me.  I crafted alligators from umbrellas.  Drums and flutes made from simple packages were a part of an under-the-Christmas-tree garden I created most years.  Gifts became things that were extravagant, silly and even beautiful. 

However, when I started with each gift, I didn‘t know where I was going with the gift.  Consequently, I started with a vague idea. Eventually, that idea grew until I had a work of art made of wrapping paper, scotch tape, ribbon, glue and nick-nacks from around my house. 

It became a game to me.  As I went along, step by step, I could see in my mind’s eye what needed to be done next.  Slowly, I knew how to wrap the gift and what it should look like.

I think God allowed me to experience this when I was younger because often I would think:  This is the way God leads us.  We start.  We take one small step at a time.  Following inch by inch, we are able to understand what God desires from us. 

A friend and former Special Gathering member who moved from our area told me that she could not attend church anymore because she did not have a Special Gathering program in her town.  She said, “If I go to another church, I will have a bad attitude.  I know God doesn’t want me to have a bad attitude.” 

Special Gathering is a chapel program for people who are developmentally delayed.  We are in eight cities in Florida and South Carolina.  We are geared specifically for people who are mentally challenged.  It is true that there was no program designed like Special Gathering  for my friend in her new city.  But that was not a good excuse.

We need to put the Lord first no matter what the circumstances.  We need to have Jesus at the beginning of each endeavor, slowly working toward the end.

Abram did not know where he was going.  Neverthless, he did know who was leading him.  You and I can trust God to lead us into the right things.  Trusting God means actively following Jesus.
Read more:


Trusting in the Lord means Action


Proverbs 3:5


Central Theme: Trusting in the Lord means we take action. 


Introduction–Show a map. When you are going on a trip, it is important to know where you are going. All of us need to know where we are going. However, most of the time God tells us that we are to go and gives us no idea exactly where we are going.


I. Have a member read Proverbs 3:5.

A. Tell the story of Abram and how God sent him away from his family. This is found in Genesis 12:1-9.

B. Trusting God means actions–not knowledge.

C. Abram obeyed God.

II. We must choose to obey God and we don‘t have to know everything.

A. When I would wrap gifts for Christmas or birthdays, it was a big deal. I made things that were extravagant. However, when I started, I didn‘t know what I was doing but I did it anyway. As I went along, I knew how to wrap the gift and what it should look like.

1. God will give us a small word and we are to follow it.

2. A friend who moved from our area told me that she could not attend church anymore because she did not have a Special Gathering program to go to and she would have a bad attitude.

a. We need to put the Lord first no matter what the circumstances

b. We need to have Jesus at the beginning not the end.

III. Abram did not know where he was going.

A. He did know who was leading him.

B. God will lead you into the right things.

Conclusion–Trusting God means actively following Jesus.

History of APD Medicaid Waiver Cuts:

The DD System Needs Stability

  • ·         In July 2003, the State of Floridaadopted the Mercer Rate system that contained up to 720 billing options for residential habilitation rates and new rates for most of the 30+ services funded by the Home and Community Based Services Waiver.  Transportation, Special Medical Homes and Intensive Behavior services continued to have negotiated rates.  The legislature basically bought a reimbursement system that was based on direct care wages funded at the 25th percentile compared to national averages for wages.
  • ·         In November 2003, the Agency reduced Residential Habilitation rates by 14.3% and Live In Residential Habilitation by 7%.  Also, billable days were limited to 350 per year for homes having more than 3 individuals.  ADT rates were reduced by about 9.5%.  The actions were taken to prevent deficit spending although the state actually realized a surplus at the end of the fiscal year.  The annualized reductions totaled about $45 million for three services.  According to Medicaid claims data, the Agency realized a $37 million surplus for the same year.
  • ·         In 2004, the Agency implemented a residential habilitation matrix approach which limited billings by looking more at the number of hours needed per home to adequately staff it.  The impact was significant in that in many cases the last two admissions to a six-bed group home received reduced hours (typically 2). 
  • ·         In 2006, agencies received a 2.81% Cost of Living Adjustment that applied to all waiver services.   This action added about $21 million back into the system.
  • ·         During the 2007 Legislative Session, the Florida Legislature mandated changes in Senate Bill 1124 that resulted in limitations and eliminations of Developmental Services Home and Community Based Services (HCBS) Waiver services funded through the Medicaid program.   Although implemented, the limitations and eliminations have resulted in little if any savings in waiver expenditures because clients often shifted to other services to meet their needs.

–     Chore, Non-residential Support Services, and Homemaker Services were eliminated for a projected $12.7 million savings to APD.  However, the definition of In-Home Support Services has been expanded to include some activities previously provided in the eliminated services.

–     Massage Therapy and IQ Testing (Psychological Assessments) services were eliminated for a projected $2.2 million savings to APD.

–     APD will be implementing a uniform rate for individuals with intense needs for and estimated $1.3 million savings, but a date for implementation has yet to be set.

–     Supported Living Coaching has been limited to no more than 20 hours a month for persons who also receive in-home support services for a $4.4 million savings.

–     Support Coordination to all persons under the age of 18 who live in the family home are limited to Limited Support Coordination only for a $1.7 million savings to APD.

–     Personal Care Assistance (PCA) services have been limited to 180 hours a month unless the person has intensive needs and all rate modifiers have been eliminated. Additional hours may be authorized if there is a substantial change in circumstances.  Projected savings were at $2.3 million.  APD and AHCA have reached an agreement which allows for people under the age of 21 to receive more than 180 hours of PCA, if medically necessary. TheMedicaidStateplan is to cover the cost of the additional hours.

  • ·         In December 2007, residential habilitation rates were collapsed and reduced overall by 7%; however, a settlement agreement reduced the reductions to 4.25%.  Some providers actually realized increases because of an averaging effect.  The net savings was about $11 million.
  • ·         As a result of the 2007 legislation, AHCA in consultation with APD sought and obtained federal approval for two additional waivers to implement a four-tiered waiver system. The tiers were implemented in the fall of 2008 and were intended to remove $120 million from expenditures in the waiver system.  However, due to rate reductions and other changes the annualized savings will be about $74 million per year.  

–     Tier 1 – Current DD Waiver with No Monetary Cap: Limited to individuals with intensive medical, behavioral, and adaptive needs that cannot be met in other tiers.  

–     Tier 2 – Capped at $55,000: Limited to clients whose service needs include support in a licensed residential facility and at least minimal moderate levels of residential habilitation with behavior focus services as well as clients in supported living who receive more than six hours of in-home support services. This tier applies only to individuals who receive residential habilitation or supported living and in-home support services.

–     Tier 3 – Capped at $35,000: Includes all individuals who do not fall into Tier 1 or Tier 2.

–     Tier 4 – Current FSL Waiver with a Cap of $14,792: Includes most families with children under 21 who are to receive Personal Care Assistance services via the Medicaid State Plan.

  • ·         In May 2008, proviso language passed that implemented a $43 million across the board rate cut for waiver services that was implemented in July 1, 2008.  Residential Habilitation and Support Coordination received a 3% cut effective July 1, 2008, (in addition to the 4% reduction taken in December 2007 for residential habilitation) and other waiver services received a 7.21% reduction in rates.  Other changes included:

–       In May 2008, legislation passed reducing the rate paid to Personal Care Assistants by four percent.

–       Support coordinator’s caseloads can increase to 43 people per month, up from 36.  APD will no longer require support coordinators to conduct a customer’s needs assessment or develop their cost plan.  Support coordinators will still be able to earn up to $68,000 a year if they have a full caseload.

–     In July 2008, South Florida providers had geographic rate differentials reduced for residential habilitation services by 2.5% in Broward,Palm Beach, andDadeCounties. MonroeCountyrealized a 5% reduction. 

  • ·         In October 2008, the APD began a rebasing exercise which was intended to freeze individual service expenditures as of January 2009 at the FY 07-08 level plus no more than a 5% increase until June 30, 2009.  Because of inaccurate data, the exercise was delayed until late December.  The intent was to control a projected 9% utilization creep that results in deficit spending.  APD projects saving $20 million per year from this exercise although the methodology used will likely result in higher savings.
  • ·         In January 2009, during a Special Session the Florida Legislature approved a 3% rate reduction ($21 million) for DD waiver services.  However, the rate reduction was vetoed by the Governor and was not implemented.
  • ·         Per the 2009 Legislature, effective October 1, 2009, Medication Administration Review services will be eliminated as a waiver service for a total reduction of $301,907 and effective January 1, 2010, consolidation of durable and consumable medical supply purchases will save another $932,093.  The 2009 legislature did add $5,934,889 to the DD Medicaid Waivers to maintain a geographic differential for residential habilitation service providers in fourSouth Floridacounties.   Also, one-time funding of approximately $19 million was added to maintain service delivery.
  • ·         The 2010 Legislature decreased the overall funding level for the waiver by $43.8 million, and did not continue anticipated federal stimulus (FMAP) dollars that would continue Florida’s current enhanced FMAP ratio from January 2011 through June 30, 2011.  The cuts are as follows:

–       $3,075,000 transfer to the Agency for Health Care Administration (AHCA) to provide disposable incontinence supplies to children ages 4-20 through the Medicaid state plan. 

–       $4,196,362 savings as a result of reducing the caps for Tiers 2, 3, and 4 by 2.5%.  Notices of reductions were sent in December 2010 with an effective date of February 2011.

–       $1,393,145 savings by limiting Tier 1 annual expenditures to $150,000 annually and excluding Intensive Behavior and Special Medical Care homes from the cap effective January 1, 2010.

The proviso language approved by the 2010 legislature included $16,811,989 for a 2.5% provider rate reduction for most waiver services excluding:  Support Coordination, transportation, personal care assistance, durable medical equipment, consumable medicals supplies, and environmental and home accessibility services are specifically excluded from this reduction target.  Governor Crist vetoed the rate cut language but did not reinstate the dollars.  The allocation also included an additional $18,396,571 in cuts that were removed as one-time funding.  These two actions reduced the appropriation by $35,208,560.

While theGeneralRevenue portion of the appropriation actually increased by about $38.9 million, the Trust Fund portion was reduced by $78,790,410. 

The following shows the funding history of the HCBS and FSL Medicaid Waivers since FY 03-04 when the System Redesign was implemented. 


DD Medicaid Waivers Summary

FY Appropriation Expenditures Surplus/Deficit Served Ave. Cost
FY 03-04 $687,255,720 $654,883,720 $32,372,000 24,257   $26,998
FY 04-05 $734,118,671 $644,339,179 $89,779,492 25,848   $24,928
FY 05-06 $798,141,900 $749,150,257 $48,991,643 30,936   $24,216*
FY 06-07 $851,549,572 $905,954,703 -$54,405,131 30,991   $29,233
FY 07-08 $961,599,474 $927,531,579 $34,067,895 30,585   $30,326
FY 08-09 $833,529,770 $882,784,502 -$49,254,732 30,166   $29,264
FY 09-10 $849,699,685 $928,167,201 -$78,467,516 30,275   $30,658
FY 10-11 $805,826,618        

From the above, we see the funding level for FY 10-11 is only about $7 million more than it was in FY 05-06 and the program is now in deficit spending status.  The deficit appears to be attributable to the fact that in FY 05-06, about 5,000 new enrollees were added late in the fiscal year but the total cost of care was not realized until FY 06-07, and this began a history of deficit spending.  In FY 07-08, funding was added to sustain the program for one year until cost control measures could be implemented; however, the anticipated savings have not materialized. 

The above data show about 660 fewer individuals are being served per year than were served in FY 05-06.  Concurrently, thousands of individuals on the waiver are receiving fewer services as a result of tier caps, rebasing, and other cost savings measures.  Also, only limited numbers of new enrollees are being added and these are typically individuals who are in crisis status.

A modest increase in average expenditures per recipient is noted and is considered reasonable (less than 2% per year), especially considering only those who are most in need of services (crisis status) are enrolled and will have higher costs than non-crisis enrollees.  Also, as the annualized cost for the FY 05-06 additional enrollees was realized in FY 06-07, average costs had to increase as shown in the above chart. 

Florida ARF opines the cost of this program is being managed; however, the program simply is not funded at the level needed to serve the number of individuals enrolled.

Florida ARF Summary of DD Waiver Cuts

Prepared: December 2008

Updated May 2009, June 2010, January 2011, March 2011


Years ago, a small, struggling church in Florida learned–to their chagrin–that they had hired a convicted felon as their secretary. She would soon be thrown into jail for embezzling as much as $150,000 from her former employer who was a federal judge.

The pastor was new to the church and young. He met with his board of elders and a plan was drawn up.  As a church, it appeared they had no choice. They had to fire her. No apology. No explanation. After all, they were a church.

Yet, God had a different plan and He interceded. The board decided to not fire the unrepentant felon. After announcing her situation on Sunday morning, the congregation agreed to take her in and love her. They arranged her work program. Traveling 75 miles each day for weeks to pick her up from jail and carry her back to jail, they gave her chance after chance.

Careful not to allow her to handle money, they went the second, third and fourth mile with her. After several years, the secretary left her position for a more lucrative spot.  Within a year, she was arrested for embezzling from her new employer.

A waste of time and energy? Never.  In the interim, a practical plan for redemption in action was worked into the hearts of the people in the congregation and the community responded.

The tone, attitude and atmosphere of this small church has been set. They are known as a congregation which cooperates with God in bringing redemption into broken lives.

As the church, we daily face many choices.  However, one choice may be essential.  While judgment and justice begin at the house of God, God’s mercy always overrides his justice. As we approach the tenth anniversary of September 11, we stand, as a people, at a crossroads. Once justice has been served, the natural inclination is to push the offender against the wall and demand another pound of flesh. Will we, however, become a community desiring redemption.

There is a lost, dying and hurting world outside the doorsteps of our sacred homes and churches.  What will they find should they stagger through our doorways?

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