The state’s Agency of Human Services is asking the Legislature for $3 million more to cover an upsurge in Developmental Services program requests, and if those funds are not enough, it wants permission to cut services.
The program, housed in the Department of Disabilities, Aging, and Independent Living (DAIL), funds private non-profit organizations to provide services to over 3,000 people with developmental disabilities.
If the caseload continues to grow, “we come up short,” AHS Secretary Doug Racine said.
AHS officials have been stumped by the increased demand for Developmental Services.
“We aren’t sure why this is happening,” Racine told legislators at a House Human Services Committee hearing on Jan. 10.
DAIL Commissioner Susan Wehry said they can point to a few trends but they don’t have a catch-all theory to explain the increased demand. DAIL Deputy Commissioner Camille George cited several contributing factors: an increase in refugee caseload, an increase in clients with autism, and increases both in the number of aging parents caring for disabled clients, and the number of aging clients themselves.
Racine said it’s not just a matter of new clients — clients are also requesting “a higher level of services than they had before” — and AHS needs clearer legislative instruction about which requests it should grant.
“Trying to determine what is medically necessary and what people need, as opposed to what people want, is a very difficult decision to be made and we don’t have a lot of policy guidance on how to make those decisions,” Racine said.
At the hearing, committee chair Rep. Ann Pugh asked why Developmental Services is being singled out for a possible rescission.
Racine said the agency feels the most confident about its rescission authority in this arena.
“In this particular case, we feel the tools are already there. We do feel there is rescission authority … all of the other [programs] would require lengthier discussions with the Legislature,” he said.
Racine said AHS lawyers have determined that “we do have the option of an across-the- board rescission,” but the agency wants the additional security of a nod from the Legislature. To this end, it included language in its Budget Adjustment Act, which states, DAIL “shall manage the developmental services program within the amount appropriated in fiscal year 2013 and shall take appropriate steps to modify the State System of Care Plan if the needs of those who meet the funding criteria … exceed the appropriated amount.”
Racine described the situation to the House Human Services Committee as a matter of fiscal prudence: “We are asking you to tell us to manage within our budget.”
DAIL makes its budget request based on a three-year average, with a one-year delay. Developmental disability advocates and service providers are making the case that AHS must figure out a better way to forecast its caseload.
“The bottom line is they are not doing very good projections,” Karen Schwartz, a member of the Vermont Developmental Disabilities Council.
Julie Tessler, executive director of the Vermont Council of Developmental and Mental Health Services, also sees problems in DAIL’s caseload projections. “You don’t get trends by doing averages, especially averages that are based on two years back,” Tessler said.
“It is a gamble,” Racine said. And if AHS has bet wrong, it wants the option of across-the-board rescissions in its arsenal.
The talk of rescission has raised concern among Developmental Services clients, advocates, and service providers who say the program is still reeling from rescissions made during the previous decade, under the Douglas administration.
“We haven’t have a cost-of-living increase in years, and the services are barely sufficient as they are,” Schwartz said.
During her testimony to the House Human Services Committee on Jan. 11, Schwartz told the legislators, “You need to consider how far the System of Care Plan’s priorities have already been rolled back. … Basically, new people can be served only when there is an emergency. … Imminent risk to a person’s health or safety cannot be redefined any more narrowly if we are going to protect the most vulnerable people from harm.”
The designated agencies, which receive funding from AHS to deliver services to the DS clients, would prefer a waiting list rather than a rescission, though they aren’t happy with either option.
“We’d rather see it adequately funded,” Tessler said. Racine said AHS prefers rescission because a waiting list would create a buildup of requests for the Fiscal Year 2014, punting the agency’s budgetary problems further down the road.
