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Spend wisely on disabled care

By A TIMES EDITORIAL
Published April 24, 2007

There are reasonable and responsible ways to address the burgeoning costs associated with providing for the needs of Florida's developmentally disabled. A blanket cutoff of services is not one of them.

Everyone agrees that the Agency for Persons with Disabilities is facing a serious funding shortfall for the next fiscal year. It is looking at a deficit of about $150-million for the 30,000 people with developmental disabilities it serves. The state House and Senate are toying with proposals to respond to this looming fiscal crisis by placing arbitrary limits on care.

Intially, the Senate considered a $30,000-a-year cap for client services while the House wanted to eliminate certain categories of services as well as change the rules for people over 22 years old. The House plan would impose a cap of $14,800 worth of services for 8,500 people who are over 22 years old and live at home or in group homes. Neither plan does much to address the state's disturbingly large 15,000-person waiting list.

This is legislating with a hammer when what is needed is a scalpel.

Unintended consequences are sure to arise when money for home-based care gets slashed. People living with cerebral palsy, mental retardation, autism or other disabilities, who can no longer receive the help they need in a home setting, will inevitably have to move to more intensive care programs, possibly state institutions.

The Legislature shouldn't fool itself. This will cost more - much more - in the long run. The average client for home-based services costs the state about $30,000 annually while the average institutionalized client costs closer to $130,000.

Advocates for this population (who are often parents of children with developmental disabilities) are suggesting a different approach. They want the Legislature to cover the shortfall for the next year. (This would cost the state $75-million since matching federal dollars will provide the rest.) Then, over the next year, they want the agency to conduct studies to determine where dollars are wasted and how sensible cuts should be made.

The agency is facing as much as a $104-million deficit this year, and under prior leadership, that shortfall was not timely reported to lawmakers. Going forward, APD must prove that it can responsibly administer state resources. That means adopting evidence-based cost containment strategies and looking for ways to constrain overutilization of services. The agency should enlist the help of professionals who have experience doing these evaluations in other states.

There isn't any doubt that Florida cannot afford to simply open its coffers wider every year for this vulnerable population. But across-the-board cuts and arbitrary caps only ensure that needy people will lose the kind of help that allows them to function in society, while others who require less care will still be able to game the system. Precision is what is needed, and that only comes with more facts.

[Last modified April 24, 2007, 07:38:09]