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‘iBudget’ rewrite brewing

People with developmental disabilities aren’t going to allow the state’s Medicaid home- and community- based waiver program to be redesigned quietly.

They’re going to get loud. And they’re prepared to take their fight to the streets of Florida.

At a public meeting in Tallahassee this week, clients, family members, advocates and business owners made it known that they want a seat at the table, as two state agencies begin work on how to redesign the $1 billion waiver program known as the “iBudget.”

The Legislature ordered the agencies to identify core services that are essential for client health and safety and to recommend elimination of other services that are too expensive. A progress report on the redesign is due to lawmakers at the end of the month.

For the most part, this isn’t the advocates’ first rodeo.

People with developmental disabilities rallied at the Capitol in 2011, after former Gov. Rick Scott’s administration ordered deep reductions to the Medicaid rate paid to providers who offer the services that keep people with developmental disabilities out of institutions. The administration backed off the reductions after the rally.

The program now being redesigned was fully implemented in Florida in 2014. That’s just six years ago, and it’s less time than some people have spent on a waiting list for services.

Danielle Schemel, the owner of a durable medical equipment company, flew from St. Petersburg to Tallahassee Wednesday, after learning about the public meeting from an email sent by the Florida Developmental Disabilities Council.

“I then called every provider I knew and said, ‘Are you going to Tallahassee? Are you going to Tallahassee?’ I brought some with me. I made some of my networking partners coming along,” Schemel said.

While Schemel is eager to help, she’s not sure how much the state really wants input from her — or anyone else.

For instance, Agency for Persons with Disabilities Secretary Barbara Palmer kicked off the meeting by noting that her agency and the state Agency for Health Care Administration have had about 12 meetings on the redesign. The agencies have been reviewing other states’ Medicaid waivers for home- and community-based services, Palmer said.

Attendees weren’t given any information about this effort — not the names of the states that were being reviewed or summaries of the dozen staff meetings. There were no documents shared, other than a vague agenda. Palmer said Wednesday’s meeting was intended to get public input, because that’s what was important.

“I think they have to hear from us because it’s mandated that you have to have a public hearing,” Schemel said  “What are they working on? They in fact told us they were not going to tell us what they were working on. Why would you have a hearing and not tell us what you have already been doing?”

Schemel and others who attended the meeting this week fear that the Medicaid iBudget program will be rolled into the statewide Medicaid managed-care program.

They may be right, and here’s why. The redesign was included in the state budget at the insistence of the House of Representatives, the creators of the exiting statewide Medicaid managed-care program.

But there’s more to it than that.

The Medicaid managed-care program has absorbed other Medicaid programs, such as the brain injury and spinal cord injury programs.

Schemel says that she thinks it will be hard to slow down the managed-care train. But she said clients, advocates and the community are prepared to try.

“If you load up the vans and the buses, and you show up and say, ‘We’re not going to accept this,’ people will listen,” Schemel said. “It’s the individuals who are being served, who may have to be pushed there in their wheelchairs by me, but that’s who’s going to make a difference. The people. You can’t say, ‘No,’ to that person standing there in front of you.”


Republished with permission of the News Service of Florida.

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