Medicaid and Adequacy of System Funding

Medicaid and Adequacy of System Funding Key Issue Action Steps

  1. Redistribution of Existing Funding to Increase Funding for Home and Community-Based Services
    1. DC-specific
      1. Request that DHS supply annual census data and cost analysis at the five (5) developmental centers
      2. Review and analyze the data related to the DCs in order to advocate that a sensible fiscal plan be developed as utilization declines and costs rise
      3. Identify best practice across the nation and apply in NJ to accomplish successful deinstitutionalization
    2. State budget process
      1. Ensure stakeholder engagement in the early stages before major decisions are made.
      2. Request budgeted and actual spending in the following categories by fiscal year: DDD’s total budget, contracts, FFS budgets, and DCs including personnel services, maintenance and operational expenses.
    3. Advocate for the passage of the HCBS Access Act
  1. Components of the DD System that Require Increased Funding
    1. DSP Wage Increase
    2. Analyze current Medicaid rates across the system and identify areas for increases
  2. Limited Flexibility and Options
    1. Increase flexibility, such as introducing “therapeutic leave” and “health and safety support during hospitalization,” so that they can visit their families, go to camp, take a vacation, and receive necessary medical care without jeopardizing their health, safety or residential service
    2. Revise Supports Program and Community Care Program language to be less rigid in how people spend their budgets to allow flexibility across services to best serve the individual, if service cannot be funded under a listed service, can use another general bucket (e.g., Goods & Services)
    3. DDAN to create concrete recommendations to submit to the State for consideration including flexibility in employment options and remote day program services

Next Steps:

  • Advocate for the increase of funding for home and community-based services and support to increase individual budgets and rates for services
      • DDAN to request and review Developmental Center data including (1) census of residents and staff and (2) cost analysis
      • Plan to shift resources from DCs when appropriate to Home and Community Based Services
    • State budget process
        • DDAN to create short-term suggestions around budget development and timing of stakeholder input to promote early engagement
    • DDAN to write concrete and specific recommendations to allow more flexibility in the way individuals and their families use their DDD budgets
    • Work with FFS Transition Oversight Board to analyze current rates and make recommendations for appropriate increases to the rate
    • Advocate for the passage of the HCBS Access Act
    • Develop recommendations and submit comments throughout the Waiver Renewal process

Communication

1.) Provide education and resources that detail the DDD Internal Appeal and Fair Hearing process when individuals/families disagree with DDD decision making.
Target Date: TBD

2.) Provide a greater level of information/education to individuals and families as to the way in which they operate, system design and changes that are implemented.
Target Date: TBD

Employment

  1. Letter to DDS and DMAHS re 2019 NJ WorkAbility Guidelines. Submitted and delivered public comment at 10/24/19 MAAC meeting.  Completed.
    Outcome: DDS updated NJ WorkAbility Guidelines to include our suggestions so that the Guidelines better reflect the intent of WorkAbility waiver which allows individuals with disabilities to make up to $63,252 a year in gross earned income for a single earner while maintaining Medicaid eligibility. 
  1. Letter to DHS Commission to urge her to sign Pre-Employment Transition Services(Pre-ETS) MOU.
    The MOU was signed by Commissioners on behalf of Office of Special Education Programs, Division of Vocational Rehabilitation Services (DVRS) and the Commission for the Blind and Visually Impaired for the coordination of Pre-Employment Transition Services.
    New Action Step: To obtain the MOU and follow up on the dissemination of information on Pre-ETS to transition students and families.
    Target Date: June 30, 2020.
  1. DDAN Employment Work Group’s meeting with DVRS re Comprehensive Statewide Needs Assessment (CSNA) on 11/18/19.  DONE
    Following the meeting on 11/18/19, we submitted a written summary of issues discussed to DVRS for the CSNA.
    New Action Step: Informed NJ People First coordinator of tentative dates of DVRS’s Public Forums to encourage advocates to make and submit comments regarding services from DVRS.
    Target Date: May 31, 2020.
  1. Conducted a survey of supported employment (SE) agencies to understand high turnover rates of SE professionals and the reasons for reduced SE services. Deadline:
    Work in progress. Target Date: June 30, 2020.
  1. Action Steps on Benefits Planning and Counseling:

5a. Met with Jennifer Joyce of DDD on 1/13/20 to advocate for capacity building of certified benefits planning counselors so that Supported Employment agencies will be able to provide benefits planning services to DDD-eligible individuals under Supported Employment services.

5b. Advocate to DVRS for more intensive in-state benefits planning services as Work Incentive Planning and Assistance (WIPA) 5-year grant to New Jersey will be awarded.
Update: The federal timeline for WIPA award has been postponed by one year from 12/31/19 to 12/31/20.
Target Date: December 1, 2020.

5c. Advocate to DVRS so that Title I fund could be used for benefits counseling to individuals with such services on their Individual Plans of Employment. Target Date: May 31, 2020.

5d. Advocate for funding and seek such sources for more widely available workshops on benefits planning to transition students and adults with disabilities and their families/caregivers.
Target Date: December 31, 2020.

    1. Minimum wage and tax credit to employers of individuals with disabilities: Disseminate information on the tax credit to individuals and families/guardians, as well as supported employment professionals and employers. Advocate to Department of Labor and Workforce Development so that New Jersey will track the impact of the $10 million in tax credit on employment outcomes of people with disabilities.
      Target Date: December 31, 2020.
    2. Advocate for and track NJ Assembly Bill 1017 which would require the Division of Equal Employment Opportunity and Affirmative Action in the Civil Service Commission to develop and implement a “State as Model Employer” preferential hiring program for people with Disabilities in the state government.
      Target Date: December 31, 2020.