Rebasing… by the Numbers

Allow me to step back on my soapbox for a few days. 

Want to know how the Medicaid waiver works for the developmentally disabled in Florida?  This year, it goes something like this.  If you aren’t already on the waiting list, apply.  Get your name on the list and sit there for the next seven years or so until you might get the opportunity to have services paid for by the state.

If you are one of the chosen who has been receiving services most of your life past the age of 22, you better have been using all of the monies you had been given by the state over the past year.  If you’ve been sick, in the hospital, or out of town on vacation and went a few days or weeks without services last year, then we’re sorry.  Those unused state dollars from last year will not be given to you this year.  Yes, that’s correct.  Last year, you saved the Florida Medicaid waiver system money, because agencies like ARC Marion couldn’t bill the waiver on days you were absent.  But apparently you don’t need to have 240-260 days of transportation, or adult day training, or companion or group home support.  At least last year you didn’t.  Never mind if you had surgery and are back in good health or went on a first-time family excursion for a few days in 2008.  The state of Florida doesn’t care if this money from the Medicaid waiver is all you have.  If you have no family and live with ARC Marion full-time, it doesn’t matter that the state support is what keeps you in a group home and gets you to and from your job every day.

That’s what rebasing is, and that’s what clients at ARC Marion are facing right now.  Do they know it?  No.  Most of these special people have no idea who foots the bill for them to be a part of the place they call home.  They just know this is where they belong, and people here love them. 

So, how is ARC Marion paying the bills?  In part due to the Heart of Florida Hope Foundation’s Scholarships for Hope program.  Luckily, the Foundation started funding some of the clients who are being rebased who live at ARC full time.  Without the nearly $20,000 in scholarship dollars paid by the Foundation in 2009 and the additional $35,000 needed over the next six months, ARC would be losing even more money than they already are.

Let me put it like this.  For the 50 clients who live with ARC Marion 24/7, if one of them suddenly only receives four days a week of transportation and adult day training services, then ARC would have to pay staff members to stay at home with that client.  Currently the residential group homes are only staffed during the evening and morning hours.  While the clients are at work or utilizing other services, those group homes are empty.  If the client has to stay home, then that’s additional staff hours and more money coming out of the budget for ARC to care for that client at home.  It’s better to either find a way to fund the one or two or more clients to attend the programs than it is to have one or more staff persons placed in the eight group homes around the community 24/7. 

Rebasing within the Medicaid waiver system not only hurts those with special needs, but it significantly affects those organizations who give them services.  It’s simply not fair to take money from those who have no other means of getting it for themselves.  Then again, maybe those extra dollars the state of Florida is saving this year in the Medicaid waiver might help them pay for high speed rail? Think about it.