Tears for Tiers

What would losing $15,000 a year do to you?  Knowing present economic situations across the country, it’s easy for someone to understand what it’s like to lose a job or have hours cut back, lose your benefits, live month to month and have all of your finances in turmoil.  Picture a similar scenario for someone who is developmentally disabled, except in most cases, those with disabilities may not even know how the services they receive and their living conditions are paid for in the first place.

ARC Marion has 51 individuals living in our care 24/7 with very few of them having any family support at all.  All of those people have Florida Medicaid waiver funding to support them for everything in their lives from housing to transportation to dental care.  Now picture the phenomenon that is the Florida legislature’s attempt to balance the budget– the tier system.  Through an odd and somewhat antiquated formula-driven assessment tool, developmentally disabled individuals are asked questions about their lives and current situation that in turn drives the amount of funding he or she receives from the state.  Many questions aren’t asked that could be, and of those that are considered, many of them don’t show the full picture.

Here’s a real life scenario of just one of those 51 clients.  Client A has lived in ARC Marion care for decades.  Until last year, Client A was receiving $50,000 a year (Tier 2) in Medicaid waiver funding for residential housing, attendance in the Adult Day Training program, companion services, use of a support coordinator, dental care, and transportation five days a week.  Suddenly, just a few short months ago, Client A was placed into Tier 3 and now only receives $35,000 a year to pay for the same service that is still needed day in and day out.  The real irony is that there are plenty of other individuals in the same tier who live with their families and don’t need group home residential support which can cost upwards of $30,000 a year in and of itself.

So what happens to Client A?  The $6,500 annual shortfall has to come from somewhere to pay for what Client A needs every day.  Does Client A have any idea this is happening?  Of course not, because Client A is one of those people who doesn’t really understand money or how things are paid for anyway.  Does Client A’s family step up to support the need?  No, because even though they are local, they don’t visit or call or have any contact with Client A throughout the year.

That’s where the Heart of Florida Hope Foundation comes in for Client A.  Monthly checks are written out of the Foundation’s scholarship fund to support this client and dozens of others at ARC Marion who have had their Tiers change within the past year for no apparent reason.  Another irony to the story is that Client A has yet to be diagnosed with early onset Alzheimer’s, but ARC Marion staff tends to believe it’s just a matter of time before that happens.  If/when it does, will Client A be re-assessed to receive more funding?  The answer is no.   To our knowledge, no one in ARC Marion’s care or any other provider’s care across the state has ever been moved to a higher tier level in order to receive more funding, though as they age (remember, Client A has lived with us for decades) they all tend to require more services.

If this scenario doesn’t make you want to shed real tears over the Florida tier system, it should!