Increase Funding for Community Services and Supports

People Receiving Medicaid
Services per 100,000 (2006)

In 2006, Texas furnished Medicaid funded services at a rate that is 43 percent below the nationwide average. For Texas to serve the national average of people per 100,000 population, the state would need to provide Medicaid services to roughly 19,662 more people.

Source:
R. Prouty, G. Smith, C. Lakin (2007).
Residential Services for Persons with
Developmental Disabilities: Status and
Trends Through 2006

Goal: Texans with disabilities will have true choice to live in their communities.

Problem: Our publicly-funded Medicaid program--which provides long term services and supports to individuals with disabilities who have significant medical and behavioral needs—is out of sync with the very clients it serves. Although Texans with disabilities have demonstrated that they prefer to live in their communities, our Medicaid program continues to serve people in large congregate settings (namely, Nursing facilities and Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) services). Serving people in these settings costs more on average than comparable community programs; and, meanwhile Texas shortchanges our community-based services spending less per capita than the national average.

Recommendation: The Texas Legislature needs to fully fund community services and supports that ensure Texans with disabilities have the opportunity to live in their communities.

Specific Recommendations: The Disability Policy Consortium (DPC) supports the Texas Legislature fully funding community services and supports that ensure Texans with disabilities have real choice in deciding where they want to receive needed services. This includes:

• Funding increases sufficient to provide services and supports to individuals currently on waiting lists for all Medicaid waiver programs, with consideration given to equitable distribution of reduction funds.
• Funding to accommodate anticipated demographic growth in Medicaid waiver programs as determined by historical patterns of requests by eligible individuals for such services.
• Funding for other federally and state-funded community programs, including non-Medicaid services.
• Developing and implementing a plan to transition individuals from state institutions to community services and supports; closing and consolidating unneeded facilities as that occurs; and redirecting all savings to community services and supports.

Background: The Health and Human Services Commission (HHSC) and the Department of Disability and Aging Services (DADS) have requested funding increases to reduce the waiting lists for all Medicaid waiver programs. The agencies have requested funding increases necessary to provide waiver services to 20 percent of the individuals on the waiting lists for those programs during the next biennium. Even with this request for additional funding, thousands of Texans continue to remain institutionalized, requiring hundreds of millions of dollars in resources that could be re-directed to home and community service options.

Moreover, state expansion of the Money Follows the Person (MFP) method of financing to large ICFs/MR and federal MFP initiatives should offer additional opportunities for Texas to support people with disabilities to transition from institutions to their communities.

In comparison to other states, Texas falls significantly below the national average in many areas. Consider that:

• Texas ranks 49th out of the 50 states in providing community-based services to individuals with developmental disabilities—above only Mississippi. Nearly 13 percent of the nation’s individuals with disabilities that reside in large state facilities are located in Texas. (United Cerebral Policy. 2007. “The Case for Inclusion.” Washington, D.C.)
• Texas spends significantly less than other states on Medicaid services to people with mental retardation or a related condition (MR/RC). On average, in 2006, states spent $131.29 per citizen on residential services for these individuals, while Texas spent just 41 percent of the national average: $53.91 (Braddock et al., 2008).
• In 2006, the number of Texans receiving community residential services per 100,000 people in the state’s overall population was 35 percent less than the national average. (Texas serves 92 people per 100,000 versus the national average of 142 per 100,000). This means that Texas would need to provide residential services to 50 more people with MR/RC per 100,000, or 11,704 individuals, just to reach the national average. (Lakin et al., 2007)

Justification:

• Providing supports to allow people to live in community settings cost less on average than institutionalization. Nursing facilities and Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) services have a higher average cost than comparable community programs. In an era of scarce resources and competing demands, the state must make the necessary policy decisions to spend its resources more efficiently and support people in their communities.
• It’s what people want. The waiting lists for community-based services demonstrate this. More than 80,000 Texans with disabilities continue to wait for Medicaid HCBS waiver services.
• State policy makers support community solutions. The Health and Human Services Commission (HHSC) and the Department of Disability and Aging Services (DADS) have requested funding increases to reduce the waiting lists for all Medicaid waiver programs. The agencies have requested funding increases necessary to provide waiver services to 20 percent of the individuals on the waiting lists for those programs during the next biennium. Even with this request for additional funding, thousands of Texans continue to remain institutionalized, requiring hundreds of millions of dollars in resources that could be re-directed to home and community service options.
• Providing community-based services is important to all Texans because there is a need to provide services in the least restrictive manner possible and the philosophy that individuals should be supported to make their own decisions concerning their lives.