Organizations that provide services for adult developmentally disabled residents in Wyoming are in financial trouble — including Ark Regional Services in Laramie.
Even with the Wyoming House of Representatives approval of an amendment to increase funds to help alleviate the hardships, some of state’s service providers said there’s much more to be done.
“There are organizations like Ark that are going out of business,” Ark President Shirley Pratt said.
“That’s a scary thing to say, but we can’t afford to provide services with the money that’s currently being paid.”
Programs such as Ark are primarily funded by a Medicaid Title XIX home-and community-based waiver program, with the goal of supporting individuals in their own communities in order to avoid the need for institutionalized care. The federal government matches the state dollar-for-dollar to support the care of individuals in need of services.
Wyoming Community Service Providers is a trade association representing providers of services in the state of Wyoming. Executive Director Jeff Gardner said the funding methodology is built into reimbursement rates. Established adult care programs around the state, Gardner said, are private businesses (though the majority of members WCSP are nonprofit). As such, he said they are bound to costs any employer is responsible for, such as health insurance for certain employees.
Community waivers are divided into support and comprehensive waivers, respectively. Support waivers provide supportive services to eligible persons of all ages with intellectual and development disabilities so they can participate in the community; comprehensive waivers provide for those who need a higher level of service.
As of Jan. 31, the number of people on developmental disability waivers was 152 for acquired brain injury, 419 on support and 1,848 on comprehensive, according to Wyoming Department of Health data provided by spokesperson Kim Deti.
For fiscal year 2015 — the expenditures for Wyoming individuals receiving Medicaid developmental disability and acquired brain injury waiver services totaled $137.1 million. These individuals represented about 3 percent of total enrollment for Wyoming Medicaid programs. Comparatively, $143.6 million was spent on medical care for traditionally enrolled children, who represent 62 percent of total enrollment.
Gardner said state lawmakers have been supportive historically, but providers are working with rates established just less than 10 years ago and don’t reflect the actual costs, leading to deficits in service programs. At this point, he said the current model is not working.
“The current methodology for determining the rates of services for individuals in inadequate,” Gardner said. “We have providers that are close to closing their doors.”
In the 2015 general budget session, Gardner said the Joint Appropriations Committee members knew the rates were too low. So, lawmakers allocated monies to hopefully fill gaps in funding for service providers in the meantime while they worked to find a solution.
“Some supportive members of the Legislature appropriated $3 million be added to the system,” Gardner said. “They said it was a down payment on what we need to do to fix the system.”
For this year’s budget session, Gardner said a cost study was performed to determine how much funding it would take to fix the system. But even after the recent cost study, Gardner said it was the opinion of the provider groups his organizations represents that it was still not enough.
Gardner said the $3 million allocation from the 2015 session happened before oil, gas and coal took a nose dive. The change in Wyoming’s revenue picture changed the conversation, he said.
“I know the Legislature was not predicting that at all, and when those things happened in the interim, it changed the conversation to the extent that we don’t know how much money we’ll have,” Gardner said.
The outcome of the cost study was to propose $6 million through the biennium — half from the state’s general fund with the federal match. On Friday, the third reading of an amendment in the House passed 40-19 with one excused, which would add an additional $1.5 million to the $6 million allocation. The bill now moves onto the Senate, as well as a probable conference committee and finally the governor’s signature.
Of three other budget amendments related to adult developmental disability services, one would call for the cost study to be redone to focus on personnel and staff compensation. Gardner said the proposed amendment is important because there are serious implications for the people service programs support if staff doesn’t perform well on the job, necessitating competitive compensation rates.
“We know the numbers in the cost study were not totally reflective of the actual cost,” Gardner said.
The majority of funding for Ark goes directly to staff wages, Pratt said. It is critical, she said, that staff be well-trained for the very skilled positions they fill. For the 260 members of staff at Ark, Pratt said it was decided not to freeze wages, as some other Wyoming organizations have done recently. With a turnover rate already around 60 percent, Pratt said it is vital to allow Ark’s staff to receive a living wage.
“It’s a fun job, but it’s a hard job, because you may have to deal with different challenges throughout each day,” Pratt said. “We feel it’s important to pay our staff and provide benefits because if they are not happy, we’re going to have turnover. When you have turnover, you have inconsistency in services and when you have that, it ultimately affects the people we are here to support. If we want them to have the best lives possible, we need staff that is going to be here for a long period of time.”
Another amendment would provide protection to service providers from further cuts if 50 percent or more of gross income relies on Medicaid, and one other that would have provided a bankruptcy contingency was withdrawn on third reading.
Even with $1.5 million added to the original $6 million allocation, Gardner said it’s not going to fix the problem for underfunded providers at risk of closing doors to the people who need services.
“The problem is more systemic,” Gardner said. “We need to do something because people are in real trouble. In the long term, we need to look at the system and how rates in the reimbursement model are determined. The amendments were critical to getting people to talk about things.”
Ark has been providing services in Laramie for more than 50 years. The question to be answered, Pratt said, is where the people they serve would go if Ark were to close its doors someday down the road.
“We provide services for folks who need them 24-7, 365 days a year,” Pratt said. “Should family members quit their jobs to take care of services on their own? Should they be put in an institution? The folks we support are residents of Laramie. For them to lose their home — to uproot them — would be unconscionable.”
Pratt said Ark provides services for 126 Laramie residents, all of whom deserve the opportunity to live the life they want to live.
“If we believe every person has value, then there’s this inherent understanding all people should be able to access communities to look for jobs, have friends and participate in events and things in life that matter, so they can make a contribution — the folks we support need help to do those things,” Pratt said. “The quality of life for the people we support is the same as quality of life for you and me.”
Because of what the program means for the people they serve and its staff, Pratt said losing Ark would lessen the community as a whole.
“The folks for whom we provide support are an amazing, integral part of the Laramie community,” Pratt said. “The thought of them losing services is sad, so we’re going to make changes and make sure we’re a viable organization.”