We look forward to seeing many of you in Juneau for our 32nd year of advocacy! We also encourage you to join us at the local level – wherever you are in Alaska, you have a voice in Key. See our event page for details on statewide rallies, which will all be held on Friday, February 8th, 2019!
2019 Key Platform
- Increase the number of individuals selected annually for services from the Developmental Disabilities Registry (waitlist) from 50 to 100.
- Ensure all eligible individuals previously receiving state grant-funded IDD services, some of whom have received services for decades, continue to receive services at the same level previously received.
- Move Component Senior and Disabilities Services (2662)from RDU:Medicaid Services (595)to RDU: Senior and Disabilities Services (487).
- Continue implementation of the Developmental Disabilities Shared Vision.
- DD Shared Vision Position Paper
COST SAVINGS RECOMMENDATIONS
Services for Alaskans with Intellectual and Developmental Disabilities (IDD) have been reduced significantly over the past several years. Individuals and families are not asking for a handout. By the nature of their disabilities, individuals with IDD require individualized, comprehensive and life-long services in order to live successfully in the community. In addition, families also contribute to the cost of care for their children with IDD – far beyond what they contributeto the care of their children without a disability. In many families, caring for a child with IDD consumes more than half of every dollar earned. Out-of-pocket expenses to care for a child with IDD has been estimated at $8,000 annually on top of all ordinary expenses associated with raising a child. (Stabile, M. and Allin, S. (2012. “The economic costs of childhood disability,” The Future of Children(22(1:65-96).
The following cost saving recommendations have been previously submitted to SDS and the Legislature by the Key Coalition and remain viable options:
- REDUCE THE WAITLIST FOR DD SERVICES
Medicaid allows states to maintain waiting lists for home and community-based waiver services (HCBS) when demand exceeds resources. In Alaska, only individuals with IDD are impacted by a waitlist. Currently, 982 individuals are on the Developmental Disabilities Registry (waitlist). In FY16, SDS reduced the number of annual selections (draws) from the waitlist from 200 individuals to 50, which means individuals and families have to wait even longer to get needed services as the waitlist increases. The longer people remain on the waitlist, the more costs increase. Without supports, young adults on the waitlist lose the skills developed during school years. Without services, family members neglect their own health, forego employment and “try to do it all,” especially as they and their loved ones face the challenge of aging.
Note:Costs per person range from $37,330-96,093 for 84% of those served compared to $164,234 in nursing homes, $201,663 in out-of-state institutions and $531,312 at the Alaska Psychiatric Institute.If an additional 50 individuals were drawn from the registry each year, State General Fund costs would range from $933,250-$2,402,075, which includes a 50% federal match.
Return on Investment:
- Cost savings to the state:Community services cost considerably less than services provided in institutions, which by federal law mustbe provided if requested by the individual and/or family, even though most families would prefer to keep their children at home or close by.
- Increased employment and productivity:Most adults with IDD want to work and help support themselves financially. Research shows that Medicaid waiver-funded supported employment services result in more job placements, higher wages and hours worked per week (Nord, D., Luecking, R., Mank, D., Kiernan, W. and Wray, C. (2013). “The state of the science of employment and economic self-sufficiency for people with intellectual and developmental disabilities”, Intellectual and Developmental Disabilities, 51(5): 376-84)
- Increased family income:Receiving services for a child having with IDD makes it more likely a parent will continue working or gain employment. (Stabile, M. and Allin, S. (2012. “The economic costs of childhood disability,” The Future of Children(22(1:65-96)
- Improved caregiver health:Elderly caregivers without adequate supports are 63% more likely to die within a four-year period compared to non-caregivers. Services for a child increases the chance of the parents maintaining good health. (Scults, R. and Beach, S.R. (1999). “Caregiver as a risk factor for morality: The caregiver health effects study,” Journal of the American Medical Association, 51(5): 376-84
- DEVELOP TECHNOLOGIES TO REDUCE DIRECT STAFF SUPPORT
The use of technologies, such as “smart home” and other electronic devices, can reduce the cost of direct staff support. Equipment may include video monitoring systems, tablets, smart phones, webcam and digital video conferencing. As technology has improved, the need for costly and highly specialized equipment has decreased. Routine investment in low-tech and even high-tech options has the potential to dramatically drive down the long-term costs of services provided to Alaskans with IDD.
Return on Investment: Charles Lea Center (CLC) in South Carolina works with SimplyHometo design customized supports for individuals with IDD based on each individual’s daily routines and priorities; 93% of the individuals served in residential settings use technology throughout their homes. Using technology costs CLC approximately $100 per day per individual; without technology, it would cost approximately $200 per day. In a recent survey, when individuals were asked if they felt safe in their homes, 100% said yes.
- ESTABLISH A MEDICAID WAIVER BILLING CODE FOR COMPANION SERVICES
Day Habilitation Services are provided to assist individuals with IDD to acquire, retain and improve their self-help, socialization and adaptive skills necessary to live successfully in home and community-based settings where the focus is on skill development.Knowing thatday habilitation focuses on skill development, the rate for services is inherently higher. Through establishing the new service and billing code for Companion Services, individuals would be able to participate in the community and practice skills learned without an emphasis on skill development. A lower rate for this new service would result in notable savings.
Return on Investment:SDS would see savings of $18.24 per hour if day habilitation services, depending on the needs of the individual, were replaced with companion services.
- RE-ESTABLISH A BILLING CODE FOR THE SEMI-INDEPENDENT LIVING OPTION THAT DOES NOT REQUIRE 1:1 STAFF SUPPORT
Current regulations no longer provide for a “semi-independent living” residential option which allows several residents to receive staff support at the same time and provides a billing mechanism for these services. As a result, individuals who benefit from and desire “semi-independent living” services (that promote increased skill development, offer more privacy in apartment settings and learning through natural supports and modeling of housemates), no longer have this service option. Instead, they receive more expensive assisted living home services where State licensing mandates close supervision and direction of their daily living routines.
Return on Investment: Re-establishing a billing code for the semi-independent living/supported living option to SDS. One provider reports that for the 50 individuals who now receive assisted living services rather than semi-independent living services, costs increased by $2 million ($40,000 per individual) annually. This simple fix would save SDS as least $2 million per year.
- DEVELOP AN ALTERNATIVE APPROACH TO FUNDING SUPPORTED EMPLOYMENT SERVICES
According to current regulations, supported employment providers can only bill for services when working directly alongside an individual, such as would occur in an institution, thus not allowing an opportunity for independent skill development. In addition, supported employment services such as work incentives assistance, developing natural supports with co-workers and job development are not reimbursed. As a result, providers have downsized or eliminated supported employment programs.
Return on Investment:There is considerable evidence from other states (Utah, Kansas, Michigan, Washington) that when individuals with disabilities work and receive ongoing supported employment services, other costs such as health care (general Medicaid program), food stamps and energy assistance decrease. In addition, the ability to use the natural supports of co-workers decrease the cost of training supported employees by 57.6% and increased the length of time they were employed by 12.36 months. (Cimera, R. (2012), “The Economics of Supported Employment: What New Data Tells Us,” Journal of Vocational Rehabilitation, vol. 37, no. 2, pp. 109-117)
- FULLY IMPLEMENT THE DURABLE MEDICAL EQUIPMENT RE-USE PROGRAM AND THE ALASKA ABLE PROGRAM
Both the programs were established by the legislature, and regulations outlining their use have also been established. However, more attention needs to be given to their full implementation, including increased marketing, development of incentives for providers to develop durable medical equipment re-use programs, and increased information about the ABLE program.
Return on Investment:Kansas saw a $3.15 return on investment for every $1 spent on its durable medical equipment re-use program. The ABLE Plan allows eligible individuals with IDD to save money for qualified disability expenses without losing eligibility for programs like SSI and Medicaid. Funds may be used for expenses that increase or maintain health, independence and quality of life. Enabling individuals with IDD to purchase what they need lowers the cost to the State.
In addition to joining Key Coalition advocacy efforts, we encourage you to contact your legislator in one of the following ways:
- By sending an email or submitting a Public Opinion Message (POM): Submit POM Online or Download, print and fax the POM Form to your local Legislative Information Office (LIO).
- By contacting your legislators directly. Find contact information on the Alaska State Legislative website by putting in your address.
- If you don’t have the exact information needed or need assistance, please call your local legislative information office. For a listing of the LIOs click here: http://w3.legis.state.ak.us/misc/lios.php
For regular updates regarding issues and the latest proceeding, join Hope’s Online Community and select Legislative Alerts.
2018 Campaign Priorities
For our 31st year of Key Campaign, we educated and advocated based on the following platform:
- Through SB174, putting into statute a shared vision of a flexible system in which each person directs their own supports based on his or her strengths and abilities toward a meaningful life in their home, their job, and their community. Our vision includes supported families, professional staff, and services available throughout the state now and into the future.
- A stable and sustainable fiscal plan which if attained would:
- Reactivate the commitment to reduce the waitlist. Currently, there are more than 700 individuals on the waitlist. It is imperative that we increase the number of individuals removed from this registry.
- Key Coalition also supports the following bills:
- SB 80, a telecommunication bill that would require telephone utilities to provide services to deaf, hard of hearing, and speech impaired subscribers that would permit the subscribers to communicate by telephone with hearing persons.
- HB 336, the Supported Decision Making Act, would empower Alaskans with guardians to form individualized Supported Decision Making Agreements. SDM Agreements foster greater independence for adults with disabilities to make life decisions with a trusted team.