One of Gov. Rick Scott's priorities after taking office in 2011 was to resolve a longstanding deficit in the Medicaid “waiver” program that serves people with developmental disabilities.
Now, nearly seven years later, the Agency for Persons with Disabilities will be in the red if the Legislature doesn't agree to spend at least an additional $89 million for a program meant to keep people with disabilities out of institutions.
“This funding is for the purpose of making sure that we do not go into a deficit, that we will make sure this year and next year that does not happen,” agency Director Barbara Palmer told members of the House Health Care Appropriations Subcommittee on Wednesday. “This agency has worked hard for the last two or three years to identify the cost drivers in this agency that are creating growth.”
Lawmakers have over the past several years provided hundreds of millions of dollars to increase the number of people served by the program and at times have provided additional funding to serve some of the neediest Floridians with disabilities, Palmer said.
But once the agency provides benefits to a client, federal law precludes the state from terminating those benefits and that, Palmer says, has caused “significant additional need.”
Palmer repeatedly described the request for $89.3 million as a “restoration” of money, but House Health Care Appropriations Chairman Jason Brodeur, R-Sanford, said he “respectfully disagreed” and instead called it a “hit” to the budget.
Detailed documents accompanying Scott's budget request underscore Brodeur's remarks.
The agency maintains it is trying to get back money that the Legislature had agreed to give it in 2014 and 2015. But that funding did not continue the last two years, and agency leaders are seeking to get it for 2018.
APD's $89.3 million request includes more than $55 million in federal Medicaid dollars. To draw down those funds, though, the state needs to pony up about $34 million. To that end, Scott has proposed tapping into about $25 million from money provided to the state in a settlement with tobacco companies and getting the rest from the state's main budget account.
The Home and Community Based Services Medicaid Waiver helps serve people with intellectual disabilities, autism, cerebral palsy or other disabilities. Through the Medicaid waiver, the state provides care people need to stay in their communities and live independently so they don't need to enter institutions.
The program started running deficits in 2004, the same time the Legislature, at the behest of then-Gov. Jeb Bush, created the Agency for Persons with Disabilities, carving it out from within theÂ Department of Children and Families.
Scott was elected governor in November 2010 and by February 2011 announced that he had directed his inspector general to conduct a review the agency's budget because of the long-standing deficits.
“We're not going to continue to do the same thing,” Scott said at the time. “Everybody else in life has to live within their means, so these agencies are going to do the exact same thing.”
After the inspector general report disclosed that the agency had a $174 million budget shortfall, Scott in April 2011 issued an executive order cutting payments to service providers by 15 percent. The governor lifted the executive order after reaching a deal with the Legislature to curb the agency's costs.
Between cost-saving measures and a $40 million-plus infusion, the agency's deficit was eliminated in July 2013.
But spending at the agency is on the rise again.
In addition to the $89 million in “restoration,” Palmer also said her agency needs $41 million to continue to pay minimum wage to the caregivers who work with the clients.
Brodeur noted that the agency reported a $400,000 deficit in fiscal year 2016-2017. In the current fiscal year, there is a $2 million surplus. On average, he said reports show that the agency's spending has been within about $1 million of its budget. That's a “wobble” Brodeur said, that is within reason.
“This year the governor's budget is asking for $34 million non-recurring (money). Why?” he asked Palmer.
Again, she described the funding request as a restoration of dollars.
Brodeur, though, said he “respectfully disagreed” with her characterization of the funding request.
“I don't think we are restoring any of that money. I would want to see more evidence of that,” he said, adding that he understands the occasional $1 million discrepancy.
“Thirty-four million (dollars) one time, that is different,” Brodeur said. “That is a hit.”