iBudget Florida: A Future of Simplicity and Equity for Waiver Services

1. Something new is on the horizon… …for individuals receiving waiver services.

2. Budget Florida The Waive(r) of the Future

3. “There’s waaaay too much paperwork” “I have to wait for decisions” “Services my son needs are denied” “We can do things better ourselves” “Give us access to a wider set of services” “I’m tired of so much change” What’s wrong with the present? You said:

4. Managing APD funding is difficult . . . Which has led to deficits Since APD must stay within the budget the Legislature sets . . . It leads to cost control measures like tiers, rebasing, and prior service authorization . . . Which increases bureaucracy and limits consumer control . . . and. . . Keeps us from serving the waiting list. How we got to this point

5. More self-direction What does the waiver of the future look like? The Answer: iBudget Florida More simplicity – less “red tape” Greater equity More stable, sustainable system

6. Other options raise concerns Managed care Greater institutionalization Continued deficits, growing waiting list, awkward legislative cost-control measures Legislature told us to develop a plan by February 2010—then passed a law requiring APD to implement it. Why iBudgets?

7. Initial implementation of iBudgets is in late Fall 2010 in one area of the state Need federal government approval first Wider phase-in begins late 2011 or 2012 The Waive(r) of the future is almost here

8. Did a lot of research Other states have similar systems - Georgia, Minnesota, Connecticut Got a lot of stakeholder input 16 dedicated self-advocates, family members, WSCs, providers, state agency representatives, and advocates on Stakeholder Group Got help from consultants Listened to consumers, families, and providers in public meetings and via our Web site How did APD make the iBudget plan?

9. Current System Services decided first Complex system: WSC writes plan PSA review Rebasing affects Tiers affect Change in services often requires new PSA review iBudget Florida Funding decided first using formula Simpler, flexible system: Can spend up to individual iBudget limit Limited service review process More choice in services What’s different about iBudget?

10. You have more control over your services—can get your priority services faster and make changes easier You’ll know your budget for services up front to help you plan Wider array of services available to all Prior service authorization ended as we know it Greater support for you WSCs will have less paperwork to do You’ll have training and tools to self-direct if you want Features of iBudget

11. Stronger quality assurance and quality improvement APD and QA contractor will review for health and safety, provider manipulation, and fraud More stable system Would phase-in gradually Features of iBudget

12. Uses a statistically validated formula or algorithm Considers consumer age, living setting, QSI subsection sum of scores, some QSI questions People with similar needs receive similar funding People with greater needs receive greater funding Total of iBudgets + funds for exceptional/ changed/one-time needs = total APD waiver funding Sounds great, but how does all this work?

13. Initially, some budgets would increase, others decrease, and some stay about the same Will phase-in gradually—over a few years Exceptional need process if critical health and safety needs are unmet with budget Expect more system stability after initial phase-in Consumers may need to prioritize use of APD funding Waiver is intended to work with other resources WSCs freed to help get more community resources What else should I know?

14. Exceptional need funding available if critical health and safety risk Temporary and permanent increase for significantly changed needs that current iBudget can’t accommodate One-time funding available—durable medical, environmental modifications, nonroutine dental Thorough review of requests for more funding What if my iBudget isn’t enough?

15. The process as we know it would go away—minimized or eliminated as much as possible while meeting federal requirements Streamlined paperwork More flexibility Review spread among areas, Central Office, and contracted experts More review for unusual situations, less (or no) review for routine decisions Service Review

16. Design of service array Services grouped in 8 service families Can switch among services within service family usually with minimal or no outside service review Easier to meet changing needs over time Broader services Personal support and day activities One worker can do a broader set of tasks Allow to meet changing needs day-to-day Services

17. • Waiver Support Coordinator’s role will shift to more of a facilitator and guide • Will be seeking to reduce paperwork Allow more customized level of service Most will have more flexibility to choose support coordination level (limited, full, or enhanced) More meaningful distinction between levels (for example: more limited support in limited WSC service) Waiver Support Coordination

18. Training would be provided to consumers and families on iBudget policies and choice-making Unless in CDC+, must use Medicaid-enrolled providers Could negotiate some rates up to maximum Consumer and Family Control

19. Greater control over your lives Less delay in getting services Services better tailored to meet your needs WSC freed up to help you more Greater equity in funding Reduced bureaucracy and “red tape” More stable system What the Future Holds

20. Budget Florida Get the latest info and provide additional input via APD’s Web site apdcares.org