Reduction List: Proposed Eligibility Changes Would Put Oregonians At Risk

As we discussed earlier this week, Oregon's Joint Ways and Means Committee Co-Chairs released a Targeted Reduction List at the end of April, which outlined a more detailed proposal for reducing costs to the 2017-2019 budget. Our legislative leaders have been warning us for months now that, without new sources of revenue, there will be cuts.The Targeted Reduction List proposes to change Oregon's IDD Service Eligibility criteria in two significant ways. Please note that no substantial changes to eligibility can be undertaken quickly. Any changes, including those discussed below, must be negotiated with our federal contacts at the Centers for Medicaid and Medicare Services (CMS). This negotiation will take at least a year, and the results are not assured. For people in services, it may help to know that any major changes will not happen for at least a full year after they are approved by the legislature.Both proposed eligibility changes would seek to disqualify portions of the population currently receiving IDD services. Without IDD services, people will be forced to seek supports in less appropriate systems like the justice system, mental health system, and hospitals. This inability to get IDD supports will put people into crisis situations. We know that stabilizing someone in crisis is more expensive than simply serving them appropriately to avoid crisis.Below we offer an examination of the Targeted Reduction List changes, and what they would mean for Oregonians in IDD services.

1.) Take into account parental income when considering eligibility for children with IDD.

Currently, Eligibility Specialists consider only the assets and income of the child with disabilities when determining financial eligibility for Medicaid services. As you might imagine, this means that pretty much all kids with IDD are found financially eligible. The reason for this decision to discount parental income is pretty smart: the Oregon legislature decided back in 2007 that it didn't want families destabilizing themselves by falling below the threshold in order to qualify for necessary IDD services--138% of the Federal Poverty Level. In 2017 dollars, that is $28,180 for a family of three. (Check out Healthcare.gov to find the Federal Poverty Levels for families of other sizes.) We learned through the public testimony offered in 2007 in support of discounting parental income that families were having to make terrible decisions to keep their children safe and supported: opting to divorce in order to seek benefits under a single parent's income; foregoing future security by spending retirement plans and life savings on care; declining job promotions and raises in order to remain under income limits; sacrificing the education of one child in order to pay for the basic care of another. More parents will have to make the traumatic and expensive choice to place their child with disabilities in a residential placement outside of the family home. The cost of this eligibility change to families is more than a financial price: it is paid in pain and suffering, at a social cost to individuals and communities alike. This was the wrong way to do things before, and it's the wrong way to do them today.Estimates pulled together by the Office of Developmental Disabilities Services and their associates put the potential numbers affected by this change at 1 out of every 3 children currently in DD services. These individuals with family income over 138% of the federal poverty level would no longer qualify for funded services. It is currently unclear as to whether or not they would retain case management services. This would have a very large impact on a group of people who qualified for funded services with the advent of the Community First Choice (K) Plan in July 2013.

In order to establish that a diagnosis of developmental disability is actually impacting a person’s life in a significant way, an Eligibility Specialist will require assessments of a person’s ability to function in areas of everyday life.

2.) Require that someone have functional adaptations in 3 areas of need, instead of the current requirement of 2 areas of need.

Many people who qualify for IDD services do so through the intellectual disability (ID) door. Intellectual disability is diagnosed by measuring IQ scores and adaptive behavior. Individuals with an IQ of 75 or below can be considered for eligibility. People who qualify for services due to their IQ score will not be affected by the changes we're talking about here. However, not every person with a developmental disability (DD) has a lower IQ. In order to establish that a diagnosis of developmental disability is actually impacting a person's life in a significant way, an Eligibility Specialist will require assessments of a person's ability to function in areas of everyday life. The areas of daily functioning measured are: self-care, communication, learning, mobility, self-direction, capacity for independent living, economic self-sufficiency. Currently, if a person has a demonstrated need for assistance in 2 of these areas due directly to their diagnosis of intellectual or developmental disability, he or she will qualify for IDD services. There are Eligibility Specialists employed by community developmental disability programs (CDDPs) across the state that assess and review each person's documented needs, and make a determination about whether or not they meet the current official standards for services.

So, why is it a problem to move from requiring 2 areas to 3? First of all, it's important to understand that looking at how many areas a person needs help in is not a very accurate way to gauge the intensity of their needs. A person may have extensive needs around self-care and communication, for example, that make it difficult for her maintain personal hygeine, pay bills, and keep a household clean and safe without significant support. In this example, the fact that she doesn't also have needs in the area of mobility might mean that she is no longer eligible for IDD services. Sometimes a person is affected in broad ways by their diagnosis; other times they are affected in narrow, but deep ways. Both groups of people have basic needs that need to be met. Right now, both groups of people are making good use of their services to live their lives.

Who would this change affect? Chances are, you are reading this and wondering if you or someone you love stands to lose services if this change is made. Short answer: right now, we don't really know. Our eligibility information in Oregon is not collected into one central location, it’s not even fully digitized. Many eligibility documents exist only in paper files. These would need to be reviewed by an Eligibility Specialist in order to determine whether a person qualifies or not under a new standard. There is no state database with the level of detail that would be required to figure out a complete list of the individuals that these cuts would affect.Our understanding is that the budget figures cited in the Targeted Reduction List document came from the Agency Request Budget submitted by DHS back in the fall of 2016. It’s important to note that, when it comes to weighing the benefit of savings through eligibility changes, those numbers are estimates at best. We think it’s a very real possibility that changes to eligibility would cost an enormous amount of money to review or re-assess a large portion of people in services. This would cause widespread upset and anxiety, for what may amount to very small economic savings.

Keep your story to less than one page, and include the ways in which you use IDD services, and what your life would be like without them.

If these changes may affect you or someone you care about, you can contact your local lawmakers to let them know. Consider emailing your story to our legislators on the Joint Ways and Means committee, found here, and to your own local legislators. Go to the Oregon State Legislature website and scroll down to the lower right-hand side to see the field entitled "Find Your District and Legislators." Once you know who to talk to, you can email, call, or request an in-person appointment to discuss your concerns. The way to make your best impression is to calmly and succinctly share how these reductions would affect you in your life. If you choose to email, try to keep your story to less than one page, and include the ways in which you use IDD services, and what your life would be like without them. Our lawmakers are doing their best to find ways to save money and keep the critical services and resources that people need. By providing a brief explanation of how this would impact your life, you are giving him or her the context needed to make an informed decision about the budget.

For fantastic advocacy tips and great information, we also recommend following the IDD Coalition's GO! Bulletin, a product of the GO! Project. You can find the Go! Bulletin, lots of resources for legislative advocacy, and fact sheets at the IDD Coalition website.