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DDS Plan to Achieve Trigger Savings of $100 Million
Due to lower than anticipated revenue projections, the Department of Finance announced on December 13, 2011, that the Department of Developmental Services Budget would be reduced by $100 Million (M) General Fund (GF) in accordance with Assembly Bill 121. In addition, Senate Bill 73 directed the Department of Developmental Services (DDS) to consider a variety of strategies including savings attributable to caseload and expenditure adjustments, unexpended contract funds, or other administrative savings to meet this target. The Department identified the following savings to meet the reduction target.
- Downsizing Funding Reduction - $1.0 M GF
- Gap Funding Reduction - $0.3 M GF
- Delayed Implementation of Program to Access Denti-Cal System for Regional Center Funded Services - $4.3 M GF
- Delays in "Start-Up" of Community Placement Plan Resources – $5.1 M (GF)
- Additional Home and Community Based Services Waiver Funding - $20.0 M GF
- Actual Increase in HCBS Waiver Funding in Prior Years - $7.3 M GF
- New and Updated 1915(i) State Plan Amendment Funding in Prior Years - $42.0 M GF
- Unexpended Regional Center Contract Funds - $20 M GF
Services provided in large community residential care facilities are not eligible for federal funding unless they have less than 16 beds or are determined "home-like" under federal standards. The use of funding available to downsize facilities or help them meet the federal "home-like" standards was less than anticipated for $1.0 M in GF savings in 2011-12.
The DDS budget includes funding to address the time period when an Intermediate Care Facility for Developmental Disabilities (ICF-DD) has changed ownership and is in the transition period before they are certified to be a Medi-Cal provider. The use of this funding was less than anticipated for $0.3 M in GF savings in 2011-12.
With the elimination of adult dental services as a Medi-Cal benefit, DDS entered into an interagency agreement with the State Department of Health Care Services (DHCS) that allows Regional Centers to use the expertise and system for reviewing treatment plans and approving claims for dental services consistent with the DHCS Denti-Cal program. Delays in program implementation reduced the need for $4.3 M in one-time GF savings in 2011-12.
Under the Community Placement Plan (CPP) process, each Regional Center provides an annual plan to DDS based on necessary resources, services and supports for consumers moving from a Developmental Center, as well as the resources needed to prevent Developmental Center admissions. One component of the plans is the cost of development of new resources ("start-up") to meet the consumers' needs. As part of this process, Regional Centers must forecast when community resources will become available. Delays in development of new resources from the 2009-10 CPP plans result in $5.1 million in one-time GF savings.
The Medicaid Home and Community Based Services (HCBS) Waiver program enables DDS to provide a broad array of services to eligible individuals who, without these services, would require the level of care provided in an Intermediate Care Facility for Developmental Disabilities (ICF-DD). Service costs for individuals under the HCBS Waiver are higher than anticipated resulting in additional federal funding and $20.0 M in one-time GF savings in 2011-12.
Service costs for individuals under the HCBS Waiver were higher than anticipated resulting in additional federal funding and one-time GF savings in 2009-10 ($2.3 M) and 2010-11 ($5.0 M).
Under a "1915(i)" Medicaid State Plan Amendment, services for individuals enrolled in Medi-Cal but not eligible for the HCBS Waiver could receive federal funding participation. Through negotiation with the Federal Centers for Medicare and Medicaid Services, new services not identified in the initial application have been added for 2009-10 and 2010-11. This, along with updated expenditures in those years, will result in additional federal funding and $42.0 M in one-time GF savings.
DDS contacts with 21 Regional Centers to provide community based services to individuals with developmental disabilities in California. Unexpended contract funds from 2009-10 will achieve $20 M in one-time GF savings.
(Note: Savings from additional federal funding as noted above takes into account potential losses in federal funding associated with other areas.)