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Florida’s Medicaid Waiver

Community-based care has proven to be more beneficial for the individual with a disability and cheaper for state and federal governments.

Florida’s goal is to shut down most of its care institutions and shift the support to cheaper at-home care, according to Shelly Brantley, executive director of Florida’s Agency for Persons with Disabilities. Her interview for 24/7 was taped in February 2005.

Individuals who are eligible for either the Medicaid waiver or institutional care in Florida are those with disabled by autism, spina bifida, Prater Willi disease, mental retardation or cerebral palsy. They must need help with daily personal hygiene, eating and walking. (

Medicaid-funded At-home Care Not an Entitlement

The key issue is that while Florida and other states guarantee people with developmental disabilities will receive care in institutions, many institutions are shutting down. Meanwhile as states switch to Medicaid-funded at-home care, they no longer guarantee that all those in need will receive care.

Just because you are eligible doesn’t mean you’re entitled to Medicaid support for at-home care.

When a person signs up for help under Florida’s Medicaid program, they waive their rights to instititutional care, which is guaranteed.

“One of the major differences between an institutional option and the waiver option, or the community option, is that the waiver is not an entitlement program,” said Brantley in a taped interview in February 2005.

States Have Broad Discretion

Federal Medicaid guidelines allow states to limit the number of disabled people who receive help and limit the dollars it spends on that assistance. Throughout the United States, this policy leaves many thousands of people without any help.

Generally, the federal government pays slightly more than half the cost of state Medicaid programs.

“It’s an option that state’s can offer, an alternative that states can offer. They have very broad discretion in how they develop and operationalize those programs. ” Bradley said. “They can limit the number of people that they serve in those programs. They can design the array of services and supports that they make available in the community. ”

Florida Is Closing Most Institutions

In a taped interview in February 2005, Brantley of APD said, “the primary intent of our agency is to decrease reliance on institutionalization. ”

She added, “One of the reasons the home and community based waiver program was started was not only to provide an alternative to institutionalization but to address higher expectations for persons with disabilities and their families.

Many families, for example, who brought their loved ones to state institutions decades ago, were told by their physicians that this was the best thing for them, that there really was no options for them.There really was no real choice for them.

“The growth and expansion not only in Florida but nationally in this area is a sign of increasing expectations (and) advances in medical technology. People are living longer. ”

“People are able to integrate in the community through assistive technology, personal care supports that they wouldn’t have been able to 20 years ago, ” Brantley said.

Florida Denies Many Care

Yet society has decided that not all people with developmental disabilities, who are in need of care, should be treated equally.

In 2005, Florida has slated three more care institutions to close, which will leave only one open, according to Brantley.

Like all state populations, about 1.5 to 2 percent of Florida’s citizens are developmentally disabled.

In 2005 among the approximately 16 million people living in Florida, the state estimates about 240,000 are developmentally disabled.

Of those 240,000, during 2004 Florida provided some funds for community-based care to 32,000 people with developmental disabilities.

As of early 2005, another 16,000 were on Florida’s Medicaid Waiver waiting list ? some for many years.

Many more disabled people are in need of financial support, but haven’t applied.

“We would never anticipate we would serve the full number of individuals with developmental disabilities in our state, nor would we anticipate that everybody with developmental disabilities would need supports, ” Brantley said.

Florida Increased Medicaid Waivers

Historically, Florida has under-funded assistance for people with developmental disabilities.

In recent years, Florida tripled the number of people with developmentally disabilities it helps with at-home from 10,000 in 1999 to 32,000 in 2005, Brantley said.

However, the needs of its developmentally disabled citizens, who need institutional-level care, far exceed Florida’s current funding. (2005)

When allocating funds for the developmentally disabled, Florida underestimated the number of families that desperately need these services.

Florida Ranks 49th

Florida hasn’t provided the funding necessary to meet the demands. As a result, the waiting list for the waiver ballooned to more than 16,000 families as of April 2005.

Florida, which ranks among the most populous and wealthiest states, ranks 49th in per capita spending for people with developmental disabilities. Only Mississippi offers its citizens less.

On average, Florida offers people with developmental disabilities $18,000, far below the national average of $35,000, according to The State of States in Developmental Disabilities: 2004 report.

Advocates Caution Those Relocating

John Hall, executive director of Florida ARC, advocates for the disabled, recommends to those thinking about relocating to Florida to either move elsewhere or to be prepared to wait years for state funding for at-home care under Medicaid waiver programs.

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