Slide 1 DOJ Settlement Agreement – 10 Year Summary January 24, 2013 As of February 24, 2015 Total Cost 1 $2.4 Billion$2.5 Billion GF Share of the Cost$1.2 Billion GF savings and offsets 2 $826.9 Million$775.5 Million New GF required 3 $380.7 Million$456.1 Million 1 Includes total state and federal costs to implement the DOJ settlement include ID/DD waivers, crisis management, family support, facility transition waivers, administration, monitoring, quality management systems, and facility closure costs. 2 Includes facility savings, appropriations that were in place in FY 2012 before the Trust Fund was established (base funding) and $60 million in Trust Funds that were provided in fiscal years 2012 and Base projections reflect actions by 2013 session of the General Assembly which added $30.4 million in adult crisis funds and $10 million in children’s crisis funding over nine years. Note: The current projections account for the additional costs needed to support the NVTC delay.

Slide 2 DOJ Funding Need over Ten Years The ten year funding need is in part forecasted as there are still six years remaining in the Settlement Agreement. $75M variance (20%) Housing Initiatives - $14M SIS Assessments - $12M DD Health Support Networks - $24M Bridge Funding - $3M

Slide 3 DOJ Funding & Expenditures 1 State match for waiver slots for those transitioning from the Training Centers to the community and for those on the community waiting list. Until the end of each fiscal year, DBHDS populates the line items with estimated accrued expenses based on average costs generated by DMAS. 2 Includes: one-time fund to provide and administer rental assistance to increase access to independent living options such as individuals’ own homes or apartments; capital subsidies for housing development; rent reserves; and transition supports. 3 Crisis stabilization programs offer a short-term alternative to institutionalization or hospitalization for individuals who need inpatient stabilization services. 4 Separation costs for Training Center employees, such as severance and retention bonuses. 5 Required Independent Reviewer that reports to the federal judge on DBHDS compliance with the DOJ settlement. 6 Expenses at DBHDS and DMAS that include licensing and Human Rights positions for community services oversight, and quality service reviews. 7 DBHDS funds some portion of the expense internally. 8 Direct and indirect savings realized from closing Training Centers. * FY 2015 budget includes both conference actions and carry forward from FY 2014.

Slide 4 DOJ Expenditure Variances Waivers Expenses are estimates until actual data is received from DMAS. Individual Family Support Program (IFSP) The IFSP application process has been broken into two cycles. The first cycle opened on September 15 th resulting in 3,000 applications. Distribution of funds will began in mid-November. The second cycle starts in March. Housing FY 2015 budget includes several initiatives funded with carry forward funds from FY The initiatives consist of: Capital subsidy for two (2) four bedroom Group Home for eight Arlington County residents; HUD 811 Rent Reserve; Transition Support (HUD 811 and Rental Choice VA); Capital Subsidy for additional integrated housing development to assistance with the closure of NVTC; and Increased integrated housing opportunities in NOVA and to create options for integrated day activities. DBHDS Administration The department is reimbursed quarterly for the relevant Medicaid reimbursable positions.

Slide 5 DOJ Expenditure Variances Licensing The current plan is to procure a Business Process Modeling vendor within the next two months to assess current state, benchmarking evaluation and proposed future state. The estimated cost for this is $90K – $100K and the effort should be completed by March The department projects closing the fiscal year with a remaining balance in this category. Discharge Monitoring Options for fulfilling this objective were reviewed with the PMO Oversight Committee on November 21 st. The Discharge Monitoring project will incorporate Referral Management at the request of the Regional Support Teams. The Discharge Planning component will be deployed to the Training Centers this spring The PMO is looking at opportunities to integrate this functionality with the planned Consolidated Waiver System. Bridge Funding There are many providers that have been approved funding that are not yet reflected in the expense data. Expenses are displayed once an invoice is received and paid.

Slide 6 Amendments to current budget General Fund $s

Slide 7 Amendments to current budget General Fund $s Additionally, the Conferees added $8.2 million general fund within DMAS to support waiver service rate increases, utilizing captured savings of $7.8 million general fund from a technical correction related to community I/DD waivers. Waiver rate increases were proposed for the following services: Congregate Residential (except sponsored placement), In-Home Residential; Day Support and Prevocational Services, Therapeutic Consultation, Skilled Nursing and EPSDT Nursing.

Slide 8 Conference Actions – Training Center Language Conferees include language which directs the Joint Subcommittee to: Monitor and review the closure plans for the three remaining training centers scheduled to close by Review detailed information from the department including cost information and analysis of training centers on a quarter basis (starting October 20, 2015). Consider options for individuals in the training centers with the most intensive medical and behavioral needs as wells as the plans for waiver redesign.

Slide 9 Conference Actions – Waiting List Language Conferees incorporate language which directs DBHDS to: Work with Community Service Boards to report available information on the services and support needs of individuals on the I/DD waiting lists by December 1, Estimate the number of graduates with I/DD who are exiting secondary education each fiscal year. This information will be used to allow the Commonwealth to better understand the needs of individuals on the waiting lists and more accurately establish enrollment priorities, project services costs, and develop capacity needed to serve such individuals.

Slide 10 Conference Actions – Waiver Redesign Language Within DMAS, the conferees include language which directs DMAS, in collaboration with DBHDS, to: Provide a report by November 1, 2015, to include “plans for the list of services to be included in each waiver, service limitations, provider qualifications, proposed licensing regulatory changes, proposed changes to rate structure for services, and cost to implement the changes.” Include in the report the number of individuals currently served by the waivers as well as level of service need. Conferees incorporate language which directs DBHDS to: Include stakeholders from the acquired brain injury community in their redesign process of the Medicaid waivers for individuals with I/DD.