1. Arkansas Health Care Reform Task Force – ID/DD Wait List
Exploring Options for Addressing the Wait List for the DDS Alternative Community Services (ACS) Waiver Program for the Intellectually Disabled and Developmentally Delayed
March 2016

2. Executive Summary
TSG reports what a new waiver benefit would look like for the 2,640 people on the ID/DD wait list
Top-5 benefits except Supportive Living

3. Agenda Review historical spending for Waiver program
Report results of a survey of households on the wait list
Model the effect of alternative capped a range of alternative waiver programs
Recommend path forward

4. Waiver Background
Improve the quality of services through Home and Community Based Waiver Services provided under a 1915 waiver for a limited number of individuals as an alternative to ICF/ID placement
Serving targeted populations: mental illness, and intellectual, developmental or physical disabilities with an age of onset before age 22
Participation capped at 3,9881, with turnover, served 4,127 different individuals in SFY2015
Wait list of 2,640
1 -

5. Services
Supportive Living – enable beneficiaries to live in their own homes, with their family, or in an alternative residence
Respite Services – short-term benefits for beneficiaries unable to care for themselves due to absence of non-paid caregivers
Supportive Employment – enable beneficiaries who need intensive ongoing support to perform in a competitive work setting
Adaptive Equipment – equipment to increase, maintain or improve functional capabilities to perform daily life tasks
Vehicle Modifications – adaptations to an automobile or van to accommodate the special needs of the beneficiary
Environmental Modifications – modifications made to or at the beneficiary’s home

6. Services (cont.)
Specialized Medical Supplies – items necessary for life support not otherwise available under Medicaid
Supplemental Support Service – enable community living, in response to crisis, emergency or life threatening situations
Case Management Services – assistance in gaining access to needed services, in or out of the Waiver
Consultation Services – clinical and therapeutic services
Crisis Intervention Services – in the beneficiary’s home or other local community site by a mobile intervention team
Community Transition Services – set-up expenses for beneficiaries who are transitioning from an institution

7. SFY2015 Services by Claim Amount
Claims data from SFY2015 federal Expenditures Report
96% of Waiver Spending is for Supportive Living
20% of beneficiaries spend less than $20,000 – 80% less than $70,000

8. Spending by Service Type
Total Waiver Claims Amount
Unique Beneficiary Count
Average for Those Claiming Benefit
Percent
Supportive Living
196,404,211
4,013
48,979
95.9%
Case Management Services
5,550,856
4,094
1,357
2.7%
Supportive Employment
668,300
103
6,617
0.3%
Specialized Medical Supplies
642,407
925
696
Consultation Services
453,751
733
621
0.2%
Adaptive Equipment -ACS
392,835
155
2,568
Respite Services
380,605
153
2,521
Environmental Modifications
238,010 52
4,760
0.1%
Supplemental Support Service
16,462 17
1,097
0.0%
Adaptive Equipment - PERS Monthly Fee
13,733 31
474
Adaptive Equipment - PERS Installation
479 6
120
Total
204,761,648
4,124
49,675
100.0%
Claims data from SFY2015

9. Supportive Living Averages $49,000
Claims data from SFY2015

10. Cost of Services Other Than Supportive Living
Claims data from SFY2015

11. Services other than Supportive Living Rarely Total More than $6,000
A program capped at $6,000 would meet 96% of needs other than Living Support
Claims data from SFY2015

12. A Program Capped at as Little as $6,000 would Cover Most Historic Claims -- Except Supportive Living
Claims data from SFY2015

13. Agenda Review current spending for Waiver program
Report results of a survey of households on the wait list
Model the effect of alternative capped a range of alternative waiver programs
Recommend path forward

14. Survey Method
Survey invitation sent by US mail to 2,640 individuals on the wait list
Asked to rank the top 5 most important benefits from the list
Respondents responded by using a web survey
Asked for comments at the end of the survey
Offered the opportunity to respond anonymously or provide detailed contact information
Respondents spent an average of 8 minutes responding (long for a web-based survey). This suggests they took it seriously

15. Responses Covered the State
440 responses in 10 days—17% response rate
81% provided addresses
All but one provided a comment
Responses represented the entire state
Note: 81% of responses provided name and address, only these are graphed

16. How the Services were Ranked

17. Services by Rank Red: Supportive Living Yellow: Respite Care
Lt. Green: Case Management
Lt. Blue: Supportive Employment
Dark Blue: Environmental Mods

18. Summary Findings from Survey
Supportive Living is #1, but not as strongly favored as the 97% of current Waiver participants that claim for Supportive Living
Respite and Case Management are clear #2&3 for those on the wait list
Responses are widely dispersed—strongly supporting the notion of self-determination of services
Response rate, and number, size and tone of comments all suggest that the wait list is a very unhappy group, looking to the legislature for quick relief
Respondents would rather have some benefits even if it is less that the whole Waiver program
Respondents seek more self-direction
The selection process should be faster, clearer and more transparent

19. Agenda Review current spending for Waiver program
Report results of a survey of households on the wait list
Model the effect of alternative capped a range of alternative waiver programs
Recommend path forward

20. What if…
TSG has modeled a waiver like those in Indiana, Tennessee and Kentucky. It would…
Provide a benefit capped at an amount much smaller that the average of claims for those already on the Waiver
Allow recipients substantial latitude to spend up to the cap on any of the services. Both models assume that for most beneficiaries, the capped amount would not be sufficient to fun a meaningful part of Supportive Living
This model considered simply for the purpose of understanding what might result from such a capped benefit

21. TSG Developed the Model Based On
Assumptions:
Services usage based on survey responses
Services cost based on historic Waiver claims
Assuming the program would allow beneficiaries to claim services up to the cap
Excluding Supportive Housing from the value assessment, as we know it averages $50,000, beyond other state caps
Seeking to find out:
What services would beneficiaries likely spend the capped amount on?
How far would the capped benefit go towards “buying” all of their 5 highest ranked services?
How much would the two scenarios cost in total, assuming 2,640 people came off the wait list into the new waiver program

22. Self-Directed Benefit Simulation
86%
72%
72% of top-5 needs (other than Supportive Living) met by a cap of $12,000
86% by a benefit capped at $15,000
The #4 & #5-ranked services are often the more expensive ones

23. Agenda Review current spending for Waiver program
Report results of a survey of households on the wait list
Model the effect of alternative capped a range of alternative waiver programs: Next Task Force Update
Recommend path forward

24. Full Cost of Capped Waiver for 2,640 on the ID/DD Wait List
Capped at $12,000
Capped at $15,000
Beneficiaries capped benefit: all services
$31,680 MM
$39,600 MM
Arkansas State Match Cost
$9,504 MM
$11,880 MM