1. State Budget

2. DAP Group Homes

3. Autism Insurance Reform

Actuarial Study of the Cost of Proposed Insurance Reform in Delaware

4. Needs-Based Funding

1. Self Directed Support Waivers
In 2006-7 Autism Delaware formed the Delaware Advocacy Coalition for the Family Support Waiver with seven other disability organizations in order to advocate for the inclusion of a Medicaid Family Support Waiver. Our partners in that effort included the ARC of Delaware, CERTS (Collaborative Effort to Reinforce Transition Success), Down Syndrome Association of Delaware, Easter Seals of Delaware, Family Voices of Delaware, Lower Delaware Autism Foundation, Parent Information Center of Delaware, Delaware Association of Rehabilitation Facilities and United Cerebral Palsy of Delaware.

Although our initial effort was unsuccessful, in 2008 the Division of Developmental Disabilities Services started a process to self-fund a new waiver, called the Self Directed Support Waiver which was successful.

Summary
The Self Directed Support Waiver is available in many states across the country including all of Delaware’s neighboring states. This waiver targets individuals who live with their families. It would allow adults with developmental disabilities and their families to select services that best meet their individual needs for a day or vocational program. The Delaware waiver would allow individuals and families to direct their major day or vocational services, and to receive a small amount to purchase ancillary services such as additional respite care, adaptive equipment, special therapies or home modification. For those who are eligible, it ensures that a day program will be available and provides transportation, education, a support broker and a fiscal intermediary. The combination of services and the flexibility to direct services is designed to enable more families to keep their adult children living at home longer, saving state funds by staying out of much more expensive residential placements. Additionally, the waiver would draw an equal amount of federal dollars to the State of Delaware, matching every state dollar with a federal dollar.

In response to citizen demand for more flexible services, the Division of Developmental Disabilities requested partial funding of the waiver ($1,128,300) in their 2007 OMB hearing. However the Governor did not include ANY funding for the waiver in that budget. Subsequently, the Division of Developmental Disabilities Services made a decision to self-fund the state component in 2008 and re-named it the Self Directed Support Waiver. That request was accepted and we anticipated opening the process to individuals in April 2009.  The recent economic crisis has impacted the waiver so the DDDS is considering pushing back the start date and starting with fewer individuals. It is currently unclear if the waiver will be put into effect in the current year.

How Service Delivery under Self Directed Supports Waiver would work:
The waiver provides the mechanism for individuals and their families to choose their providers and direct the services they receive. Individuals and families may even choose to hire their own staff instead of working with a community agency. Additionally, each family would receive an allocation of $2,500 to use for services called for in the Essential Lifestyle Plan, developed with their Support Coordinator. (The Coordinator is responsible for advising the individual and family, arranging services and providers, and serving as a job coach or other support when needed.)

The Human Factor: The Self Directed Support Waiver would benefit families by: 
  Promoting access to supports that allow adults to stay at home and out of fully funded state residential placements.

  Promoting cost-effective decisions that meet real needs while enhancing decision making.

  Keeping families together longer allowing more productive and economically prosperous lives for all involved.

Financial Facts about the Self Directed Supports Waiver: 
  The costs of residential care far outweigh the costs of home care.

  The cost of a group home ranges from an average of $35,000 (state dollars), to as much as $65,000 for someone with significant behaviors or other support needs.

  Flexible, appropriate services provided in the community reduce the use residential placements, which in turn reduces the state’s costs.

  Over the years, that reduction in costs will add up to a substantial savings to the State of Delaware.

2. Medicaid Buy-In:

The Medicaid for Workers with Disabilities (MWD) Program is available to current and new Medicaid beneficiaries with disabilities who meet the MWD eligibility requirements. MWD is an employment initiative that provides comprehensive health insurance coverage to encourage people with disabilities to work or increase their level of work, increase their disposable income, and reduce or eliminate dependency on cash assistance programs. In FY 2008 the State supported funding of the Medicaid Buy-In program however it’s not clear what the future of this program will be with the change in administration and the change in economic conditions.