The 34th Annual Key Campaign will take place over a virtual platform in early March. The 2021 campaign priorities will be announced soon.
2021 Campaign Priorities
Priority 1: Eradicate the Waitlist for Developmental Disabilities Services
The Key Coalition has been advocating for over 30 years to eradicate the waitlist, giving people with disabilities access to needed services. Enhanced access will result in long-term cost savings to the State of Alaska by providing services early on and keep people in their home communities rather than in costly out-of-state institutions, Alaska Psychiatric Institute or jail.
Priority 2: Implement the Developmental Disabilities Shared Vision
Priority 2: Implement the Developmental Disabilities Shared Vision
2020 Campaign Priorities
Priority 1: REDUCE THE IDD WAITLIST REGISTRY
- As of January, 2020, 730 Alaskans with disabilities are on the waitlist for community-based services funded by the Medicaid Waiver.
- Only 50 people each year are drawn from the Waitlist. Previously, 200 people were selected annually.
- Savings from Medicaid Reform SB74 (2016) are available to help Alaskans with disabilities who are waiting for needed services.
Our 2020 Key Campaign ASK: Use the savings from SB74 to increase the waiver waitlist draw to a minimum of 100 people per year, in addition to filling vacancies from death or other circumstance to make sure the baseline of people getting services increases by 100 people per year.
Priority 2: PREDICTABLE, STABLE POLICES AND FUNDING
- The DD Shared Vision, through SB174 (2018, authorized in 2019), describes a flexible system in which individuals direct their own supports based on their strengths and abilities, toward a meaningful life in their home and community.
- Our current system does NOT provide predictable, stable funding, or a structure that supports the DD Vision
Our 2020 Key Campaign ASK: Bring SB174, the DD Vision, to life by reinvesting the cost savings from SB74 into new and existing waiver services that fulfill the vision for Alaskans with disabilities.
2019 Campaign Priorities
Increase the number of individuals selected annually for services from the Developmental Disabilities Registry (waitlist) from 50 to 100.
Ensure all eligible individuals previously receiving state grant-funded IDD services, some of whom have received services for decades, continue to receive services at the same level previously received.
Move Component Senior and Disabilities Services (2662)from RDU:Medicaid Services (595)to RDU: Senior and Disabilities Services (487).
Continue implementation of the Developmental Disabilities Shared Vision.
COST SAVINGS RECOMMENDATIONS
The following cost-saving recommendations have been previously submitted to SDS and the Legislature by the Key Coalition and remain viable options:
1 - REDUCE THE WAITLIST FOR DD SERVICES
Medicaid allows states to maintain waiting lists for home and community-based waiver services (HCBS) when demand exceeds resources. In Alaska, only individuals with IDD are impacted by a waitlist. Currently, 982 individuals are on the Developmental Disabilities Registry (waitlist). In FY16, SDS reduced the number of annual selections (draws) from the waitlist from 200 individuals to 50, which means individuals and families have to wait even longer to get needed services as the waitlist increases. The longer people remain on the waitlist, the more costs increase. Without supports, young adults on the waitlist lose the skills developed during school years. Without services, family members neglect their own health, forego employment and “try to do it all,” especially as they and their loved ones face the challenge of aging.
Note: Costs per person range from $37,330-96,093 for 84% of those served compared to $164,234 in nursing homes, $201,663 in out-of-state institutions and $531,312 at the Alaska Psychiatric Institute.If an additional 50 individuals were drawn from the registry each year, State General Fund costs would range from $933,250-$2,402,075, which includes a 50% federal match.
Return on Investment:
- Cost savings to the state: Community services cost considerably less than services provided in institutions, which by federal law must be provided if requested by the individual and/or family, even though most families would prefer to keep their children at home or close by.
- Increased employment and productivity: Most adults with IDD want to work and help support themselves financially. Research shows that Medicaid waiver-funded supported employment services result in more job placements, higher wages and hours worked per week (Nord, D., Luecking, R., Mank, D., Kiernan, W. and Wray, C. (2013). “The state of the science of employment and economic self-sufficiency for people with intellectual and developmental disabilities”, Intellectual and Developmental Disabilities, 51(5): 376-84)
- Increased family income: Receiving services for a child having with IDD makes it more likely a parent will continue working or gain employment. (Stabile, M. and Allin, S. (2012. “The economic costs of childhood disability,” The Future of Children(22(1:65-96)
- Improved caregiver health: Elderly caregivers without adequate supports are 63% more likely to die within a four-year period compared to non-caregivers. Services for a child increases the chance of the parents maintaining good health. (Scults, R. and Beach, S.R. (1999). “Caregiver is a risk factor for mortality: The caregiver health effects study,” Journal of the American Medical Association, 51(5): 376-84
2 - DEVELOP TECHNOLOGIES TO REDUCE DIRECT STAFF SUPPORT
The use of technologies, such as “smart home” and other electronic devices, can reduce the cost of direct staff support. Equipment may include video monitoring systems, tablets, smartphones, webcam and digital video conferencing. As technology has improved, the need for costly and highly specialized equipment has decreased. Routine investment in low-tech and even high-tech options has the potential to dramatically drive down the long-term costs of services provided to Alaskans with IDD.
Return on Investment: Charles Lea Center (CLC) in South Carolina works with SimplyHometo design customized supports for individuals with IDD based on each individual’s daily routines and priorities; 93% of the individuals served in residential settings use technology throughout their homes. Using technology costs CLC approximately $100 per day per individual; without technology, it would cost approximately $200 per day. In a recent survey, when individuals were asked if they felt safe in their homes, 100% said yes.
3 - ESTABLISH A MEDICAID WAIVER BILLING CODE FOR COMPANION SERVICES
Day Habilitation Services are provided to assist individuals with IDD to acquire, retain and improve their self-help, socialization, and adaptive skills necessary to live successfully in-home and community-based settings where the focus is on skill development. Knowing that day habilitation focuses on skill development, the rate for services is inherently higher. Through establishing the new service and billing code for Companion Services, individuals would be able to participate in the community and practice skills learned without an emphasis on skill development. A lower rate for this new service would result in notable savings.
Return on Investment: SDS would see savings of $18.24 per hour if day habilitation services, depending on the needs of the individual, were replaced with companion services.
4 - RE-ESTABLISH A BILLING CODE FOR THE SEMI-INDEPENDENT LIVING OPTION THAT DOES NOT REQUIRE 1:1 STAFF SUPPORT
Current regulations no longer provide for a “semi-independent living” residential option which allows several residents to receive staff support at the same time and provides a billing mechanism for these services. As a result, individuals who benefit from and desire “semi-independent living” services (that promote increased skill development, offer more privacy in apartment settings and learning through natural supports and modeling of housemates), no longer have this service option. Instead, they receive more expensive assisted living home services where State licensing mandates close supervision and direction of their daily living routines.
Return on Investment: Re-establishing a billing code for the semi-independent living/supported living option to SDS. One provider reports that for the 50 individuals who now receive assisted living services rather than semi-independent living services, costs increased by $2 million ($40,000 per individual) annually. This simple fix would save SDS at least $2 million per year.
5 - DEVELOP AN ALTERNATIVE APPROACH TO FUNDING SUPPORTED EMPLOYMENT SERVICES
According to current regulations, supported employment providers can only bill for services when working directly alongside an individual, such as would occur in an institution, thus not allowing an opportunity for independent skill development. In addition, supported employment services such as work incentives assistance, developing natural supports with co-workers, and job development is not reimbursed. As a result, providers have downsized or eliminated supported employment programs.
Return on Investment: There is considerable evidence from other states (Utah, Kansas, Michigan, Washington) that when individuals with disabilities work and receive ongoing supported employment services, other costs such as health care (general Medicaid program), food stamps, and energy assistance decrease. In addition, the ability to use the natural supports of co-workers decrease the cost of training supported employees by 57.6% and increased the length of time they were employed by 12.36 months. (Cimera, R. (2012), “The Economics of Supported Employment: What New Data Tells Us,” Journal of Vocational Rehabilitation, vol. 37, no. 2, pp. 109-117)
6 - FULLY IMPLEMENT THE DURABLE MEDICAL EQUIPMENT RE-USE PROGRAM AND THE ALASKA ABLE PROGRAM
Both the programs were established by the legislature, and regulations outlining their use have also been established. However, more attention needs to be given to their full implementation, including increased marketing, the development of incentives for providers to develop durable medical equipment re-use programs and increased information about the ABLE program.
Return on Investment: Kansas saw a $3.15 return on investment for every $1 spent on its durable medical equipment re-use program. The ABLE Plan allows eligible individuals with IDD to save money for qualified disability expenses without losing eligibility for programs like SSI and Medicaid. Funds may be used for expenses that increase or maintain health, independence, and quality of life. Enabling individuals with IDD to purchase what they need lowers the cost to the State.
In addition to joining Key Coalition advocacy efforts, we encourage you to contact your legislator in one of the following ways:
- By sending an email or submitting a Public Opinion Message (POM): Submit POM Online or Download, print and fax the POM Form to your local Legislative Information Office (LIO).
- By contacting your legislators directly. Find contact information on the Alaska State Legislative website by putting in your address.
- If you don’t have the exact information needed or need assistance, please call your local legislative information office. For a listing of the LIOs click here: http://w3.legis.state.ak.us/misc/lios.php
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