Medicaid Waiver Would Help Residents with Developmental Disabilities

Beth Fitzgerald | June 12, 2012 | Health Care
The state is seeking more federal money to support community services over institutional living

New Jersey’s application for a Medicaid waiver would change the way federal money is administered for people with developmental disabilities, allowing many to stay out of institutions by receiving more community-based support services.

If approved, the state is proposing to spend $90 million a year on support that includes day programs for the disabled as an alternative to living in one of the state’s seven developmental centers. The Christie administration has added $57 million in its proposed budget to further help these efforts for people with a range of disabilities that include cerebral palsy, Down syndrome and autism.

On average it costs $260,000 a year to support an individual in a developmental center, compared with $170,000 in a community placement, according to Dawn Apgar, deputy commissioner for the Division of Developmental Disabilities in the state Department of Human Services.

Apgar recently told the annual conference of The ARC of New Jersey that DHS expects a decision on the New Jersey waiver proposal by the end of this year from the federal Centers for Medicare and Medicaid Services.

Called a “waiver” because it will allow New Jersey to design a Medicaid program different from other states, the proposal makes sweeping changes to the Medicaid program, which serves about 1.3 million low-income adults and children. Besides helping persons with disabilities avoid institutionalization, the waiver seeks to deliver mental health services more efficiently, and help the elderly age in their homes instead of nursing homes.

If the waiver gets federal approval, New Jersey projects getting federal reimbursement for about 40 percent to 50 percent of that spending, or as much as $45 million. About 2,500 individuals with disabilities now live in the state’s developmental centers, and the state wants to deinstitutionalize as many of them as possible. A task force appointed by Gov. Chris Christie is now studying whether to recommend closing one or more of the centers and is expected to issue a report in August.

Meanwhile, the increased state funding will allow New Jersey to provide services to about 600 more people in fiscal 2013 to enable them to live in the community, either in their homes or in supportive housing. Most of the 600 already live in the community and need more support in order to remain where they are. The figure also includes 175 people who will be able to move out of a developmental center into supportive housing the in the community.

“That is more than we have ever done before,” Apgar said. “This is a major initiative. There is definitely an enhanced commitment to moving people out of development centers.”

Thomas Baffuto, chief executive of The ARC of New Jersey, said New Jersey currently does not receive federal reimbursement for many of the community-based services it provides via Medicaid. “Under the waiver, New Jersey will be able to get money back — and 50 cents on the dollar is pretty good money.”

“What is new and different in 2013, is that in the governor’s proposed budget, we really are looking at serving people in the community,” Apgar said. “This investment in the community is really essential as we move from what has been more of an institutional focus, to a community-based model here in New Jersey for people with intellectual and developmental disabilities.”

Baffuto sees the increased funding sought by New Jersey as essential to carrying out the long-term goal of keeping New Jerseyans out of institutions and in the community. The Medicaid waiver envisions numerous changes to the program.

“We are optimistic that it will lead to better services, but we don’t have all the details yet, and we won’t know until we see how much of the waiver is approved by CMS,” he said.

ARC has 20 chapters around the state and serves about 4,000 people with disabilities in New Jersey. Baffuto noted that all the state’s efforts are leading in the direction of community care “and we absolutely support that — we believe people belong in the community.”

Robert Titus, public policy director of Autism New Jersey, noted that tens of thousands of New Jerseyans with disabilities are already living in the community. “There are organizations that have been doing this work successfully for 30 or 40 years.” His son, for example, who is 29 and has autism, lives in supervised housing operated by Eden Autism and is enrolled in a day program that includes social activities, work and recreation.