Friday, January 20, 2023
Illinois Association of Rehabilitation Facilities CEO calls for additional dollars for providers serving people with disabilities
Before lawmakers wrapped up last week’s lame duck session, they amended a broader spending plan to provide $12.5 million in new supplemental funding to address workforce shortages for community-based providers serving children and adults with intellectual and developmental disabilities and serious mental illnesses.
Josh Evans, CEO of Illinois Association of Rehabilitation Facilities, told Health News Illinois this week they appreciated the support and hop to get that money to providers quickly.
The association sought $56 million during the session for a five-year funding plan to support developmental disability services as laid out in a 2020 state report that sought to further fund providers after years of under-investment.
“I don’t want it to be lost on any member of the General Assembly or the administration, we are very thankful for the prioritization of services and increased funding,” Evans said. “We’re doing the best we can to put those dollars to work to meet the missions of our organizations and service. It’s just we’ve got to do more, and we have to continue to prioritize, and we will get to a point of excellence in Illinois.”
He spoke about the latest funding and advocacy work planned for the months ahead as lawmakers prepare for the 2023 spring session.
Edited excerpts below:
HNI: What will that $12.5 million in new supplemental funding mean for improving the workforce?
JE: Our understanding about the intent of those dollars, both in the language as put in but also with legislators talking on the floor during debate, was that the $12.5 million goes in the form of recruitment and retention bonuses for front-line staff working in developmental disability service provider and grantee agencies. We understand front-line staff to be broadly construed — direct support professionals, qualified intellectual disability professionals — basically those that work in our member agencies that are implementing service plans and supporting persons directly. So not administrative level staff. That’s our understanding of the intent of that $12.5 million.
HNI: The association had been advocating for $56 million during the lame-duck session. What was the intent of that ask?
JE: So during much of the pandemic, the Department (of Human Services) had applied the equivalent of a 7 percent rate adjustment on a lot of residential services that persons with developmental disabilities receive, and that was being phased out at the end of the calendar year or mid-way through the current fiscal year. That was a pandemic-era rate adjustment and attempted to help those service providers have additional resources to deal with the costs associated with the pandemic economy. We knew those were going to be phased out. And one of the things that we have frequently heard from members is concerns about workforce recruitment and retention. It’s the number one thing that I think a lot of healthcare and social services talk about with their members. And we knew with the approval of the fiscal year 23 budget and the amount that was put in for the rate study and the timing of implementing those rates, that we were going to continue to run into workforce challenges. And so we tracked data from our member agencies over the summer to figure out where they’re at with vacancy and turnover rates. And then what we decided was this remains enough of an issue that we needed to try to seek supplemental funding from the General Assembly. And so our communication efforts, our advocacy and outreach began well before the veto session. Our expectations were that we needed to try to communicate the need to members of the General Assembly, understanding it’s a rare thing that there would be a supplemental advance during a veto session. So we were really sort of engineering our efforts then, understanding that hopefully there would be a consideration in the lame duck session of a supplemental. As we were making the case for that supplemental, we were tracking what was coming from (the Office of Management and Budget), what was coming from the Commission of Government Forecasting and Accountability on where the revenue growth was with the state of Illinois for our current budget year that was not appropriated. And this is the second year in a row where we under-appropriated or our projections are off in terms of revenues. And so that emboldened the entire disability space, which is to say that we knew there were going to be revenues that were appropriated and so we continued to push with lawmakers, ‘We have a need here. We would like to address pandemic-related costs. We would like to get dollars that we could use as incentives for recruitment and retention in our space.’ And that was really where the advocacy was.
And we requested $56 million based on an overall number across all disability services in Illinois, developmental disability services, not just group home services. I mentioned that 7 percent adjustment that applied to one sector of developmental disability services. There wasn’t a pandemic relief adjustment for the other sectors of disability services, and we wanted to try to get resources into the hands of those providers to help them with recruitment and retention. So that was sort of the goal. Where we ended up with the supplemental bill that was ultimately passed was about 22 percent, I think, of that overall ask. I don’t know what the rhyme or reason was about the amount that was ultimately appropriated. We were just thankful that the General Assembly ended up prioritizing that and the supplemental and our goals would be is to do what we can to work with the administration on whatever path they decide upon to get those dollars out as quickly as possible.
HNI: Where is the state at in regard to funding the rate study to support community-based services for people with disabilities?
JE: It took about two years from soup to nuts to identify recommendations and to put numbers around those recommendations with that rate study. It was published in 2020, and what we did — and by we, I mean the broader advocacy community and all the groups that traditionally advocate on behalf of persons with developmental disabilities and those services boards — we went to the General Assembly seeking full funding immediately, which year one would have been about $329.5 million to fund all the priorities in the rate study. Sort of concurrently with that, the administration has identified a seven-year funding plan from the fiscal 22 budget … They’ve identified a plan because they’ve stated the commitment, ‘We are going to find the rate study.’ And we acknowledge and we thank the administration for that commitment. But I think the issue is, and we’ve been pretty clear with that, is that that timeline is not something that we’re in sync with. We think it’s too long of a timeline. It doesn’t recognize the staffing shortages that predated the rate study, and certainly predated COVID-19 and the impact of the COVID-19 economy across all healthcare and social services. So we’re immediately behind in terms of our perspective on getting this rate study funded because it’s a pre-pandemic report. Inflation has impacted the workforce substantially. It’s impacted take-home dollars, everything else. It’s not been inflation adjusted, so to speak. I guess you could say that we’re now two years into the administration’s seven-year funding plan, and we continue to have or try to have discussions with them about where the pressure points are, continue to try to bring them along with us in terms of what we’re seeing in the field and what we see as the need in the field. And we would really like to see that plan expedited in the governor’s introduced budget as soon as this coming Feb. 15. And so our efforts right now are engineered by talking with the administration, talking with lawmakers to see if we can’t adjust that plan so that we can get dollars out more meaningfully more quickly.
HNI: How are you looking to adjust your advocacy work headed into the spring session?
JE: We sought year-one funding, full funding, which was $329.5 million. That’s the gross number. When you roll in Medicaid matching on that, it brings that number down substantially. We weren’t successful. So what would have been year two, which is the current budget year, we advocated trying to get caught up to what full funding would be, because if you don’t fund the rate study fully in year one, you’re increasing your out-year costs and your annualization costs and the costs that are associated with that. And so we were seeking like a $400 million-plus appropriation for fiscal year 23 to get caught up. Ultimately, we weren’t successful with that. There was about $94.5 million that the General Assembly did graciously include in this fiscal year 23 budget.
And what we’re going to be seeing now through the end of this calendar year is a lot of those rate increases going into place. Where we are now is that we’re seeing mid-fiscal year rate adjustments. These rate adjustments don’t start at the beginning of the fiscal year, which is July 1 of every year. It takes about six months for the administration to negotiate with (the Centers for Medicare and Medicaid Services) on the appropriate waiver changes, and we recognize that they need that time to do that. And so that’s where we’re at in terms of what has been put in place for the current fiscal year. Where we’ve landed for next year is we’ve looked at where our efforts are, and we’ve looked at where the need is, and we’ve decided as an association, ‘Let’s try to advocate to fully fund one component of the rate study at least for fiscal year 24.’ And that component is to try to get the direct support professional wage rate up to 150 percent of the statewide, the regional and the local minimum wage. And that’s because Cook County and Chicago, they’re on a different minimum wage than the rest of the state. So rather than seeking to get the remainder of the rate study funded in fiscal year 24, which the state has on a seven-year timeline, can we at least fund this most pressing need, which is to get that 150 percent adjustment in place? And we’re currently in the process of trying to figure out what that cost is because, according to our numbers, that would have basically be about a $4 an hour increase to the DSP rate for fiscal year 24.
HNI: How is the workforce doing at this point?
JE: So I mentioned earlier that we have been tracking across the trades and the They Deserve More coalition what our indicators were and where we stand going into this calendar year. We were looking at about a 25 percent vacancy rate for DSPs, 23 percent vacancy rate for the next step up, which is our front-line supervisors and our case managers. Equally concerning, we were seeing 28 percent, nearly 30 percent of providers that were not accepting individuals newly into their services, entirely almost a byproduct of not having sufficient staff. So I mean, 28 percent, nearly 30 percent is not an insignificant number when one of the goals of all of us here in Illinois, both on the regulatory side and on the service side, is to expand services. We want to serve more people, and we had 30 percent of organizations that are saying, ‘We can’t serve people because we don’t have the staff.’ Regrettably, over that same timeframe, we had heard that 14 percent of providers across the state had closed down residential services. What’s that mean? It means that they’ve either had to consolidate a group home. Where there may have been four individuals living in a group home, maybe now there are six to eight. That’s not a direction we want to go as a state as well. We want to see smaller, more integrated service options. But additionally, some of that capacity has closed down. They’ve had to shut down group homes and consolidate. We want to be going in the opposite direction. That’s not a positive indicator when we think about where we’re going as a service array. And then finally, 72 percent, an overwhelming majority of providers, delayed service expansion because of staffing shortages. And so I think that’s a tough thing to think about.
The General Assembly and administration has prioritized increased funding for disability services, particularly in the last two fiscal years, but we’re not seeing what we want to see in terms of workforce expansion and service expansion. And I think that’s largely due to some things that are beyond our control. The pandemic environment really impacted a lot of industries, including healthcare and social services, but also it’s the pace with which the administration is identifying they want to fund the rate study. I firmly believe — I don’t know if it’s hindsight 20/20 or speculation — that had we been in a position to fund that rate study fully in the previous fiscal year, I think we would have had a leg up on a lot of sectors in our ability to offer wages and benefits that would be very attractive to keep our workforce staffed. I guess it’s easy for me to say that because we’ll never know. But knowing that it was a pre-pandemic rate study and knowing that it’s not been adjusted for the pandemic environment, we’re behind. So every year we’re trying to put dollars in, we’re trying to play catch up at this point, rather than get ahead, which was one of the goals. So we continue to struggle. We hope that the current adjustments that are in place now and going out here soon will make a difference, particularly in a group home setting. And depending on the timeline with which this $12.5 million supplemental goes out, we hope that will be effective as well. But we’re going to continue to plow ahead to try to get this DSP wage rate funded in the fiscal year 24 budget. We’ve sought conversations with the administration before they announce their budget plans, and we’re hoping that we can see some synergies there in the governor’s introduced budget that will be our goal for the year, to continue to try to put dollars where the most pressing need is, and that is in workforce.