Under pressure from legislators to cut costs, the Department of Human Services outlined a plan Tuesday that will seek federal permission to close the door on children with intellectual and developmental disabilities, cutting off a program to receive in-home supports unless their families are in or near poverty.
Disabled children who currently receive in-home supports would continue to get help for now, but next July, the Department of Human Services plans to cap the number of kids in the program based on current projections, and then force any new kids to sit on a waiting list if their families made more than 138 percent of poverty, about $34,000 for a family of four.
Parents might consider quitting their jobs to get assistance for their children. Otherwise, the only option would be to cover those costs themselves or place their child in foster care or a residential care facility, which the state will continue to fund at a clip of $13,000 a month, versus $1,800 a month on average for in-home supports.
A family of four living on an income of $35,000 would be on the hook for an annual average of $21,600 for in-home costs now picked up by the state.
The state has budgeted $3.1 billion from the general fund for the Department of Human Service this biennium. The changes would save about $300,000 this biennium and $3 million in 2019-2021 -- when the plan calls for current kids to be kicked out of the program if their families don’t meet the stringent income requirements. About a third of the children in the program could lose service.
Sen. Sara Gelser, D-Corvallis, protested the plan, noting that cutting these services for all but the poorest children could cause a hardship to many middle-class families, and likely lead to increased use of more expensive services for kids in residential facilities, of which there is also already a shortage of providers.
“We have boarding of children in hospital emergency rooms,” Gelser said. “We are taking away the safety net that keeps people from falling into poverty.”
Gelser gave an example of an upper-middle-class couple that hurt their backs lifting their disabled child without help, causing them to leave their jobs on disability. Examples of in-home supports in the current program include relief care for family caregivers; training for parents to assist their child; help preparing meals and bathing the child; and help with behavioral challenges.
DHS Just Following Legislative Orders
But DHS is only making these changes at the insistence of Gelser’s fellow Democrats in the Legislature, who demanded that the Developmental Disabilities Division shed $12 million and get on a path to sustainability.
A budget note slipped into the funding bill for the agency directed it to avoid limiting children’s services by income, but there was only so much low-hanging fruit to cut before taking steps to drastically curtail the program for disabled kids.
Developmental Disabilities Director Lilia Teninty testified that negotiations for a new waiver with the federal government are ongoing, but so far Oregon has not been given permission to set a new income threshold above 138 percent of poverty. The state would simply be allowed to limit services to a fixed number of children for those with any family incomes above that figure.
Placing an arbitrary limit on the number of enrollees would allow the state to finally rein in program costs, and funding for in-home services for disabled kids could more easily rise and fall based on budget constraints. The move announced Tuesday would return the state to the “bad old days,” when kids were arbitrarily denied help and a cap was placed to limit assistance to 800 children. Since the adoption of the Community First Choice program, or K Plan, the state now serves between 3,0000 and 4,000 children.
“The door to children was shut before the K Plan,” Teninty said. “The K Plan flew that door open wide.”
Under the K Plan, all children with qualifying disabilities could get whatever assistance they needed. The state badly underestimated the number of families who would apply for help and the program has grown substantially.
The cuts to service for some of the most vulnerable children in the state call into serious question the Democrats’ priorities, particularly after the passage of a $934 million deal to fund Medicaid, complete with tax hikes for hospitals and health insurers. That deal allowed the state to add new programs, including spending $36 million to provide healthcare for unauthorized immigrant children who would qualify for Medicaid except for their legal status, as well as $9 million for reproductive health services, including abortions, for women in similar immigration limbo.
Children as Bargaining Chip?
Sen. Elizabeth Steiner Hayward, D-Beaverton, defended the budget logic, which is often at the mercy of arcane federal rules governing Medicaid. “The federal government doesn’t let us merge funding streams. We’re very hamstrung by federal government restraints,” she said. “It’s not acceptable, but we also don’t have a choice.”
But with their legislative majority, the Democrats’ do control Oregon’s general fund, which provides all the funding for these new programs while they curtail support for disabled children.
The reaction from Rep. Knute Buehler of Bend, the only Republican present for a hearing on the cuts, was muted; Buehler had opposed the new healthcare programs for unauthorized immigrants because the cost would be borne entirely by the general fund.
Without mentioning how he’d continue to fit disabled children into the budget, Rep. Cedric Hayden, R-Cottage Grove, who was absent from Tuesday’s hearing, told The Lund Report afterward that he would oppose the plan as presented.
“That’s not an area that I would support cutting,” Hayden said. “There’s lots of other areas that we could look.”
Hayden, who has a daughter with a developmental disability, pays for her services with his own income as a dentist. But he said the state should not deny help to people based on income. “A disability is not something anyone chooses,” he said.
Democrats may be implementing a similar strategy as last year with Oregon Project Independence, using a popular program and a sympathetic group -- in that case, senior citizens -- as a bargaining chip to extract new revenue or make budget cuts elsewhere, even if actually cutting the program could cost the state money in the long-run.
In the end, Oregon Project Independence, which provides services to middle-class seniors to allow them to stay in their homes and avoid going on Medicaid, maintained its funding levels, even though Gov. Kate Brown warned the program was on the chopping block last December.
Brown and the Democrats did not get most of the new tax money they wanted in the most recent session, but they did pass the tax on hospitals and health insurers which helped backfill Medicaid, and the economy has been improving, bringing in more income tax revenue to the state.
Reach Chris Gray at [email protected].