Background: The Developmental Disabilities Administration (DDA) within the Department of Social and Health Services (DSHS) serves clients in a variety of community and institutional settings. The level of support needed by DDA clients to assist them in their daily lives and help them participate in the community varies greatly across individuals. Some clients who have exceptional care and treatment needs receive care in state-run Residential Habilitation Centers (RHCs). Others may receive services through residential programs in community living situations, or receive services in their own homes. Services are offered under waivers; Home and Community Based Waiver services are a capped program and are only provided to individuals based on available funding. A number of individuals meet the statutory definition of having a developmental disability, have requested a service, and are waiting for an available slot.

On July 31, 2013, the State Auditor's Office released its Performance Audit of the DDA within DSHS. The Performance Audit found that over 20,500 individuals with developmental disabilities receive services from the state while an additional 15,100 who meet financial and physical eligibility requirements do not currently receive any services. The Performance Audit determined that this is "due in part to policy choices the state has made about the services it offers combined with insufficient funding to meet the demand for services." The Performance Audit recommended that the Legislature set policy and develop strategies to use cost-effective service options such as: (1) reducing the number of RHCs; (2) expanding crisis stabilization and emergency respite services in the community; and (3) providing resources to build peer support networks in the community to aid clients and their families with transportation, respite, and day activities. The Performance Audit also recommended that the Legislature set targets to reduce the waitlist and prioritize the people waiting for services by their needs.

Summary of Bill: DSHS must establish and maintain a service request list for individuals who are found to be eligible and have an assessed and unmet need for services offered under a home and community-based services waiver, but funding is not available to provide that service. Services must be prioritized for Medicaid-eligible clients and made available to non-Medicaid eligible clients based on available funding.

Appropriations are made as follows:

$116,000 from the general fund-state and $542,000 from general fund-federal for DSHS to develop and implement a Medicaid program to replace the Individual and Family Services program for Medicaid-eligible clients. The new Medicaid program must offer services that resemble the services offered through the individual and family services program. By June 30, 2017, DSHS must increase the number of clients served by 4000. General fund-state dollars previously provided for the Individual and Family Services may be used to cover the costs of increasing the number of clients served.
$20,000 from the general fund-state and $17,000 from general fund-federal to increase the number of clients served on the Home and Community Based Services Basic Plus Waiver program. By June 30, 2017, DSHS must increase the number served on the Home and Community Based Services Basic Plus Waiver program by 1000. General fund-state dollars previously provided for the Individual and Family Services may be used to cover the costs of increasing the number of clients served.
$301,000 from the general fund-state and $222,000 from the general fund-federal to implement the Community First Choice Option. DSHS must refinance Medicaid personal care services under the Community First Choice Option.

For fiscal year 2015, the general fund savings achieved by implementing a Medicaid program to replace the Individual and Family Services program must be used to implement the Community First Choice Option. For the 2015-17 and 2017-19 biennia, the general fund savings achieved by refinancing Medicaid personal care services under the Community First Choice Option must be used to offset costs relating to the increased client caseloads, and the remaining savings must revert to the general fund.

Staff Summary of Public Testimony: PRO: This addresses the list of people who are requesting a DDA service, but who are waiting for the service because funding is not available. This will address the waitlist in three years and provide 5000 people services. Services that will be provided include respite and employment services. This will keep families together and is an economical approach for the state. Giving people access to employment services is beneficial to all. There is a need for respite services to help families; some have been on the waitlist for years. This provides needed support for families and demonstrates the need for community support to take care of children in their homes. We need families to have resources, and we need to get them off the waitlist. Rather than have savings revert to the general fund, savings should go back to the home and community system. The no-paid services caseload is bigger than the waitlist, and the no-paid services caseload still needs to be addressed. Services that will be provided will teach people to become more independent, and this will lower the fiscal note over time. People with significant disabilities live at home, and those people need more help. They need services to teach them more skills. We support families and the opportunity to keep people in their homes. People on the waitlist receive services if they go into crisis; providing them services prevents these crisis situations.

CON: The Community First Choice Option will move people into community placements. This will close residential habilitation centers, will cost more money, and put people in harm's way.

OTHER: We support use of the Community First Choice Option and remaining savings should be distributed between the aging and disability communities.

Persons Testifying: PRO: Senator Hill, prime sponsor; Marcie Osborne, Community Employment Alliance; Margaret-Lee Thompson, The Arc of the United States, Board; Heather Hebdon, Partnerships for Action Voices for Empowerment; Sue Elliott, Arc of WA State; Donna Patrick, Developmental Disabilities Council; Evelyn Perez, Asst. Secretary for the Developmental Disabilities Administration; Emily Rogers, Self Advocates in Leadership; Jerry Reilly, ElderCare Alliance; Cathy Knight, WA Assn. of Area Agencies on Aging; Darla Helt, WA State Parent Coalitions; Kelly Church, Diane Perry, citizens.

CON: Paul Strand, Action DD.

OTHER: Mary Clogston, American Assn. of Retired Persons.