FY 2016 Appropriation

The Community Supports (Medicaid Home and Community-based Services) Waiver allows states to provide services to individuals using Medicaid funds outside of standard institutional programs. Participants must be qualified for admission to an institution such as an ICF/ID. Assistance that may be provided under the waiver program includes a multitude of services ranging from family support to 24-hour residential care.

Funding History

Funding Issues

Direct Care Staff Salary Increase

This request would raise the wage of direct care workers providing services for the Division of Services for People with Disabiities (DSPD). The increase would apply to any 'waiver code' where there is a direct care worker. During FY 2014 DSPD had difficulty placing individuals already funded by the Legislature because community providers were unable to staff these placements due to lack of appropriate staff. This difficult is evidenced by DSPD nonlapsing $6.7 million in state funds (meant for services) at the end of FY 2014. The issue meant that families anticipating receiving services already approved had to wait for as long as six months to receive that service. The issue also involves access with regard to the Medicaid waiver and quality of care when appropiate staff cannot be hired.

Disabilities Mandated Additional Needs

There is a Medicaid requirement that the health and safety service needs of individuals receiving waiver services be met. Of the 4,800 covered individuals, 660 or 13.8 % identified last year as having increased health and safety needs. This is an increase from the base of 1.9%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."

Disabilities Waiting List

The Disability Waiting List was funded in the 2014 General Session with one-time money. Advocates are looking to make this funding ongoing plus any additional funding request in the 2015 General Session. If the Legislature funds approximately 150 individuals currently on the waiting list for services it would cost about $1,000,000 in General Fund and $3,500,000 in total funds. This is an increase from the base of 1.86%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."

Federal Medical Assistance Percentage Change (FMAP)

This increased cost reflects a lower federal medical assistance match rate for FY 2016. The Federal Medical Assistance Percentage (FMAP) represents the federal share of the programmatic costs for Medicaid, Foster Care, and Adoption Assistance. When the federal government's participation rate goes up, the state of Utah's participation goes down in a commensurate manner. The federal government utilizes a formula to determine its annual percent of FMAP based on a rolling three year average of per capita income levels compared to the national average. By law the FMAP rate cannot be lower than 50 percent or higher than 83 percent.

Youth Aging Out of DCFS Custody

This request maintains youth with intellectual disabilities on the Medicaid waiver who are aging out of the Division of Child and Family Services (DCFS) custody. DCFS is currently providing the funding until a person reaches age 18 (sometimes up to age 22). This item was funded $455,200 one-time General Fund in 2014 General Session. The underlying dynamics of the program would require an ongoing funding to replace the one-time funding plus any estimate in growth (or decline) of the need. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $222,652,200 from all sources for Community Supports Waiver. This is a 10.9 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $63,615,000 from the General/Education Funds, an increase of 26.2 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

The following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Background Checks/HB 145 Vulnerable Adult Workers$231,400$0
OngoingOne-TimeFinancing Source
$88,700$0General Fund
$142,700$0Transfers - Medicaid
Human Services - Background Checks & HB 145 - Vulnerable Adult Worker Amendments - "to enable background checks of employees working with vulnerable adults."
Direct Care Staff Salary Increase$14,260,400$4,211,600
OngoingOne-TimeFinancing Source
$4,232,500$0General Fund
$0$1,250,000General Fund, One-time
$10,027,900$2,961,600Transfers - Medicaid
This request would raise the wage of direct care workers providing services for the Division of Services for People with Disabiities (DSPD). The increase would apply to any 'waiver code' where there is a direct care worker. During FY 2014 DSPD had difficulty placing individuals already funded by the Legislature because community providers were unable to staff these placements due to lack of appropriate staff. This difficult is evidenced by DSPD nonlapsing $6.7 million in state funds (meant for services) at the end of FY 2014. The issue meant that families anticipating receiving services already approved had to wait for as long as six months to receive that service. The issue also involves access with regard to the Medicaid waiver and quality of care when appropiate staff cannot be hired.
Direct Care Staff Salary Increase - Internal Funding$3,917,500$0
OngoingOne-TimeFinancing Source
$1,162,700$0General Fund
$2,754,800$0Transfers - Medicaid
This request would raise the wage of direct care workers providing services for the Division of Services for People with Disabiities (DSPD). The increase would apply to any 'waiver code' where there is a direct care worker. During FY 2014 DSPD had difficulty placing individuals already funded by the Legislature because community providers were unable to staff these placements due to lack of appropriate staff. This difficult is evidenced by DSPD nonlapsing $6.7 million in state funds (meant for services) at the end of FY 2014. The issue meant that families anticipating receiving services already approved had to wait for as long as six months to receive that service. The issue also involves the issue of access with regard to the Medicaid waiver and quality of care when appropiate staff cannot be hired.
Disabilities - Capital Development Assistance$0$500,000
OngoingOne-TimeFinancing Source
$0$500,000General Fund, One-time
The funding could either be for FY 2015 or FY 2016. The funding will be used to assist individuals with disabilities living in community settings where the services are throughout much of the state.
Disabilities - Inclusive Schools, Communities, Workplaces$0$50,000
OngoingOne-TimeFinancing Source
$0$50,000General Fund, One-time
The funding is to provide assistance for creating inclusive schools, communities, and workplaces for individuals with disabilities.
Disabilities Mandated Additional Needs$5,157,000 ($3,697,100)
OngoingOne-TimeFinancing Source
$1,530,600$0General Fund
$0 ($1,097,300)General Fund, One-time
$3,626,400 ($2,599,800)Transfers - Medicaid
There is a Medicaid requirement that the health and safety service needs of individuals receiving waiver services be met. Of the 4,800 covered individuals, 660 or 13.8 % identified last year as having increased health and safety needs. This is an increase from the base of 1.9%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
Disabilities Transportation$0$508,600
OngoingOne-TimeFinancing Source
$0$150,000General Fund, One-time
$0$358,600Transfers - Medicaid
Increases the rate for transportation services for people with disabilities to get from their homes to day programs, jobs, and other activities. This item was funded with one-time money during the 2014 General Session. Intent language was included to study the issue and provide a report to the LFA (which was done). The report included a number of recommendations almost all of which consisted of increasing the rates in various ways.
Disabilities Waiting List$0$4,211,600
OngoingOne-TimeFinancing Source
$0$1,250,000General Fund, One-time
$0$2,961,600Transfers - Medicaid
The Disability Waiting List was funded in the 2014 General Session with one-time money. Advocates are looking to make this funding ongoing plus any additional funding request in the 2015 General Session. If the Legislature funds approximately 150 individuals currently on the waiting list for services it would cost about $1,000,000 in General Fund and $3,500,000 in total funds. This is an increase from the base of 1.86%. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
DSPD Nonlapsing Carryforward$0 ($6,676,200)
OngoingOne-TimeFinancing Source
$0 ($6,676,200)General Fund, One-time
DHS - DSPD Nonlapsing carryforward - the Division of Services for People with Disabilities (DSPD) has a large amount of unspent General Fund it has carried from FY 2014 into FY 2015. DSPD suggests this funding is due to difficulties in placing individuals into services in a timely manner. This funding is one-time. Utah Code (UCA 62A-5-102(7) dictates how nonlapsing funds may be used. DSPD would like to use the one-time funding to provide $5,000 in Respite Services per person to 850 people currently on the DSPD Waiting List ($4,250,000) and to cover: 1) the costs of Mandated Additional Needs for individuals currently receiving Medicaid Waiver Services who experience a loss of natural supports or a deterioration in health or behavior requiring additional supports to ensure their health and safety ($1,530,600); 2) the additional General Fund costs of children aging out of DCFS and DJJS custody who are receiving Medicaid Waiver Services through DSPD ($537,900); and 3) continue, and add to, the one-time transportation rate increase appropriated for FY 2015 ($357,700). The subcommittee may choose to agree with these uses or to use the funding in an alternate manner.
Nonlapsing Balance Transfer$0$475,000
OngoingOne-TimeFinancing Source
$0$475,000Beginning Nonlapsing
No Description
Portability - Transfer IN - DOH to DHS$1,146,900$0
OngoingOne-TimeFinancing Source
$340,400$0General Fund
$806,500$0Transfers - Medicaid
Transfer ongoing General Fund of $1,466,000 for portability and transition programs beginning in FY 2015 from the Department of Health's Medicaid Optional Services to the Department of Human Services' Division of Services for People with Disabilities. The clients associated with the funding have already transferred from Health to Human Services. This adjustment facilitates the funding following the person. Both the Department of Health and the Department of Human Services agree with this transfer.
Youth Aging Out of DCFS Custody$537,900$0
OngoingOne-TimeFinancing Source
$537,900$0General Fund
This request maintains youth with intellectual disabilities on the Medicaid waiver who are aging out of the Division of Child and Family Services (DCFS) custody. DCFS is currently providing the funding until a person reaches age 18 (sometimes up to age 22). This item was funded $455,200 one-time General Fund in 2014 General Session. The underlying dynamics of the program would require an ongoing funding to replace the one-time funding plus any estimate in growth (or decline) of the need. How Measure Success? "Percent of people who are satisfied with their staff, support coordinator, and fiscal agent."
Staff Analysis

For the most recent completed fiscal year, the following information represents the purposes for which the money was used:

Community Supports Waiver Detailed Purposes

Community Supports Waiver Expenditures by Category

DSPD Community Services Providers

The Community Supports Waiver is considered a statewide program including all rural areas and is open to all residents of Utah with intellectual disabilities eligible for care. There is no statutory requirement for distribution of funds or allocation of slots by geographic region. The Division of Services for People with Disabilities (DSPD) "does not distribute funds based on location, but rather based on the unique needs of the individual receiving services. Persons are not brought into DSPD services based on location but rather the severity of their needs, and those with the most severe needs are brought into services first . . . DSPD serves Utahns in greatest need of services without consideration of their location."

Percent of providers meeting fiscal requirements of contract

Percent of providers meeting non-fiscal requirements of contract

Residential Services include five basic models which fall under two broad categories: 1) supported living and 2) supervised living.

  1. Supported Living -- Trained staff are available to provide support services as needed for less than 24 hours a day. There are two models of supported living services:
      2. Supported living arrangements: Consumers live independently in their own homes or apartments and receive periodic assistance and training with money management and other skills necessary for independent living.
      Supervised apartments: Consumers live in apartments with two or three people. Apartment supervisors are available to provide whatever assistance may be needed.
  2. Supervised Living -- Trained staff are available to provide supervision and support 24 hours a day. There are three models of supervised living services:
      3. Residential Habilitive Supports: Individually tailored 24 hour supports that assist with acquisition, retention, or improvement in skills related to living in the community. The services may be provided in group homes or supervised private residences.
      Professional parent homes: These are family homes in which one or two children beneath the age of 22 with disabilities live with 24-hour support in a very intensive habilitative family arrangement. The families are supported by trainers and consultants and also receive respite care.
      Host homes: These services are provided for individuals who turn 18 years of age but have been living in professional parent homes and wish to continue to live in that family home with other adults. The professional parent assumes more of a peer role with the individual and the individual works with the trainer in the acquisition of skills that allow independence as an adult. The person may receive support and/or supervision up to 24 hours per day.

Day Services programs take place in the community or in workshops and are designed to provide work opportunities as well as maintain skills in post-school years.

  • Day programs - are designed to promote the ongoing development and maintenance of skills. The services may be provided in a variety of settings, including natural workplace settings throughout the community or at sheltered sites. Most participants in these programs receive federal funding through the Medicaid program. Care must be taken that the goals and objectives for each individual are not directed at teaching specific job skills. Medicaid will not pay for vocational training that is part of a day training program, though DSPD works closely in coordination with the Utah State Office of Rehabilitation to leverage available federal funding opportunities.
  • Supported retirement - is designed for people who are age 55 or older or whose health prevents their continued participation in employment or day training. This program utilizes senior citizen centers, adult day centers, or other community programs that provide a variety of activities for seniors.

Supported Employment programs place people with disabilities in jobs in regular work environments. A job coach is assigned for each person to provide on-the-job training and to help solve problems that may arise. The cost of supported employment is $34.08 per job coach hour. In some cases, individuals are able to reduce the need for a job coach and may eventually handle a job on their own. For most individuals who enter this service, the Utah State Office of Rehabilitation in the State Office of Education funds the first 170 hours of training and the Division of Services for People with Disabilities provides the ongoing funding.

In-Home Support provides services to families that enable them to care for their children with disabilities at home. These services are provided through contract providers or by staff hired directly by parents. The individualized nature of the program does not allow for fixed rates or funding allocations. The annual average expenditure per consumer is about $15,582.

Transportation Services helps people with disabilities in getting from their homes to day programs, jobs, and other activities. The need for transportation assistance and the cost of transporting people is a frequently mentioned issue when public hearings are held on services for people with disabilities. This is especially true in the rural areas of the state.

Intent Language

SB0002: Item 83

The Legislature intends the Division of Services for People with Disabilities (DSPD) in the Department of Human Services provide to the Office of the Legislative Fiscal Analyst no later than September 1, 2015 a report that includes a(n): 1) response to each specific audit recommendation found in A Performance Audit of the Division of Services for People with Disabilities (October 2014 - Audit No. 2014 - 10), 2) identification of specific efficiencies gained by DSPD through implementing the audit's recommendations, 3) estimate of savings, if any, achieved through implementation of each recommendation, and 4) measures that demonstrate effective implementation of each recommendation. The Legislature further intends the Office of the Legislative Fiscal Analyst provide the report to the Office of the Legislative Auditor General (OLAG) and that OLAG review the report in order to assess: 1) if the measures accurately demonstrate effective implementation of the recommendations and 2) the accuracy of the savings estimates, if any. The Legislature further intends OLAG report its review of the DSPD report to the Social Services Appropriations Subcommittee.

SB0002: Item 83

The Legislature intends that for the building block titled "DSPD - Direct Care Staff Salary Increase," the Division of Services for People with Disabilities (DSPD) shall: 1) Direct funds to increase the salaries of direct care workers; 2) Increase only those rates which include a direct care service component, including respite; 3) Monitor providers to ensure that all funds appropriated are applied to direct care worker wages and that none of the funding goes to administrative functions or provider profits; 4) In conjunction with DSPD community providers, report to the Office of the Legislature Fiscal Analyst no later than September 1, 2015 regarding: 1) the implementation and status of increasing salaries for direct care workers, 2) a detailed explanation with supporting documentation of how DSPD providers are reimbursed, including all accounting codes used and the previous and current rates for each accounting code, and 3) a conceptual explanation of how DSPD community providers realize profit within the closed market of providing DSPD community services.

SB0003: Item 134

The Legislature intends that the $400,000 in Beginning Nonlapsing provided to respite care for individuals with disabilities in the Division of Services for People with Disabilities is dependent upon up to $400,000 funds not otherwise designated as nonlapsing to the Department of Human Services - Division of Substance Abuse and Mental Health line item being retained as nonlapsing in FY 2015.

SB0003: Item 134

The Legislature intends that the $75,000 in Beginning Nonlapsing provided to respite care for individuals with disabilities in the Division of Services for People with Disabilities is dependent upon up to $75,000 funds not otherwise designated as nonlapsing to the Department of Human Services - Executive Director Operations line item being retained as nonlapsing in FY 2015.

SB0007S01: Item 28

The Legislature intends that the Division of Services for People with Disabilities (DSPD) use Fiscal Year 2016 beginning non-lapsing funds to provide services for individuals needing emergency services, individuals needing additional waiver services, individuals who turn 18 years old and leave state custody from the Divisions of Child and Family services and Juvenile Justice Services, individuals court ordered into DSPD services and to provide increases to providers for direct care staff salaries. The legislature further intends DSPD report to the Office of Legislative Fiscal Analyst on the use of these non-lapsing funds.

SB0007S01: Item 28

The Legislature intends that the Department of Human Services report on the following performance measures for the Services for People with Disabilities line item: (1) Community Supports, Brain Injury, Physical Disability Waivers, Non-waiver Services - % providers meeting fiscal requirements of contract (Target = 100%), (2) Community Supports, Brain Injury, Physical Disability Waivers, Non-waiver Services - % providers meeting non-fiscal requirements of contracts (Target = 100%), and (3) People receive supports in employment settings rather than day programs (National ranking) (Target = #1 nationally) by January 1, 2016 to the Social Services Appropriations Subcommittee.

The division has statutory authority to not lapse funds at the end of a fiscal year and will typically have some amount of Beginning Nonlapsing balance available. The statute restricts use of nonlapsing funds for one-time purposes unless authorized for ongoing expenditures by the Legislature.

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COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.