(Cross-posted from the COFAR blog)
It has been more than a month since we asked Secretary of Health and Human Services JudyAnn Bigby for public records detailing the costs of specified services in a particular group home program for intellectually disabled persons in Massachusetts.
It has been almost two months since we asked Commissioner of Developmental Services Elin Howe for the budgets of the Templeton, Monson, and Glavin developmental centers.
To date, we’ve received neither set of records.
As we’ve previously noted here, we’ve been attempting to compare the cost of an apparently typical vendor-run group home program with the three developmental centers. We wanted to see whether the Patrick administration was comparing apples to apples in claiming to the Legislature in the last two fiscal years that closing the Templeton, Monson, and Glavin centers will save tens of millions in state funds.
As we reported, a group home contract, which we did receive last May from DDS, specified a yearly cost per resident of $104,400. In its cost savings analysis, the administration compared a very similar residential cost based on group home contracts with an average calculated cost of care at Templeton, Monson, and Glavin.
The potential problem with the administration’s analysis that we found in examining the single group home contract was that it specified budgeted costs for only direct-care, supervisory, and minimal nursing staff. What about the extensive nursing, medical, clinical, and therapeutic staffing that exists at the developmental centers and to which the residents of DDS group homes are entitled?
The fact that those additional medical, clinical, and therapeutic costs were not in the group home contract we examined appeared to raise the question whether the administration’s savings analysis was accurate. One immediate question was: if those additional costs are not paid through DDS contracts, how are they paid? Secondly, what is the total amount of those community-based costs that the administration may have missed in its analysis?
Once we get the answers to those questions, we can determine for ourselves whether there would be a savings or not in closing the developmental centers.
On July 29, we sent Public Records requests to both Secretary Bigby and Commissioner Howe, asking for copies of any documents detailing funding for medical, nursing, clinical, and therapeutic services for individuals residing in the community-based group home program we had selected for review. About three weeks prior to that, we had asked DDS for the Templeton, Monson, and Glavin budgets for the same time periods as the group home contract.
On August 9, I received a letter from the records custodian at EOHHS, stating that the agency was in the process of identifying the records we had requested regarding the group home contract. Last week, I called the records custodian, and was told EOHHS was still working on our request. He wasn’t able to tell me when the records would be found.
We’ve appealed to the Public Records Division for the Templeton, Monson, and Glavin budget documents. We’re close to filing an appeal for the group home contract records.
But one piece of useful information may have emerged here. The fact that the August 9 response to our request came from EOHHS and not from DDS does appear to confirm that it is not DDS, but some other source at EOHHS, that funds medical, clinical, and therapeutic services in the DDS vendor-run group home system. We believe that other source of funding is MassHealth.
In any event, it’s getting clearer and clearer that the administration wasn’t counting all the community-based costs of care it incurs when it told the Legislature there would be major savings in closing the developmental centers.
Peter Porcupine says
Keep the facility open, and add slots to make it pay off.
It’s the only economic language the administration seems to understand.
AmberPaw says
If one is careful to compare appels with watermelons, as if they are equal, the most outrageous comparisons can be touted. Look at the Governor’s proposal for indigent defense! Saving money by hiring 1000+ attorneys and 500-700 support staff, while destroying small law firms or causing them to downsize all across the Commonwealth! Add public employees while reducing private jobs and tout it as saving money! Amazing mental acrobatics, at least that is what I think. Same with the notice-only-some costs in the community placements that YOU are noticing.
truth.about.dmr says
for these public officials not giving you the numbers and other data to support their claims of cost savings that you have asked for—unless of course they are trying to hide something. Like maybe that their “community first”
thing is not exactly what they claim, either.
mzanger says
In terms of who pays and why EOHHS has the answers, DDS is a division of EEIOHS, so they might be saving staff time. But as you suggest, the medical and therapeutic costs for group home members are paid by MassHealth, and thus oranges to the ICF apples. Since ICFs are also Medicaid funded, the taxpayers only save if the services are very diluted, because it is much more efficient for a staff occupational therapist or speech therapist or psychiatrist or internist to see a full caseload at a facility than for group home staff to make the appointment, get the van, get the person to and through the appointment, one at a time. The ICF staffer is more likely to have training and experience with persons with intellectual disability. The only way the taxpayers save is if fewer appointments are made and kept, which may well be happening, and might have something to do with the increased mortality of people moved from ICFs to group homes.
Another state-federal cost share is Medicare, and yet another is SSI. But some of the cost shifts are from apples to watermelons, for example group home residents are eligible for food stamps and section 8 housing supports, while I don’t think such federal funds are collected by ICF residents, or on their behalf. Thus although taxpayers still pay, in this case, if I have it right, the state shifts some costs almost entirely out of the state budget, not just the DDS budget. Multiplied by 8-9000 group home residents, this is a substantial item, although squeezing even imaginary savings out of moving the few hundred remaining ICF residents just doesn’t produce any useful help for 34,000 persons served by DDS. The math isn’t there even in a good economy, and what seems to be happening in now is that DDS is losing budget faster than closing ICFs, thus adding to its demographic problem and residential gridlock. I believe that the real financial incentive for the Governor’s policy was to sell off the property of the developmental centers — the older ones were set up as farms and Templeton still is a working farm — and buy group homes with federally-subsidized funds and loans for low-income housing. In addition, because both the state’s purchasing and that done by providers is not tracked in the DDS budget, this is a potential area for corruption. Meanwhile, the recession has knocked down property values — at one time the governor was expecting $100-200 million from the sale and development of most of the Fernald Center. Instead I recently drove past a piece of commercial property sold off from the Glavin Center some years ago — and it was a shuttered Borders bookstore! For a few years, part of Fernald was used as housing for homeless people while the state was trying to evict the residents with intellectual disability for whom Fernald was built. This year, parts of the Monson Center became temporary housing for people dislocated by the tornadoes in Western Mass. — again while the Governor and DDS were trying to evict the very people for whom the taxpayers originally built that facility.
Meanwhile, there are some state budgets for which there is no federal reimbursement. If someone with intellectual disability commits a crime (uncommon, but it does happen, for example in the 1999 Worcester Cold Storage Warehouse fire in which six firefighters died fighting the fire, and two persons with ID/D were charged with manslaughter for failing to report the accidental fire they had started) and is imprisoned, that bed has no federal reimbursement, and the cost to Mass. taxpayers is thus comparable to the state’s share of an ICF bed. Unlike some other state disability agencies, DDS has no outreach program in prisons. When this question is raised with DDS officials, they tend to change the subject or deny that the particular person was an enrolled Mass. DDS client — which is exactly the point. Had the two homeless and disabled people who started the Worcester fire been receiving DDS services, possibly even ICF residential, they might not have started the fire, or might have reported it properly, saving lives and property.
AmberPaw says
Worthy poor, like “widows and orphans” got help. Those who displayed public drunkenness, or were too annoying, like the communis rixatrix (probably traumatized or manic women, only women were punished for the ‘crime’ of common scold) got the dunking chair or the stocks. No joke, see: http://lawschool.courtroomview.com/acf_cases/8992-state-v-palendrano (the last case, I believe, where a woman was prosecuted for being a “common scold”) or, for fun, the wikipedia entry: http://en.wikipedia.org/wiki/Common_scold
But those with behavior different from the norm, or who were perceived as “less than” as some DDS clients unfortunately are, did not get the same care and compassionate as worthy widows and orphans.
Isn’t it time to bring our state into the year 2011 and provide mental health and DDs services in the prison population? 70% of the women incarcerated in MCI Framingham are mentally ill. I consider this shameful, and backward, and that we could and should do so much better.
End of rant.
dave-from-hvad says
in shutting the ICFs. The administration appears to be simply shifting costs out of the DDS budget and into other budgets. The problem is the administration is apparently misleading the Legislature by presenting the Legislature with a “savings” analysis that concerns only the DDS budget. Senator Brewer and Rep. Dempsey, we hope you’re listening.
AmberPaw says
Susanne Bump is seeking that authority – doesn’t have it now. No wonder they don’t want to give out the numbers. No audits. No oversight, No accountability. Kind of like the special ed collaboratives, you think?
dave-from-hvad says
and Inspector General Greg Sullivan to expand their probes of the special education system to include the entire DDS contracting system. In the meantime, we’re also continuing to push for an independent cost analysis in closing the developmental centers, which would be done by a non-governmental entity selected by Sullivan’s office.
AmberPaw says
You have to wonder why a nonprofit head is making $250-$500k and what would show up on their Visa, Mastercard, and American Express accounts after what came out about the READ and Merrimack SPED collaboratives. A high sounding mission without any true oversight and without a truly impartial audit at least every three years is a recipe for pillage and waste. I know many fine nonprofits do excellent work, but in the absence of oversight there are too many folks who are over whelmed by temptation.
adnetnews says
Getting this information is like pulling teeth from a patient with lockjaw.