New HampshireNew HampshireDevelopmental Services SystemDevelopmental Services System
Present and Future ChallengesPresent and Future Challenges
Intent Of The ForumIntent Of The Forum
The State is facing a The State is facing a severesevere funding shortage funding shortage Projected to last for awhileProjected to last for awhile
It is likely that our service system will be It is likely that our service system will be affectedaffected Individuals, families, providers, area agencies, Individuals, families, providers, area agencies,
BDS, DDHS and local communitiesBDS, DDHS and local communities BDS and area agencies are soliciting input, BDS and area agencies are soliciting input,
ideas and suggestions regarding how we may ideas and suggestions regarding how we may collectivelycollectively deal with the difficulties we are deal with the difficulties we are facingfacing
Intent Of The ForumIntent Of The Forum
An opportunity to consider creating changes An opportunity to consider creating changes that are more effective with respect tothat are more effective with respect to Desired service outcomes and Desired service outcomes and CostCost
A chance to imagine how:A chance to imagine how: The service system may operate in the futureThe service system may operate in the future It may support individuals and their families It may support individuals and their families Resources can be used in more effective waysResources can be used in more effective ways
Fiscal Conditions And ChallengesFiscal Conditions And Challenges
Fiscal Year 2009Fiscal Year 2009[July 1, 2008 - June 30, 2009] [July 1, 2008 - June 30, 2009]
The State budget hasThe State budget has $5,2 billion$5,2 billion in Total Funds in Total Funds $1,6 billion$1,6 billion in General Funds (GF) in General Funds (GF)
DHHS was assigned the largest share of the DHHS was assigned the largest share of the $1.6B General Funds$1.6B General Funds $713M$713M of the $1.6B of the $1.6B About About 44%44% of the total General Funds of the total General Funds[The next largest GF portion is only 11% of the [The next largest GF portion is only 11% of the
state total] state total]
FY 2009 DHHS General Funds by Program Unit
$0
$50,000
$100,000
$150,000
$200,000
$250,000
Fiscal Year 2009Fiscal Year 2009 Out of the $713M GF within the DHHS Out of the $713M GF within the DHHS
budgetbudget About $103About $103M (14%) GF was assigned to BDSM (14%) GF was assigned to BDS BDS has the second largest share of the GF BDS has the second largest share of the GF
dollars within the DHHS budgetdollars within the DHHS budget Both DHHS and BDS have “high profiles” Both DHHS and BDS have “high profiles”
within the state budgetwithin the state budget
““Cost DriversCost Drivers” According To” According ToNH Center for Public Policy StudiesNH Center for Public Policy Studies
1.1. Medicaid Provider PaymentsMedicaid Provider Payments
2.2. Retirement SystemRetirement System
3.3. Retirement Health Care Retirement Health Care
4.4. CorrectionsCorrections
5.5. BDS Wait ListsBDS Wait Lists
6.6. Catastrophic Aid to SchoolsCatastrophic Aid to Schools
7.7. School Building AidSchool Building Aid
FY 2009 Budget ReductionsFY 2009 Budget Reductions The State has a The State has a $250M$250M (15%) shortage in GF. (15%) shortage in GF. So far DHHS has given up about So far DHHS has given up about $43M$43M in GF in GF The impact on BDS (as of January 2009) The impact on BDS (as of January 2009)
BDS has given up about BDS has given up about $1.2M$1.2M in General in General Funds Funds without interrupting any direct serviceswithout interrupting any direct services• The planned 2% cost-of-living rate increase The planned 2% cost-of-living rate increase
has been eliminatedhas been eliminated• All of the FY ’09 Wait List funds have so All of the FY ’09 Wait List funds have so
far been preservedfar been preserved After two rounds of budget cuts the State is still After two rounds of budget cuts the State is still
facing a facing a $75M$75M deficit deficit
Historical Financial Perspective Historical Financial Perspective On The Current SystemOn The Current System
Area Agency System Total Funding
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09
FISCAL YEARS
Other Direct State Medicaid
Area Agency System Total Funding
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
'89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09
FISCAL YEARS
Other Direct State Medicaid
StateSpending Per $1,000 Income
National Ranking
Maine $8.00 1st
Connecticut $7.66 3rd
Rhode Island $7.15 5th
Vermont $5.72 12th
Massachusetts $4.78 20th
New Hampshire $3.72 34th
National Average $4.12
Source: Braddock, 2008
Fiscal Effort Regarding DD Services Spending For Services Per $1,000 Personal
Income
NH’s DD Waiver per person cost compares favorably with the other NH’s DD Waiver per person cost compares favorably with the other New England States’ average costs. New England States’ average costs.
State
Average Per Person Waiver
Expenditures*Variance
to NH
Maine 84,203$ 40,609$ Rhode Island 74,987$ 31,393$ Connecticut 58,139$ 14,545$ Massachusetts 58,045$ 14,451$ Vermont 47,575$ 3,981$ New Hampshire 43,594$ -$ Source: Braddock 2008 *2006 Data
BDS Rate Increase HistoryBDS Rate Increase History
Medical Inflation Inflation
Rate Increase to AAs
1996 3.5% 3.0% 4.9%1997 2.8% 2.3% 0.0%1998 3.2% 1.6% 0.0%1999 3.5% 2.2% 0.0%2000 4.1% 3.4% 0.0%2001 4.6% 2.8% 2.6%2002 4.7% 1.6% 0.0%2003 4.0% 2.3% 0.0%2004 4.4% 2.7% 0.0%2005 4.2% 3.4% 0.0%2006 4.1% 3.8% 2.3%2007 4.4% 2.8% 2.3%2008 4.2% 2.1% 2.0%
Total 51.7% 34.0% 14.1%
Source: US Bureau of Labor Statistics
Future ChallengesFuture Challenges
FY 2010 & 2011 FY 2010 & 2011 Budget ForecastBudget Forecast
NH Center for Public Policy StudiesNH Center for Public Policy Studies The State is likely to have an overall The State is likely to have an overall
shortage of shortage of $500M$500M for the biennium for the biennium Level funding for FY ’10 and 3% growth in Level funding for FY ’10 and 3% growth in
FY ’11 will result in a deficit of FY ’11 will result in a deficit of $403M$403M A 3% cut in 2010 and restoring the 3% in A 3% cut in 2010 and restoring the 3% in
2011 will still lead to a 2011 will still lead to a $230M$230M deficit deficit
BDS Request For FY 2010 & 2011BDS Request For FY 2010 & 2011[ In Comparison To The 2009 Budget ][ In Comparison To The 2009 Budget ] Fiscal Year 2010Fiscal Year 2010
Increase of about Increase of about $25M$25M in General Funds in General Funds $50M in total funds (state and federal)$50M in total funds (state and federal)
Fiscal Year 2011Fiscal Year 2011 Increase of about Increase of about $40M$40M in General Funds in General Funds
$80M in total funds (state and federal)$80M in total funds (state and federal)
2006 - 2007 2008 - 2009 2010 - 2011GF Increase $11M $26M $65M
BDS Request For FY 2010 & 2011BDS Request For FY 2010 & 2011 Enrolment Increases for:Enrolment Increases for:
DD Waiver (648)DD Waiver (648) ABD Waiver (53)ABD Waiver (53) In-Home Support Waiver (80)In-Home Support Waiver (80) Early Intervention (338)Early Intervention (338)
Cost of Living Increase (across the board) Cost of Living Increase (across the board) Direct service staff wage increaseDirect service staff wage increase Health care coverage for home providersHealth care coverage for home providers Family Support (respite, transportation, heating, etc.)Family Support (respite, transportation, heating, etc.) Intensive training for children with Autism (age birth to Intensive training for children with Autism (age birth to
3)3) Core training for direct service staffCore training for direct service staff Fire safety modificationsFire safety modifications
FY 2010 FY 2011
General Fund Requested
$8,600,524 $18,549,405
Individuals To Be Served
476 701
Total GF for the Biennium $27,149,929
BDS General Fund RequestDD and ABD Wait Lists
FY 2008 FY 2009 FY 2010 FY 2011
General Fund Requested $4,410,273 $9,064,722 $8,600,524 $18,549,405
Individuals To Be Served 269 377 476 701
Total GF for the Biennium $13,474,994
Total GF for the Biennium $27,149,929
BDS General Fund RequestsFor DD and ABD Wait Lists
Reasons For Increases In The Reasons For Increases In The Wait List Numbers?Wait List Numbers?
103
122
151 149 149
7079
56 56
71
95
183
270
138 143
164
113
158
181
0
50
100
150
200
250
300
Jun-04
Sep-04
Dec-04
Mar-05
Jun-05
Sep-05
Dec-05
Mar-06
Jun-06
Sep-06
Dec-06
Mar-07
Jun-07
Sep-07
Dec-07
Mar-08
Jun-08
Sep-08
Dec-08
Bureau Of Developmental ServicesDD Wait List
Number Of People
Total Number of Students with Disability[Source: Bureau of Special Education, DOE]
30,077
32,274
27,000
28,000
29,000
30,000
31,000
32,000
33,000
2000 2001 2002 2003 2004 2005 2006 2007
Changes from 2000 to 2007: 2,197 additional students
Increase of 7%
Total Number of Students In NH Schools [Source: DOE]
232,906
221,614
208,000
216,000
224,000
232,000
240,000
2000 2001 2002 2003 2004 2005 2006 2007
Changes from 2000 to 2007: 11,292 fewer students
Decrease of 4.8%
Number of Students with Autism, Intellectual Disability, or Traumatic Brain Injury [Source: Bureau of Special Education, DOE]
1,4691,524
1,590
1,709
1,814
1,903
2,008
2,309
1,000
1,200
1,400
1,600
1,800
2,000
2,200
2,400
2000 2001 2002 2003 2004 2005 2006 2007
Changes from 2000 to 2007: 840 additional students
Increase of 57%
Number of Students (ages 3-21) Diagnosed with Autism (Source: Bureau of Special Education, DOE)
397
474
568
667
799
905
1,060
1,320
100
300
500
700
900
1,100
1,300
1,500
2000 2001 2002 2003 2004 2005 2006 2007
Changes from 2000 to 2007:Additional 923 students
Increase of 232%
Number of Graduating (turning 21) Students Who Have Autism, Intellectual Disability or Traumatic Brain Injury
[Source: Bureau of Special Education, DOE]
4956
44
6979
115
87
161
62 60
194
202
162
166
152
164169
0
50
100
150
200
250
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
The projections for years 2008 through 2017 are based on the December 2007
numbers for different age groups
Cumulative Numbers
Age 65 or older 71
Age 65 or older 71
Age 60- 64 52Age 60 or older 123
Age 55-59 48Age 55 or older 171
Age 50-54 102Age 50 or older 273
Age 45-49 102Age 45 or older 375
Age 40-44 120Age 40 or older 495
Age 35-39 106Age 35 or older 601
Number of people living with their families or independently [ NOT receiving residential services currently; supported by elderly parents or other family members]
Bureau of Developmental ServicesAging Consumer Base
Future Wait List Enrollees For Residential Services
Cumulative Numbers
Age 65 or older 193
Age 65 or older 193
Age 60-64 102Age 60 or older 295
Age 55-59 126Age 55 or older 421
Age 50-54 184Age 50 or older 605
Bureau of Developmental Services
[Future Wait List Enrollees For Additional Services] Number of people receiving residential services [Aging and medical issues mean greater need for supports from others]
Aging Consumer Base
FY 2009 FY 2010 FY 2011(Backlog)
DD Wait List 257 181 210
ABD Wait List 23 15 15
Totals 280
701
421
Total Number Of To Be Served
Bureau Of Developmental ServicesDD & ABD Wait List Projections
FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 Totals(Backlog)
DD Wait List 257 181 210 215 178 1,041
ABD Wait List 23 15 15 15 15 83
Totals 280 1,124
BUREAU OF DEVELOPMENTAL SERVICESDD and ABD Wait List Projections for FYs '09, '10, '11, '12, '13
421 423
Senate Bill 138Senate Bill 138RSA-171-A:1(a)(II)RSA-171-A:1(a)(II)
““Beginning with the fiscal year ending June Beginning with the fiscal year ending June 30, 2010, and thereafter, the department of 30, 2010, and thereafter, the department of health and human services shall incorporate health and human services shall incorporate the cost of fully funding services to eligible the cost of fully funding services to eligible persons … and the legislature shall persons … and the legislature shall appropriate sufficient funds to meet such appropriate sufficient funds to meet such costs and requirements.”costs and requirements.”
Aging Careg
ivers
More
Students
Aging Out A
ging Individuals
Financial Challenges
$126,885,412
$99,813,337
$120,231,000
$197,464,766
$-
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
2001 2002 2003 2004 2005 2006 2007 2008
Waiver Institution
What NH would have paid for combined residential and day (24/7) services under institutional (ICF/MR) rates vs.what it actually paid under the Medicaid Waiver