OFFICE OF FISCAL ANALYSIS

Legislative Office Building, Room 5200

Hartford, CT 06106 (860) 240-0200

http://www.cga.ct.gov/ofa

sHB-5534

AN ACT CONCERNING THE PROVISION OF SERVICES TO INDIVIDUALS WITH INTELLECTUAL DISABILITY.


OFA Fiscal Note

State Impact:

Agency Affected

Fund-Effect

FY 15 $

FY 16 $

FY 17 $

Department of Developmental Services

GF - Cost

35,000

89,037,119

181,653,584

Social Services, Dept.

GF - Cost

None

4,388,400

8,952,336

State Comptroller - Fringe Benefits1

GF - Cost

None

109,131

229,175

Total State Cost

   

93,534,650

190,835,095

Resources of the General Fund

GF - Revenue Gain

None

44,369,718

90,514,224

NET TOTAL COST

GF – Cost

35,000

49,164,932

100,320,871

Municipal Impact: None

Explanation

The bill requires the Department of Developmental Services (DDS) to develop a plan to serve all DDS consumers with service needs and also requires the agency to provide all eligible individuals with the required services by July 1, 2016. While a plan to accomplish these requirements is not known at this time, the following cost estimate is provided based upon the identified current service needs of DDS consumers. The requirements of the bill result in a state cost of $35,000 in FY 15, $93.5 million in FY 16 and $190.8 million in FY 17. The state receives a 50% reimbursement for services provided under the Medicaid home and community-based waiver programs. Assuming services provided under the bill are under the waivers, estimated revenue to the General Fund is anticipated to be $44.4 million in FY 16 and $90.5 million in FY 17. The net state cost after anticipated federal Medicaid waiver revenue is $49.2 million in FY 16 and $100.3 million in FY 17.

Department of Developmental Services (DDS)

It is anticipated that DDS may require $35,000 in funding in FY 15 for consultant services to assist the agency in the planning and implementation of the significant number of placements of DDS consumers required under the bill.

Services to DDS consumers not currently being served will likely be phased in during FY 16 to meet the July 1, 2016 deadline established by the bill. New funding for community residential services is typically provided through a network of private providers and may include: (1) the development of group homes, (2) continuous resident supports with support staff and clinical supports, (3) individual home supports where a person can work with a provider for services or they can hire someone on their own to provide services, and (4) community companion homes which are licensed family homes for three or fewer individuals. This estimate addresses the services needs of 2,445 DDS consumers. The DDS Management Information Report, as of December 2013, identifies 2,347 DDS consumers with varying needs for residential services (635 - Waiting List, 362 - Other Residential Needs, 1,356 - Planning List). The agency has currently identified an additional 98 individuals in need of day programs.

The anticipated total cost to fund residential and day services in DDS for 2,445 individuals as required by the bill is $88.7 million in FY 16 and $181 million in FY 17 is detailed below.

Service Category

# Consumers

FY 16 Cost $

FY 17 Cost $

1. Residential

2,347

87,367,436

178,229,569

2. Day Program

98

1,372,000

2,798,880

Total

2,445

88,739,436

181,028,449

1. Residential Services

The cost of residential services for DDS consumers on the Waiting and Planning Lists is $87.4 million in FY 16 and $178.2 million in FY 17. This estimate is based on a varying average cost and implementation throughout FY 16 that equates to six months of funding and full year cost in FY 17 shown below.

Placement Category

# Consumers

Average FY 16 Cost $

FY 16 Cost $

FY 17 Cost $

Emergency

37

100,037

1,850,686

3,775,400

Priority One

598

88,777

26,544,249

54,150,269

Other Residential Needs

362

45,000

8,145,000

16,615,800

Planning List

1,350

75,300

50,827,500

103,688,100

Total Residential

2,347

 

87,367,436

178,229,569

2. Day Programs

The cost of day programs, including transportation, for the 98 DDS consumers with unmet service needs is $1.4 million in FY 16 and $2.8 million in FY 17. This estimate is based on six months of funding in FY 16 and full year cost in FY 17 and is shown below.

Placement Category

# Consumers

Average FY 16 Cost $

FY 16 Cost $

FY 17 Cost $

Day Services

98

28,000

1,372,000

2,798,880

Agency Staffing

The agency will require additional staff to support the expansion of services provided under the bill. The following nine positions have been identified but additional positions may be needed depending on how the plan to provide services is implemented. DDS will require four licensing inspectors to conduct inspections and assure the safety of consumers in their residential placements. Additionally, five case manager positions are necessary to provide the 183 individuals with residential needs and currently have no case manager. The average caseload of a case manager is approximately 40 individuals. Funding of $297,683 for six months in FY 16 and $625,135 for FY 17 supports these 9 new positions. Associated State Comptroller- Fringe Benefit costs for these positions are $109,131 in FY 16 and $229,175 in FY 17.

Position Title

Number Required

Average FY 16 Salary $

FY 16 Cost $

FY 17 Cost $

Licensing Inspector

4

64,462

128,925

270,742

Case Manager

5

67,504

168,759

354,394

Total Positions

9

 

297,683

625,135

Department of Social Services (DSS)

DSS funds the room and board costs for DDS consumers in group homes through the Aid to the Disabled account. Assuming that approximately half of the new placements are in group homes the following costs result for DSS' Aid to the Disabled account.

DSS - Account

Estimated Placements

Average Monthly Cost $

FY 16 Cost $

FY 17 Cost $

Aid to the Disabled

1,150

636

4,388,400

8,952,336

Federal Revenue

Under the Medicaid home and community-based waiver program the state receives 50% reimbursement for all DDS consumers receiving services under the waiver. The current application would require an amendment to expand the slots under the waiver. Based on the estimated costs of residential and day services under the bill, the estimated Medicaid revenue to the General Fund is shown below.

 

FY 16 $

FY 17 $

Expanded Residential and Day Services - Cost

88,739,436

181,128,449

Anticipated Medicaid Waiver - Revenue

44,369,718

90,514,224

Additional federal funds are also anticipated under Targeted Case Management.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to inflation. It is not clear if the bill requires services to those eligible after July 1, 2016. To the extent that it does, it would result in additional future costs that would depend on the number of DDS consumers who required services and the level of service provided

Sources:

Core-CT Financial Accounting System

 

DDS Management Information Reports

 

Department of Administrative Services website

 

Personnel Expenditure Projection

1 The fringe benefit costs for most state employees are budgeted centrally in accounts administered by the Comptroller. The estimated active employee fringe benefit cost associated with most personnel changes is 36.66% of payroll in FY 15 and FY 16.