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State-run facilities being asked to do more with less

State-operated care appears to be in increasing fiscal trouble in Massachusetts even though that type of care remains the choice of many families, including those whose loved ones have been transferred from developmental centers in recent years.

Unfortunately, the Legislature seems to be either unaware of the situation or simply doesn’t care about it.

The Patrick administration appears to be relying on state-operated residences and two remaining developmental centers to care for a large number of former residents of four developmental centers targeted for closure in 2008.

As a result, funding for state-operated residences was increased by about 17 percent between Fiscal Year 2010 and the current fiscal year.  However, funding for the developmental centers has been cut in that time by the same percentage, according to the Massachusetts Budget and Policy Center’s interactive Budget Browser

An analysis of the Budget Browser numbers by COFAR shows that as a result of the drop-off in developmental center funding, total funding for state-operated care in the Department of Developmental Services system has actually declined slightly in inflation-adjusted numbers since FY 2010. 

We’ve previously noted that the funding previously provided to the developmental centers in the budget doesn’t appear to have been transferred to most community-based budget accounts.  However, during that same period from FY 2010 to 2013, funding for corporate, provider-operated group homes did increase by roughly 6 percent.

It appears that the relative decline during that period in funding for state-operated care is putting strain on the state system.  DDS Commissioner Elin Howe projected in April that two to three state-operated group homes might be forced to close if the governor’s proposed $7.8 million increase in funding for those residences for the coming fiscal year wasn’t approved. 

Yet, in April and May, the House and Senate chose to cut the governor’s proposed increase for state-operated group homes, and made larger cuts than the governor proposed in the developmental center account.   While lawmakers subsequently approved budget amendments to increase funding for some community-based accounts, administration-supported amendments to restore funding for both state-operated group homes and the remaining developmental centers were rejected by the House and Senate.

Currently, a House/Senate conference committee is considering how big a cut to make in the governor’s budget for state-operated group homes.  The conference committee must decide between the House budget, which would cut the governor’s proposal by $1.9 million, and the Senate budget, which would cut it by $1.5 million.  COFAR has been seeking adoption of the Governor’s budget recommendations in the state-operated group home and developmental center accounts.

We intend to ask DDS for data on the number of former developmental center residents who have opted for state versus provider-operated care.  The administration projected in 2008 that state-operated group homes and two remaining developmental centers slated to remain open would accept close to 50 percent of the roughly 400 residents then remaining in four developmental centers targeted for closure.  Provider-operated group homes were projected to accept the remaining 50 percent of those former developmental center residents, yielding these entities millions of dollars of additional revenue.

In the current fiscal year, funding for state-operated group homes and developmental centers comprises about 23 percent of the DDS’s total $1.4 billion budget, compared with funding for privately run group homes, which comprises 57 percent of the DDS budget. 

The administration has claimed for a number of years that it is committed to a “Community First” agenda of boosting funding for corporate  group homes and other community-based initiatives.  That’s all well and good; but if the administration is continuing to rely on state care, particularly for those with the most severe and profound levels of intellectual disability, we hope the Legislature will agree to fund that care adequately.

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