Public Comment — Home and Community-based Services and Texas Home Living Rate Reduction

Public Policy Input — 2017

TCDD letterhead May 2017

Public Comment
Home and Community-based Services (HCS) and
Texas Home Living (TxHmL) Rate Reduction
May 17, 2017

Thank you for the opportunity to provide comments on the proposed 21% rate reduction to the Community First Choice (CFC) attendant and habilitation services provided in the Home and Community-based Services (HCS) and Texas Home Living (TxHmL) programs. TCDD is established by state and federal law and is governed by 27 board members, appointed by the Governor, 60% of whom are individuals with developmental disabilities or family members of individuals with disabilities. TCDD’s purpose in law is to encourage policy change so that people with disabilities have opportunities to be fully included in their communities and exercise control over their own lives.

Attendant Wages
Across the board, attendant wages remain unacceptably low. Rates for attendant wages in high-demand should be increased to support a living wage for all direct support professionals — by raising the floor — not by reducing wages for experienced direct support workers willing to work split shifts to assist people with intellectual and developmental disabilities with activities of daily living. While we are speaking specifically to the system of services for persons with intellectual and developmental disabilities, the state must recognize that the broader system cannot be maintained without a strong direct support professional workforce. This proposal was made without accounting for associated quality measures including statewide direct support professional vacancies and turnover rates. An adequate living wage is essential to combating turnover and attracting quality community-based attendants.

Rate reductions are typically targeted to providers; however, this proposed rate cut is directed at attendant wages in the most integrated and least expensive service option used by individuals and families in the long-term services and supports system. Individuals with intellectual and developmental disabilities and their families, particularly those using consumer direction, warn that such a drastic cut will threaten the stability of long-term attendant care teams. Adequate support services must be available to people with disabilities so that they can remain in the community rather than face inappropriate institutional placements. Without community-based attendants, some people will be forced to move to more restrictive, more expensive settings to receive needed support, but the cut’s associated cost increases do not seem to be included in the proposal’s accompanying fiscal analysis.

Expand Provider Qualifications
Some CFC service recipients are granted more policy flexibility with respect to direct support provider qualifications and who they can hire to support them. With the exception of people using HCS and TxHmL waivers, adult waiver participants are allowed to pay a member of their household to be their attendant. In fact, this expanded flexibility was granted to HCS and TxHmL waiver participants for a short period in 2014, but was subsequently rescinded. National caregiver studies estimate that more than 85 percent of individuals with developmental disabilities reside with and rely on their families for care. Expanding provider qualifications to allow adults equitable choice in who they may employ as their attendant would make qualifications uniform across systems, as intended in the federal CFC regulations. This could also reduce the negative impact of these harmful attendant wage reductions.

Finally, the system continues to be severely underfunded. Since 2007, Texas has ranked 50th in the nation for promoting independence for people with intellectual and developmental disabilities, primarily due to the low level of funding for and number of people in community services. There must be an emphasis on access to community services to support integration and employment even if it is daunting for a system in transition. The state of Texas must allocate the requisite resources to support community living for people with disabilities. An honest dialogue about building community capacity and the true cost of service provision to ensure a successful transition and strong long-term services and supports system is needed.

Respectfully submitted,
Jessica Ramos, Public Policy Director