W.Va. Grapples With IDD Waiver Program

The IDD Waiver Program

By connecting people with disabilities with resources like home health care workers and financial support, the Intellectual and Developmental Disabilities (IDD) Waiver program allows people with disabilities to live outside hospitals and institutions.

Department of Human Services (DHS) Secretary Christina Mullins testified before the Joint Standing Committee on Health and Human Resources on Dec. 12, 2023 about the status of the IDD program. 

Alongside her, Robert Hansen, special assistant for IDD at DHS, also testified about the program, stating West Virginia has approximately 33,000 individuals in the state who have a mental, intellectual or developmental disability.

“Six thousand of these individuals are currently being served by the IDD waiver program,” Hansen said. “And then we also have 530 individuals who are on the waitlist to enter that program. And today we have approximately 73 individuals who are IDD who are in our two state hospitals.”

Hansen also told the joint committee that workforce shortages place a burden on the IDD system.

“There’s also a lack of specialists that can work effectively with people with IDD, and that includes individuals that are trained in positive behavior support, and then people who are trained in applied behavior analysis,” Hansen said. “These are individuals that can work with patients, clients who are identifying and having serious issues and could be a support and for the direct service staff and helping to develop active treatment plans to address the behavioral issues that may be becoming more and more of a concern.”

Mullins testified that not only are workforce shortages the biggest challenge DHS faces but that those workers need development training.

“We’d like to increase the availability of training for all levels of staff,” Mullins said. “This training should include coaching and mentoring to ensure that select placement can be achieved. It’s not enough just to train, we have to also mentor.”

During the last 10 months, Mullins and Hansen have provided sworn testimony to various committees of the legislature that depict a crisis among the workforce of the IDD program largely due to low wages that cause operating losses at the state psychiatric hospitals.

Budget Cuts

In the final hours of the 2024 regular state legislative session, West Virginia lawmakers passed a budget that cut funding for IDD waivers.

In 2023, the IDD Waiver budget line item was $108,541,736. In this year’s budget, the IDD Waiver program was allotted $97,687,562 — a decrease of more than $10.8 million.

Senate Finance Chairman Eric Tarr amended the cuts into the budget on the last day of the session. He said the decrease in funds for individuals with disabilities was an effort to increase transparency on the state health department’s spending following last year’s split of the Department of Health and Human Resources into three departments.

In a statement published on March 12, Tarr explained that his committee broke down much, but not all of Human Services in subsections and restricted the ability to transfer funds outside of those subsections.

“Ultimately, we increased the aggregate level of appropriation to Health, Human Services, and Health Facilities (what would have been DHHR) by about $9 million this year,” Tarr wrote. “However, this included a $100,000,000 improvement to contract nursing. This necessary improvement (which was needed to keep the state-owned hospitals open) required reductions in other areas.”

Tarr said during this process of breaking the department up, the Legislature found out that appropriations they made to medical services in previous years had been redirected to contract nursing in facilities. 

“In other words, it became clear where money was being redirected relative to the Department’s appropriation request,” Tarr wrote. “The previous secretary was using a soft target request to fund mismanagement of contracts, which now exposed, is being corrected.”

Tarr said a subsection was created in the budget this year for waiver programs. He said his committee fully funded Title XIX, the Aged and Disabled Waiver, but cut all other line items, including the IDD Waiver, by 10 percent.

“The department can now transfer between waivers, but can no longer transfer to or from other sections,” Tarr wrote. “So, in short, there was a $100 million improvement to health facilities that resulted in a collective reduction of about $91 million to Human Services and Health Services.”

Mike Folio, legal director for Disability Rights West Virginia, said the budget cut not only affects those on waivers but loses federal matching dollars.

“With a budget cut of $11 million when you factor in the match through Medicaid, it’s roughly $33 million. What that translates into is diminished services,” Folio said.

Folio said the IDD waiver program was created decades ago by Congress to provide a lifeline to those individuals who are disabled and keep them from being committed to a psychiatric hospital.

Not only are outcomes better when an individual is able to be treated in a community-based program, but according to Folio, it is a cost-saving measure.

He said the cost to place someone at Sharpe Hospital is roughly $990 per day, per person. To place someone in a community program costs approximately $390 per day.

“They failed to do the required financial analysis to determine the impact of cutting the IDD waiver budget,” Folio said. “Had they done this and had they actually looked at the cost differential between institutional costs compared to community integration, they would realize that they would save $600 a day, get better outcomes, and actually comply with the law,” Folio said. “Certain members of the Legislature ignored those three accepted realities, and instead slashed the equivalent of $33 million out of the budget for individuals with developmental disabilities.”

During a press briefing, Gov. Jim Justice said he will call a special session for lawmakers to make adjustments to the health and human services budget.

“We have hundreds of thousands of people in West Virginia that are going to be affected — can you imagine, can you imagine the good work that we did and now we could possibly hurt those folks?” Justice said.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Marshall Health.