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Plan may reduce wait for services: Legislative proposal would cost $16 million

November 28, 2006

People with developmental disabilities could find their months-long waits for services reduced if lawmakers approve a proposal that would cost the state $16 million over the next two years.

Lengthy delays and money woes have plagued state services for the developmentally disabled for more than a decade. But a proposal by two Republican lawmakers would cut the waiting time by requiring the state to provide services within 90 days.

Over the years, "the one constant has been that the waiting list still exists," said Rep. Charles McMahon, a Windham Republican who hopes to sponsor the legislation with Rep. Peter Batula. "It's wrong. It's not the New Hampshire way," added McMahon. Health and Human Services Commissioner John Stephen joined lawmakers in announcing the proposal yesterday.

The era of community-based care dates to 1991, when the state closed the Laconia State School, ending the age of institutionalized care for residents with developmental disabilities. A new, less restrictive era had begun. Ten agencies across the state provide respite care, medical assistance and day care for adults with developmental disabilities and their families. The majority of individuals who receive the services - 80 percent - live with their families.

The state, however, has failed to cover the full cost of services, and wait times fluctuate. In September 2005, the average delay was 425 days, said Matthew Ertas, who directs the state's bureau of developmental services. Currently, 213 adults with developmental disabilities are waiting for services, half the size of the waiting list at its peak in 2003. The list grows when individuals need additional services - residential care instead of day care, for example - or when residents turn 21 and become eligible for the agency services.

"We've made a commitment that people shouldn't be in institutional settings. But that does mean that community-based supports are essential," said Amy Messer, an attorney for the Disabilities Rights Center. The current waiting list "can result in families having to leave their jobs to care for their developmentally disabled children."
Patients, she added, "run the risk of regressing and losing skills if they wait."

"I think the legislation is really an essential commitment on the part of the state," Messer said.

Previous efforts to cut the delay in services failed. In 2001, HHS staff developed a five-year plan to eliminate the waiting list. But the money to provide additional services never materialized, and lengthy waits remained.

"We didn't fund it as required," said Batula, a Merrimack Republican. At the time, Batula said, he promised to introduce legislation mandating waits be capped at 90 days if the waiting lists weren't reduced in five years. Hence the current proposal.

Once again, money will be the likely hurdle. "I think it's going to be well-supported until it hits finance" committee, Batula said. "Like any major financial bill, there will be some hesitation there."

The proposal calls for $4.1 million in general funds in the next fiscal year and $11.9 million the following year. The federal government is expected to match the state's allotment, bringing the total figure to $32 million.

Adding services will take time, Ertas cautioned. "It is challenging to recruit staff and train staff, so that's going to take awhile," Ertas said.

Services can range from respite care worth $500 to $100,000 annual bills, he added. About 10,000 residents receive the services. An additional 210 will likely join the waiting list in the coming two-year budget cycle.

Stephen has already made a formal request for more money, in part to pay for services for adults with developmental disabilities. The state health department is asking for $3.8 billion over the next two-year budget, $1.4 billion of which would come from the state's general funds.

The request is $428 million more than the agency's current allotment. The proposed legislation would require the state to cover the cost of the services, instead of relying on the budget process.

Gov. John Lynch, who has said he is trying to curtail spending, singled out Stephen's request for criticism this month. Agency heads recently presented their requests to Lynch, who will introduce his own budget to the Legislature in February.

The proposal "will be reviewed in the context of the budget," said Pamela Walsh, Lynch's spokeswoman. "Governor Lynch has been working with the department to make progress in reducing the developmental disabilities waiting list."

Batula and McMahon, who is chairman of a committee on the developmental disabilities waiting list, have spent years studying the list. The timing of their proposal, Batula said, resulted from the upcoming budget season and the failed five-year plan to eliminate the waiting list. The shift in political power - earlier this month, Democrats won new majorities in the House and Senate - wasn't a factor.

"It doesn't really matter" who controls the Legislature, Batula said.

But some Democratic lawmakers deemed the proposal a political ploy.

"Democrats have tried for years to eliminate the developmental disabilities waiting list," said Sen. Peter Burling, a Cornish Democrat. Yesterday's announcement was "simply one of a number of press conferences that are going to be like this, in which they clasp to the bosom the Democratic ideals we've been fighting for."

Burling criticized the legislation's sponsors for failing to identify ways to raise the $16 million, especially as Lynch is poised to enter a tight budget season. Burling also accused Stephen of posturing for future political gain.

"This is about carving out a role visible to Republican insiders of himself as a person who's prepared to throw dirt in the eyes of Gov. Lynch," Burling said.

Lynch and Stephen have wrangled in the past over Stephen's Medicaid reform proposal. Recently, Lynch and other lawmakers worried about Stephen's plan to cut $26 million from his agency to fix a projected deficit for this fiscal year.

Stephen denied that the proposal had a political edge.

"For Sen. Burling to try to bring politics into this issue is not only patently false, but it's also unfair to the representatives who in a bipartisan manner have worked collaboratively with the department," he said.

"HHS has made it abundantly clear during this budget process that the elimination of the developmental disabilities wait list will be our top priority," Stephen added. "I will respect whatever decision is reached in this issue by the governor or the Legislature."