Massachusetts Rehabilitation Commission

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-1000	Admin.	$367,321	$480,788	$421,311	$404,864	$409,264	$571,395
4120-2000	VR Services	7,520,413	7,660,311	7,672,261	7,259,207	7,459,207	7,476,987
4120-3000	Employmnt. Srvcs.	9,025,618	8,399,240	8,098,927	7,780,098	7,886,816	7,968,942
4120-4000	Ind. Living	7,023,433	7,628,212	7,255,346	7,471,512	7,520,512	7,798,601
4120-4001	Housing Registry	100,000	93,060	93,060	83,754	83,754	83,754
4120-4010	Turning 22	--	320,000	440,760	565,000	1,065,000	712,550
4120-5000	Home Care	4,704,801	4,774,767*	4,694,767	4,342,733	4,339,768	4,391,217
4120-5050	Home Care Ret. Rev.	2,000,000	2,000,000	2,000,000	2,000,000	2,000,000	2,000,000
MRC	Subtotals w/o SHIP:	$30,741,586	$31,356,378	$30,676,432	$29,907,168	$30,764,321	$31,003,446
4120-6000	SHIP	6,923,277	6,954,509	6,504,692	5,979,149	6,000,568	$7,218,168
4120-6001	SHIP Trust Fund	750,000	1,000,000	1,800,000	off budget	off budget	--
4120-6002	SHIP Trust Ret. Rev.	2,000,000	4,500,000	5,000,000	off budget	off budget	6,748,592 off budget
SHIP**	Head Injury Totals:	$9,673,277	$12,454,509	$13,304,692	$5,979,149**	$6,000,598**	$13,966,760
MRC	Totals:	$40,414,863	$43,810,887	$43,981,124	$35,886,317	$36,764,889	$44,970,206

*   Includes $312,024 passed in supplemental budget.

** SHIP totals do not include "off budget" trust fund dollars. MRC spends $6.8 million annually from the trust, based on historical collections.

The Massachusetts Rehabilitation Commission (MRC) is part of the Office of Community and Disability Services under the EOHHS umbrella. MRC contains 3 divisions-the Vocational Rehabilitation (VR) Services, Disability Determination Services Division, and the Community Services Division. The Commission provides services so individuals with disabilities can achieve maximum quality of life and economic self-sufficiency, including job training and placement, home care, and independent living services.

Over 150,000 people with all types of disabilities (except blindness, because those persons are served by the Massachusetts Commission for the Blind [MCB]) are served. Approximately 12% of the general population is made up of people with disabilities-representing 736,000 individuals in Massachusetts-and unemployment rates for people with disabilities are approximately 70% or higher.

FY05 OVERVIEW

Lowlights and Highlights: Waiting Lists Prevail in All

Programs, but FY05 is an Improvement over FY04

Aside from the Statewide Head Injury Program, MRC's budget has not grown since FY01 and therefore fails to keep up with inflation or maintenance needs. Waiting lists are the norm at all programs, including Home Care (an entitlement under the state Medicaid plan). See the line-by-line analysis below for details on the waiting lists, under-funding, and FY06 needs at Community Services/Independent Living programs, Home Care, the Statewide Head Injury Program, Vocational Rehabilitation, and Statewide Employment Services.

The FY05 budget is a small improvement over FY04, which was the low of the FY01-FY05 period. A restoration of $878,000 (2.4% above the FY04 allocation) includes $500,000 of badly needed Turning 22 program funding (see line item 4120-4010, below).

New Funds Provided for Two Important Loan Programs

The Home Modification Loan Program provides loans for access modifications (like ramps and bathroom alterations). It helps keep elders, adults and children with disabilities in their own homes (or moves them home), rather than live in nursing facilities. Loans average $20,800.

Advocates worked hard to see this program reauthorized in FY05, as part of a housing bond bill, and harder still to see a minimal $2 million appropriated. Full funding would have required $5 million, based on a $25 million recapitalization over 5 years. MRC estimates that 65-70 families will be helped, leaving approximately 200 additional applications on the waiting list. Advocacy is needed to see more funds appropriated for FY06-$8 million would provide full funding (including "catch up" funding for FY05).

The Assistive Technology Loan Program will provide eligible applicants with low-interest loans to purchase any type of assistive technology (van lifts, computers, recreation equipment, etc.). Loans may be for as low as $500 or as much as $60,000-70,000. MRC was provided $565,000 in the FY05 supplemental budget as one-time funding to support start up of this new program. The state funds were the needed match to draw down $1.7 million in federal grant support.

New Community-Based Housing Program Authorized

The governor authorized the creation of a new Community-based Housing Program in FY05, the result of advocacy efforts by the disability community to begin to address the dire lack of affordable accessible housing in Massachusetts. Once designed and funded, the program will serve very low-income people with disabilities who are not clients of either the Departments of Mental Retardation (DMR) or Mental Health (DMH) and are either institutionalized or at risk of institutionalization. The program is still in the planning stages at MRC and has not received any bond capitalization funds to date.

The Building Blocks Coalition, led by the Citizens' Housing and Planning Alliance (CHAPA) and other groups has been advocating for bond capitalization for the program. A minimum of $3.5 million is requested for the first year. There are no estimates as yet for how many units of integrated, affordable, accessible housing the program will create. As of this writing, the Executive Office of Administration and Finance has yet to release the bond cap allocations for FY06.

H1 FOR FY06 OVERVIEW

A Solid Start to the Budget Debate, But No Help for Most Waiting Lists

H1 provides a solid foundation to build on. The governor has proposed no cuts to MRC and has recommended continued progress on the Turning 22 funding problem ("Turning 22" services are adult services provided to students who graduate or age out of special education, or other youth services). The budget provides funding to continue services to current Turning 22 clients (annualization) and $712,550 for new program participants. It is the first time MRC's new T22 account (line item 4120-4010), for those newly age 22, really will pay exclusively for new clients.

There is no help, however, for the Independent Living Centers (ILCs) or for the Home Care crisis. The ILCs have had level funding for 5 years and Home Care has a 4-month processing list for services. Home Care is supposed to be an entitlement under the state Medicaid plan and not carry waiting lists. Vocational Rehabilitation (VR) and its long waiting list would also make no progress under this budget. Individuals with disabilities, advocates, and families will be looking to the legislature to help restore the effectiveness of these programs for FY06.

Line Item Analysis

Account:      Administration

Line Item:   4120-1000

The Administration account funds the administrative expenses of the MRC, including the state-funded staff who run MRC programs. Federal funds pay for the bulk of MRC staff salaries, including vocational rehabilitation and disability determination staff.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-1000	Admin.	$367,321	$480,788	$421,311	$404,864	$409,264	$571,395

FY01-FY05 Impact

FY02 brought a large rent increase to MRC; it is reflected in that year's administration appropriation and the vocational rehabilitation appropriation.

FY03 cut this account nearly $59,477 and MRC distributed this reduction throughout the rest of its state accounts, thereby impacting programming. FY04 cut another $16,447. New line item language allows the Commissioner to transfer up to 10% of any account to any other account. This change is positive for the agency, allowing for a greater degree of flexibility.

The FY05 budget, improved funding for this account by $4,400.

FY06 Needs

The FY05 funding level remains $71,524 below that of FY02, a cut of nearly 15%. Consequently, operational costs are still being shifted to program/service accounts-this is a problem to address in FY06.

H1 for FY06 Recommendations

H1 for FY06 recommends $162,131 (39%) above the FY05 allocation.

Account:      Vocational Rehabilitation (VR) Services

Line Item:   4120-2000

The Vocational Rehabilitation (VR) account-along with federal VR matching funds required by the federal vocational rehabilitation program (line item 4120-0020)-provides funding to operate 25 Vocational Rehabilitation area offices and 215 rehabilitation counselor positions. Vocational rehabilitation, employment, job placement, and van and housing modification services are provided to persons with mental or physical disabilities (except those who are blind and are served through the Massachusetts Commission for the Blind [MCB]).

VR served 34,000 individuals with disabilities in FY04, of whom 2,848 achieved employment. In comparison, over 39,688 were served in FY01, when 2,014 more people with disabilities were moved into competitive employment than in FY04. Although the State Rehabilitation Council reports that for every dollar invested in VR services, $16 is returned, VR is serving thousands fewer clients on an annual basis.

Since 1999, anyone who is disabled and chronically unemployed, but not severely disabled, receives no VR services. The use of a waiting list triggers an order of selection system that prioritizes individuals with the most severe disabilities. Even counseling and guidance, as unpaid services, cannot be provided if the applicant fails to fit the federally-mandated order of selection criteria.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-2000	VR Services	7,520,413	7,660,311	7,672,261	7,259,207	7,459,207	7,476,987

FY01-FY05 Impact

In FY03, the VR waiting list ballooned to 7,000. Many went unserved and dropped off the list out of discouragement. By FY04, the waiting list was 1,500-2,000 (with an average 4-month wait per individual).

In FY04, state funding to VR was cut by nearly 5.4%. Although the total state/federal VR budget is $50 million, federal reimbursements and state funding have not come close to keeping pace with the effects of collective bargaining increases, the increased cost of services purchased for program participants to go to work (and other inflationary increases), or the double digit increase in demand for services by persons with significant disabilities. Federal funds to VR fell below what they were in FY97. Additional federal funding cuts were threatened but not enacted. Despite rehiring 30 rehabilitation counselors in FY04, caseloads were at 100-120 per counselor.

In FY05, the legislature provided an additional $200,000 above FY04, partially restoring that year's cut. However, the Disability Policy Consortium and the State Rehabilitation Council had advocated for an additional $600,000. The wait for services remains approximately 4 months from the date of application. Large counselor caseloads, coupled with the order of selection system (triggered by a lack of resources), are the biggest limitations.

FY06 Needs

MRC has established the need for an additional $500,000 for VR in FY06. The funds would provide services for young adult clients of the Departments of Youth Services (DYS) and Social Services (DSS) who are receiving special education and transitioning to adult services, thereby assisting at-risk youth to get into the work force. The State Rehabilitation Council is requesting an additional $800,000 for this account in FY06 to reduce the waiting list.

H1 for FY06 Recommendations

H1 recommends an increase of just $17,780. There are no new service funds for VR.

Account:      Statewide Employment Services (SES)

Line Item:   4120-3000

Statewide Employment Services (SES) funds the Extended Employment Program (EEP) and Community-Based Employment Services (CBES).

EEP, with $5 million in FY05, funds rehabilitation facility-based (sheltered) and community-based employment settings for persons with severe disabilities. Individuals learn basic work skills and complete subcontracted work that the facilities procure. People who participate in these programs work for at least 5 hours a day, 5 days a week. They earn minimum wage or are paid piece rate earnings (often sub-minimum wages). In FY05, 832 people with disabilities are served. MRC has cut this program in half in the last 15 years.

CBES is a supported work program, funded in FY05 with $2.4 million. It operates various federal- and state-funded programs for people with severe disabilities. The programs provide assessment, job placement, individual employment supports, extended services, training, and job development. Individuals must work for a minimum of 20 hours per week to be eligible. In FY04, 800 persons were served; 229 of these were placed in competitive employment. Approximately 190 receive ongoing (called "extended") supports to remain employed.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-3000	Employmnt. Srvcs.	9,025,618	8,399,240	8,098,927	7,780,098	7,886,816	7,968,942

FY01-FY05 Impact

Between FY01-FY04, SES was cut by over $1.1 million (13.8%), unadjusted for inflation. As a result, 300 placement slots were cut, most from EEP. MRC has had limited funds to provide ongoing supports to CBES program participants who need them in order to remain in competitive employment. The cost per program participant per year averages $2,500, and only $419,000 was available in FY04. Only state funding can be used for these "extended" employment supports. There are waiting lists for both programs.

In FY05, the legislature restored $106,718 to the SES account, leaving it down over 12.5% from the FY01 funding level. The restoration enabled MRC to take 18 people off the 50-person EEP waiting list. Although MRC has prioritized CBES in recent years, they report that dozens of people have been waiting 3-4 years for EEP services.

FY06 Needs

MRC has requested $416,000 to eradicate the EEP and CBES waiting lists in FY06. The State Rehabilitation Council has requested an additional $500,000 for CBES to provide the extended supports that individuals need to remain in competitive work.

H1 for FY06 Recommendations

H1 recommends just $82,126 above the FY05 funding level, which is mostly salary reserve funding for vendored direct care workers only.

Accounts:    Independent Living and Turning 22 Services

Line Items:  4120-4000 and 4120-4010

The Independent Living and Turning 22 Services accounts fund a number of programs-Independent Living Centers, Adult Supported Living Services, Assistive Technology (including Project SHARE), Protective Services, and Turning 22 Services (including the Transition to Adulthood Program). Each of these programs is presented separately in the list below.

·       There are currently 11 Independent Living Centers (ILCs) (line item 4120-4000). ILCs provide independent living services, peer counseling, skills training, help in finding housing, information, advocacy and other services to assist individuals with severe disabilities to leave institutions and to prevent institutionalization of people who currently live in the community. ILCs are staffed, for the most part, by people with disabilities, and the ILC boards of directors are made up of at least 51% of people with disabilities. Annually, 12,000 people are served by ILCs. Formal waiting lists are not maintained. In FY04, 80-90 people were helped to leave institutions, while over 480 people were assisted to stay out of nursing homes.

·       Adult Supported Living (ASL) Services (line item 4120-4000) are provided to help people move out of or prevent them from entering nursing homes. Approximately 4 hours per week of case management is provided for those individuals participating in the personal care attendant (PCA) program. PCAs are employees who provide at-home assistance for people with disabilities, allowing many to avoid living in facilities. In FY03, the average cost for ASL case management was $6,551 per program participant. With PCA services it was $38,902. In contrast, nursing homes can average $65,000 per person per year. In FY04, this program moved 7 people with severe disabilities out of nursing homes into community living. Currently, 93 adults receive ASL services. These persons all have severe physical disabilities in addition to the presence of cognitive impairments, mental illness, multiple medical problems, or other difficult life circumstances.

·       Assistive Technology (AT) Services (line item 4120-4000) provide low- and high-tech solutions to increase independence for individuals in major life functions such as seeing, hearing, breathing, manual dexterity, mobility, communicating, learning, working, or self-care. These are last resort services. People who are eligible for similar services through Special Education, Vocational Rehabilitation, and other EOHHS agencies may not receive AT through this program. Annually, 300 persons are served. A related program, Project SHARE, is operated at UMass Dartmouth and funded through an interagency services agreement. This cost-effective program provides technology to help people with severe disabilities communicate and have as much independence as possible.

·       Turning 22 (T22) Services (line items 4120-4000 and 4120-4010) are for young people with severe physical disabilities when they reach 22 years of age and graduate from special education programs. T22 provides a continuum of community living options, from minimal supported living case management-personal care attendant (PCA) and financial case management for those in their own apartments-to intensive services with 24 hour / 7 day supports for those in secure residential settings. Most of the young people who receive supported living services are graduates of the Massachusetts Hospital School in Canton. Case management and transition planning begin while the young people are still in school through the Transition to Adulthood Program (TAP), also funded here. TAP provides skills trainers from ILCs who go into school systems to work with individuals before they turn 22, in order to facilitate a smooth transition from school to the community. In FY04, 67 persons were served. Service to 74 individuals is projected for FY05.

·                           The Protective Services program (line item 4120-4000) handles referrals that MRC receives from the Disabled Persons Protection Commission (DPPC) hotline. [Editor's Note: See the "Other Disability Advocacy and Information Agencies" chapter, line item 1107-2501, to learn more about the DPPC.] MRC then conducts investigations, provides post-investigation services to people who have been found to be at risk for further abuse-including emergency shelter, increased home health aide services and counseling-and reports back to DPPC. Referrals are on the rise due to staffing shortages at the DPPC as well as increased hotline activity.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-4000	Ind. Living	7,023,433	7,628,212	7,255,346	7,471,512	7,520,512	7,798,601
4120-4010	Turning 22	---	320,000	440,760	565,000	1,065,000	712,550

FY01-FY05 Impact

The recent impact on each of the programs funded by these line items is discussed separately below.

·       ILCs (line item 4120-4000): In FY05, the 11 ILCs received $3.2 million. ILCs have received level funding for 5 years. Staff are poorly compensated, so low staff retention and high burn-out are problems. ILCs have become crisis centers, responding to emergency situations, with less attention given to aftercare. Cuts across the service sector impact their ability to be effective (i.e., it is hard to move people out of nursing homes when there is no housing to move them into). In FY05, the ILCs are contracted to move 10-20% more people out of institutions, without any corresponding increase in funds. Although the Statewide Independent Living Council (SILC) had advocated for an additional $600,000 to the ILCs in FY05, the money was not allocated.

·       ASL (line item 4120-4000): In FY05, ASL received $837,739. There are 25 people currently un-served on a waiting list. MRC conducts no outreach to people in need and estimates that over 2,000 people could benefit from ASL in the Commonwealth. The ASL Program has not grown substantively in 5 years-91 people were served in FY02 and only 93 are projected for FY05-despite a sharp increase in need. Most people are brought off the waiting list through attrition only, causing a 4-year wait for services. Meanwhile, the PCA program has exploded over the last 5 years, with 5,000-11,000 using PCA services. The need for case coordination is severe.

·       AT Services (line item 4120-4000): In FY05, AT Services received $573,100. AT has been level-funded for 5 years. The waiting list hovers at about 75 people annually. Beyond the waiting list, MRC conducts no outreach to determine the extent of need. In FY03, Project SHARE was cut and MRC estimates the Commission served 37% fewer persons as a result. The funding was restored in FY04 and in FY05 Project SHARE was funded at $200,000.

·                           T22 (line items 4120-4010 and 4120-4000): In FY02, the legislature created a separate account for new T22 (line item 4120-4010) MRC program participants. The challenge since has been to secure annualization funds in the Independent Living (line item 4120-4000) and Statewide Head Injury Program (line item 4120-6000, see below) accounts each year to continue to serve each previous year's new participants. Annualization funds provide a full year of services for those individuals brought into the system part way through the previous year. In FY03 and FY04, under-funding meant the creation of a waiting list for T22 services. In FY05, line item 4120-4000 included $1.99 million for Turning 22 (T22) services, while line item 4120-4010 provided an additional $1.065 million to serve the new T22 participants, including an additional $500,000 for the T22 waiting list and $565,000 in annualization funds for the previous years' new participants.

·       Protective Services (line item 4120-4000): In FY02, Protective Services was cut by 3 full-time equivalent staff (FTEs), from 10 to 7. In FY03: 138 individuals received Protective Services; there were 145 new service plans; 132 individuals received paid services; there were a total of 279 investigations; and 3,146 home visits were conducted. Services to 40 individuals were cut due to inadequate funding. These were individuals who were not eligible for services under the abuse statute, but were still at risk for abuse. MRC reports that the intensity of the investigations has increased and they are seeing many more cases of domestic violence and criminal activity. The agency anticipates that because of housing shortages and economic instability these trends will continue. In FY05, the Protective Services budget remains at $623,300, representing level funding with FY04 and FY03.

FY06 Needs

The FY06 needs for each of the programs funded by these line items is discussed separately below.

·                           ILCs (line item 4120-4000): MRC has established the need for an additional $500,000 for the ILCs in FY06. Meanwhile, the Statewide Independent Living Council (SILC) and the Disability Policy Consortium (DPC) are advocating for a $1 million increase-$500,000 to help the ILCs meet the nursing home diversion goals being set by EOHHS and $500,000 for base funding parity (equal base funding to each center) to the ILCs statewide.

·                           Adult Supported Living (line item 4120-4000): MRC has established the need for an additional $312,000 to eradicate the current ASL waiting list in FY06. Advocates have been talking for years about the need to expand supported living. There is also a need for PCA workforce development and PCA screening services.

·                           Assistive Technology Services (line item 4120-4000): Advocates at the SILC and the DPC identify AT funding as just scraping the surface of the needs in the Commonwealth. Easter Seals Massachusetts has also been advocating for AT funding, as has the State Rehabilitation Council. MRC estimates that an additional $375,000 would serve the current waiting list of 75 people.

·                           Turning 22 (line items 4120-4000 and 4120-4010): For FY06, MRC needs an additional $210,000 to continue services to the FY05 T22 program participants (annualization funds in line item 4120-4000). Line item 4120-4010 needs $179,100 to serve a projected 21 new T22 students. Also needed are $900,000 new dollars in the SHIP account (line item 4120-6000, also for annualization funds). Finally, MRC is assigned T22 cases from the Transitional Advisory Committee that fall through the eligibility cracks between the disability agencies. Additional funds will be needed to cover these cases; exact figures are still to be determined. The State Rehabilitation Council and the DPC have been advocating for improved T22 funding for FY06.

Turning 22 has been a growing problem for many years at MRC and has squeezed funding from other programs. Central to the issue has been how to pay for Turning 22 annualization, particularly for brain-injured Turning 22 program participants, whose needs can run up to $150,000 per year per person for a 24 hour / 7 day residential program. Unlike at DMR and MCB, where the annualized costs-the second year of services for a young person who started adult services the previous year-are rolled into the base of the appropriate services account, MRC has had to scramble to continue services for these individuals, and routinely has had to obligate much of its new Turning 22 funds for the annualization costs of last year's group. As a result, MRC has had a hard time paying to bring new people into adult services. Waiting lists have resulted, and other IL and SHIP services have been squeezed.

H1 for FY06 Recommendations

H1 provides T22 annualization funds to the base of two accounts at MRC-$210,000 to the Independent Living account (line item 4120-4000) and $1.1 million in the Statewide Head Injury appropriations account (line item 4120-6000, see below). In addition, $712,550 is recommended in the Turning 22 account (line item 4120-4010) for new program participants. This amount is less than last year, but most of FY05's Turning 22 account is paying for annualization, not new participants. For the first time in a long time, expansion dollars are in the budget to serve a significant number of new Turning 22 participants.

Outside of the progress for Turning 22 funding, this budget would provide level funding to the other IL programs, including the ILCs. Finally, $86,000 is provided for the salary reserve initiative for the lowest paid vendored direct care workers.

Account:      Housing Registry (Mass Access)

Line Item:   4120-4001

The Housing Registry, also known as Mass Access, is a service that matches people who have disabilities and are seeking housing with available accessible units in the state. In 1990, the legislature passed the Housing Bill of Rights for Persons with Disabilities (Mass. G. L. c. 722), which required MRC to develop and operate a central registry of accessible and adaptable housing for people with disabilities. In FY02, there were 26,000 housing calls to the Independent Living Centers (ILCs) and the Housing Registry recorded just 541 vacancies, including 112 new listings. In FY03, over 500 people were able to locate accessible housing through the registry.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-4001	Housing Registry	100,000	93,060	93,060	83,754	83,754	83,754

FY01-FY05 Impact

Since FY01, the Housing Registry account has been cut by 16.25%. Meanwhile, the costs of operating the Registry have gone up. Cuts impact the Registry's ability to maintain real-time updates of the housing database. In FY05, the account is level-funded with the FY04 allocation.

H1 for FY06 Recommendations

H1 recommends level funding to this account again in FY06.

Account:      Home Care Services

Line Items:  4120-5000 and 4120-5050

The Home Care Services program provides grocery shopping, meal preparation, medication pick-up, laundry, and light housekeeping assistance for people with severe disabilities between the ages of 18-59 who live alone (or with minor children) and whose disabilities put them at risk of re-hospitalization or institutionalization. Only MassHealth-eligible individuals are now served.

Home Care generates federal financial participation (ffp) revenue through MassHealth, and services under this account are an entitlement under the state's MassHealth plan. The ffp money goes to the General Fund, but MRC has a retained revenue account (line item 4120-5050) that captures up to $2 million and helps to cover rate increases for Home Care services. The average vendor rate, set by the Department of Elder Affairs (DEA), is $18-$27 per hour.

Demand for Home Care Services increases as more people with disabilities gain access to other services that allow them to live in their own homes. Openings in the program occur when people die, become more seriously disabled, turn age 60 (when they are covered by DEA) or are found no longer eligible. The annual cost of services averaged $3,800 per client in FY04.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-5000	Home Care	4,704,801	4,774,767*	4,694,767	4,342,733	4,339,768	4,391,217
4120-5050	Home Care Ret. Rev.	2,000,000	2,000,000	2,000,000	2,000,000	2,000,000	2,000,000

*   Includes $312,024 passed in supplemental budget.

FY01-FY05 Impact

Since FY02, the Home Care Services program has been cut nearly 9%. Budget cuts have trimmed Home Care service hours and tightened eligibility. In FY04, budget cuts ended Home Care services to non-Medicaid-eligible individuals. As a result, although the program served 1,792 clients per month in FY01, only 1,632 were served per month in FY04. MRC is spending more on re-evaluations to ensure program attrition and keep the "processing list"-a euphemism for the term "waiting list" that is used because this is program is an entitlement-moving.

In FY04, the processing list of Medicaid-eligible individuals was at 256 persons. It has ballooned to 400 persons in FY05. People now are waiting 4 months to be served. Currently, there are also about 150 non-MassHealth-eligible persons on the processing list who will not be served but desperately need the help.

In FY05, the program received less than level funding and is now 9% below its FY02 level (which was the high funding mark between FY01-FY05 for this account).

FY06 Needs

MRC has established the need for an additional $2,774,571 (a 64% increase) for Home Care in FY06 to address the current "backlog" of clients (including those who are not MassHealth-eligible) and the projected increase of 20 additional client applicants per month. MRC also would like to see line item 4120-5050, the retained revenue account that captures federal financial participation (ffp) and is largely obligated by Home Care rate increases, increased by $500,000.

H1 for FY06 Recommendations

H1 provides no relief for the waiting list. The $51,449 increase to this line item is for the salary reserve initiative funded in FY05 for the lowest paid vendored direct care workers.

Account:      Statewide Head Injury Program (SHIP)

Line Item:   4120-6000, 4120 and 4120-6002

The Statewide Head Injury Program (SHIP) supports community services for people with traumatic brain injury (TBI), including: community-based residential placements; regional head injury centers; service coordination; case management; respite; assistive technology; one-to-one skills training and support; substance abuse services; social and recreation programs; technical assistance; and information referral.

SHIP focuses resources on developing a statewide network of community-based programs to serve children, those turning 22, the aging population, those from diverse cultures and the elderly. In FY04, over 550 individuals with TBI were served. The SHIP waiting list now holds 2,500 eligible individuals.

A recent Department of Public Health report indicates the needs could be much greater. In 2002, 4,605 people were released from Massachusetts hospitals with TBIs, while another 33,073 were treated in emergency rooms and sent home. Injuries are up 23.5% since 1995. Some advocates have called TBI an epidemic.

Line Item	Description	FY01	FY02	FY03	FY04	FY05	H1 for FY06
4120-6000	SHIP	6,923,277	6,954,509	6,504,692	5,979,149	6,000,568	7,218,168
4120-6001	SHIP Trust Fund	750,000	1,000,000	1,800,000	off budget	off budget
4120-6002	SHIP Trust Ret. Rev.	2,000,000	4,500,000	5,000,000	off budget	off budget	6,748,592 off budget

FY01-FY05 Impact

Each of the funding sources for the SHIP line items is discussed separately below.

·       The Head Injury Trust Fund (off-budget): Prior to FY04, successful advocacy helped expand access to Head Injury Trust Fund dollars. These funds are collected from speeding and DUI (driving under the influence) surcharges/fines and are not from the General Fund (i.e., they are not tax dollars). The trust fund monies were formerly allocated in line items 4120-6001 (SHIP Trust Fund) and 4120-6002 (SHIP Trust Fund Retained Revenue). In FY04, trust fund money was moved off budget, so the accounts are no longer subject to appropriation (which makes sense since they are not tax dollars).

·       The 4120-6000 SHIP account (from the General Fund): Since FY01, this account has been cut by nearly $1 million. However, including access to the trust, the total SHIP budget is now $12.8 million, compared with $9.6 million in FY01. As a result, approximately 50 more individuals are receiving paid SHIP services than did in FY01. Hampering SHIP's capacity to take on more clients are the needs of SHIP Turning 22 program participants. SHIP's budget should grow annually, reflecting the addition of T22 annualization dollars (see line 4120-4000 above). It has not.

·       Federal matching funds: SHIP services now generate federal financial participation (ffp) matching dollars, but the money reverts to the General Fund instead of benefiting SHIP.

In FY05, no expansion funds are provided for SHIP and the appropriation does not keep up with inflation. No one new will be offered residential services off the 2,500 person waiting list.

FY06 Needs

Survivors of head injuries, in particular, are in need of increased residential services. About 75% of individuals with head injuries live with their parents, and as individuals and parents grow older, the need for supportive residential services increases.

MRC reports that an additional $900,000 is necessary in FY06 to annualize FY05 new SHIP Turning 22 program participants.

Advocates are calling for an additional $3 million for the SHIP account in FY06. The funds would be divided as follows: $500,000 for a regional Information and Resource system statewide; $500,000 for a comprehensive residential program for battered women who have sustained a TBI (many of whom are homeless); and $2 million for the waiting list (to provide services to 40 people). MBIA is also calling on the state to create services for those with Acquired Brian Injuries (such as stroke victims).

H1 for FY06 Recommendations

H1 proposes $1.1 million in annualization funding for Turning 22 program participants to be added to the base of SHIP's 4120-6000 line item. MRC reports that $180,000 of this money is for non-SHIP participants, however, and will need to be shifted into the Independent Living account (line item 4120-4000, see above) to correct the problem. In addition, $124,880 is provided for annualization costs of the FY05 salary reserve initiative.

Full funding for Turning 22 annualization means that the funds in the new Turning 22 account will fully support new clients, including several SHIP program participants who would otherwise wait for services. Aside from Turning 22, there are no new service dollars in this budget for SHIP program participants.