Massachusetts Rehabilitation Commission

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-1000	Admin.	$367,321	$409,264	$571,395	$571,395
4120-2000	VR Services	7,520,413	7,459,207	7,476,987	7,476,987
4120-3000	Employment Services	9,025,618	7,886,816	7,968,942	7,960,068
4120-4000	Ind. Living	7,023,433	7,520,512	7,798,601	7,869,714
4120-4001	Housing Registry	100,000	83,754	83,754	83,754
4120-4010	Turning 22	--	1,065,000	712,550	712,550
4120-5000	Home Care	4,704,801	4,339,768	4,391,217	4,417,049
4120-5050	Home Care Ret. Rev.	2,000,000	2,000,000	2,000,000	2,000,000
MRC	Subtotals w/o SHIP:	$30,741,586	$30,764,321	$31,003,446	$31,091,517
4120-6000	SHIP	6,923,277	6,000,568	$7,218,168	6,955,515
4120-6001	SHIP Trust Fund	750,000	off budget	--	--
4120-6002	SHIP Trust Ret. Rev.	2,000,000	off budget	off budget	Off budget
SHIP	Head Injury Totals:	$9,673,277	$6,000,598**	7,218,168**	6,966,515**
MRC	Totals:	$40,414,863	$36,764,889	$38,221,614	38,047,032
** SHIP totals exclude “off budget” trust fund dollars. MRC spends about $6,748,592 annually from the trust.

This chapter focuses on the House of Representatives’ FY06 budget recommendations for the Massachusetts Rehabilitation Commission (MRC). For additional information on the impacts of FY01–FY05 budget cuts and more details about program services, go to the People First website at www.mass.gov/mddc/peoplefirst/index.html and click on the MRC chapter in the Volume I table of contents.

HOUSE BUDGET OVERVIEW

No Relief for Most Waiting Lists

The House budget recommendation is $174,582 below that in H1 for FY06. It is $1,282,143 (3.48%) above the FY05 funding level. As does H1 for FY06, this budget makes some progress in funding Turning 22 (T22)—the adult services provided to students who graduate or age out of special education or other youth services. The House budget provides $712,550 for new T22 program participants, but inadequate annualization funding to continue services to all current clients. The $174,582 missing from the House budget would impact those services. In order to continue services to current T22 clients, MRC would have to serve fewer “new” Turning 22 consumers in FY06. In contrast, H1 FOR FY06 had fully funded both annualization and new Turning 22 participant needs.

In addition, the House budget proposes no relief for the Independent Living Centers (ILCs) nor 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 Senate 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.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-1000	Admin.	$367,321	$409,264	$571,395	$571,395

FY06 Needs

FY05 funding remains $71,524 below that of FY02 (when it was $480,788), a cut of nearly 15%. Consequently, operational costs are still being shifted to program/service accounts—this is a problem to address in FY06.

House Budget Recommendations

Both the House budget and H1 for FY06 recommend an increase of $162,131 (39%) above the FY05 allocation.

Account: Vocational Rehabilitation (VR) Services
Line Item: 4120-2000

The Vocational Rehabilitation (VR) account 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]).

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-2000	VR Services	7,520,413	7,459,207	7,476,987	7,476,987

FY06 Needs

In FY03, the VR waiting list ballooned to 7,000 persons. Many went unserved and dropped off the list out of discouragement. By FY04, the list was at 1,500–2,000 persons, with an average 4-month wait. While MRC has established the need for an additional $500,000, the State Rehabilitation Council is requesting an additional $800,000 to reduce the waiting list.

House Budget Recommendations

Both the House budget and H1 for FY06 recommend 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, $5 million) and Community-Based Employment Services (CBES, $2.4 million). EEP funds rehabilitation in facility-based (sheltered) and community-based employment settings for persons with severe disabilities. EEP served 832 people in FY05. CBES—a supported work program for people with severe disabilities—served 800 people in FY04.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-3000	Employment Services	9,025,618	7,886,816	7,968,942	7,960,068

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.

House Budget Recommendations

The House budget recommends $73,252 above FY05 funding, a less than 1% increase. The House budget proposal is $8,874 less than in H1 for FY06. The increase is 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: Independent Living Centers, Adult Supported Living Services, Assistive Technology (including Project SHARE), Protective Services, and Turning 22 Services (including the Transition to Adulthood Program).

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-4000	Ind. Living	7,023,433	7,520,512	7,798,601	7,869,714
4120-4010	Turning 22	--	1,065,000	712,550	712,550

FY06 Needs

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

ILCs (line item 4120-4000): MRC has established the need for an additional $500,000 for the ILCs in FY06. Meanwhile, independent living advocates are asking for a $1 million increase—$500,000 to help the ILCs meet the nursing home diversion goals being set by EOHHS (Olmstead)and $500,000 for base funding parity (equal base funding to each center) for the ILCs statewide.
Adult Supported Living (line item 4120-4000): MRC has established the need for an additional $312,000 to eliminate 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 identify AT funding as just scraping the surface of the needs in the Commonwealth. MRC estimates that an additional $375,000 would serve the current waiting list of 75 people.
Turning 22 (T22, line items 4120-4000 and 4120-4010): For FY06, MRC needs an additional $390,000 to continue services to the FY05 T22 program participants (annualization funds in line item 4120-4000). Also needed are $900,000 new dollars in the SHIP account (annualization funds in line item 4120-6000). Line item 4120-4010 needs a minimum of $600,000 for new Turning 22 participants from the SHIP program, the Independent Living programs, and for students assigned to MRC through the Transitional Advisory Committee. These are people with serious disabilities who fall through the eligibility cracks of the disability agencies.

Under funding of Turning 22 services has been a growing problem for many years. 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. At DMR and MCB, 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. In contrast, MRC routinely has had to shift much of its new Turning 22 funds for services to last year’s group. Waiting lists have resulted, and other IL and SHIP services have been squeezed.

House Budget Recommendations

Both the House and H1 for FY06 propose $712,550 for the T22 account (line item 4120-4010) for new program participants. This amount is less than that for FY05, and most of FY05’s Turning 22 account is currently paying for annualization, not new participants. For the first time in a long time, expansion dollars are recommended to serve a significant number of new Turning 22 participants and annualization funds are provided for last year’s group.

The House budget, like H1 for FY06, provides T22 annualization funds to the base of two accounts— $280,000 in the Independent Living account (line item 4120-4000) and $817,347 in the Statewide Head Injury appropriations account (line item 4120-6000, see below). The House budget is $126,247 short of what is needed in line item 4120-4000 for annualization, and $82,653 short of what is needed in line item 4120-6000. This funding would provide inadequate support for those who entered adult services in FY05. If the House budget amount prevails, MRC will likely have to “raid” the new T22 funds to cover those already being served, and therefore fewer students will enter adult services in FY06 than would be possible with adequate annualization funding.

Outside of T22 funding, the House budget provides just level funding to other IL programs, including the ILCs. The salary reserve for the lowest-paid vendored direct care workers receives $85,449.

Account: Housing Registry (Mass Access)
Line Item: 4120-4001

The Housing Registry, also known as Mass Access, maintains a central registry of accessible and adaptable housing for people with disabilities and matches people seeking housing to available accessible units. In FY03, over 500 people located accessible housing through the Registry.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-4001	Housing Registry	100,000	83,754	83,754	83,754

FY06 Needs

Since FY01, the Housing Registry account has been cut by 16.25%. Cuts impact the Registry's ability to maintain real-time updates of the housing database.
House Budget Recommendations Both the House budget and H1 for FY06 recommend just level funding for this account.

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.

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-5000	Home Care	4,704,801	4,339,768	4,391,217	4,417,049
4120-5050	Home Care Ret. Rev.	2,000,000	2,000,000	2,000,000	2,000,000

FY06 Needs

MRC has established the need for an additional $2,774,571 (a 64% increase) for Home Care. The money would help to address the current “backlog” of clients (including those who are not MassHealth-eligible) and the projected increase of 20 additional applicants per month. MRC also would like to see an increase of $500,000 for the retained revenue account that captures federal financial participation (ffp) and is largely obligated by Home Care rate increases (line item 4120-5050). Advocates are calling for an additional $250,000 in line item 4120-5000 to address the Home Care waiting list.

House Budget Recommendations

Both the House and H1 for FY06 provide no relief for the waiting list. The House budget recommends just $77,281 more than FY05, and $51,449 of the 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).

Line Item	Description	FY01	FY05	H1 for FY06	House Budget for FY06
4120-6000	SHIP	6,923,277	6,000,568	$7,218,168	6,955,515
4120-6001	SHIP Trust Fund	750,000	off budget	--	--
4120-6002	SHIP Trust Ret. Rev.	2,000,000	off budget	off budget	Off budget
SHIP	Head Injury Totals:	$9,673,277	$6,000,598**	7,218,168**	6,966,515**

FY06 Needs

Survivors of head injuries 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. There are 2,500 people on the SHIP waiting list. MRC reports that a $900,000 increase is necessary in FY06 to annualize services for SHIP T22 participants who entered the program in FY05.

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 Traumatic Brain Injury (TBI), many of whom are homeless; and $2 million for the waiting list (to serve 40 people). Advocates are also calling on the state to create services for those with Acquired Brain Injuries (such as stroke victims).

House Budget Recommendations

The House budget proposes $262,653 less than H1 for FY06. Still, the House budget amount would be an increase of $954,947 over FY05 funding. Of this increase, $124,880 is for annualization costs of the FY05 salary reserve initiative and $12,720 is for other salary increases, leaving $817,347 for Turning 22 annualization needs. SHIP needs $900,000 to cover services to current program participants. Aside from Turning 22 funds, no expansion funds are provided to address anyone off the long SHIP waiting lists for services.