Patrick Cadigan: 0:00

Welcome. This is the Postsecondary Transition conversation. We focus on the ins and outs and everything in between of the transition process for families of students with disabilities, I am one of the hosts. My name is Patrick Cadigan. I am a public school transition coordinator.

Meghan Smallwood: 0:14

And I am the co host. My name is Meghan Smallwood, and I am also a public school transition coordinator. Well, we know we've had conversations in the past about self directed services, but we wanted to bring back one of our self directed services expert, Jamie broad, next to kind of review self directed services, what it all means. And I know there's been some potential updates and proposals and changes and all that fun stuff, so we'll just have a nice little conversation about that. So welcome Jamie.

Jamie Brodnax: 0:43

Thank you. I am happy to be back talking to you guys. We appreciate you coming.

Meghan Smallwood: 0:48

We know there's a lot of unknowns upon us, and uncertainty about self-direction and what the pathway is going to be. So this is all kind of just, you know, general information, nothing is set in stone. Just to throw that disclaimer out there.

Patrick Cadigan: 1:06

I would say, given that, Meghan, for new listeners, do you want to give us a definition like, what are we talking about when we say self directed services?

Meghan Smallwood: 1:15

Yeah, so self directed services. We're obviously talking about our DDA or Developmental Disabilities Administration funding. And there's two different paths, where there's traditional, which is agency directed, and your budget from DDA would go directly from DDA to agency, and you wouldn't have to worry about, you know, managing the money. But that being said, you also aren't involved in the planning of activities or the supports or services that are being given with self directed it's a service delivery model for individuals and their support circle who wish to have more choice, control and authority over their supports, so they have control over what their services and staffing will be like. They have the ability to be creative, to use the funding and to pretty much completely individualize their day. So it really promotes that personal choice and control over the delivery of services and budget.

Jamie Brodnax: 2:11

And then, if I remember correctly, so then the reason that we're going to have to have this conversation is because funding comes through Medicaid, right? And so with so much of the discussion about Medicaid, surrounding potential budget cuts that could have an impact on our families, and then it sounds like that some of these proposed budgets would then go towards having a direct impact on self directed services. Jamie, did? I did? I word that correctly. You did. So everything that you hear impacting Medicaid budget and even our state budget is then trickling down to impact DDA and the people that receive those DDA services always easy to track where the money is coming from. But it is important that people realize you know what is happening at our federal and state level, ultimately does impact every single one of us, and right now, very much so the people that are receiving DDA services on traditional and self directed side.

Meghan Smallwood: 3:19

Yeah, and I hear that question a lot from families, like, with everything going on, what's the impact? And I'm like, I don't have the answers yet. There's a lot of speculation, but I don't have the exact information.

Jamie Brodnax: 3:31

Absolutely and...being made literally right now. So just this past week, our state legislator was hearing stories from families and provider agencies and having those discussions to determine what the budgets are going to look like for the agencies that fall under our Health and Human Services, which is DDA.

Patrick Cadigan: 3:56

So those discussions are ongoing, and so nothing, nothing is set in stone yet. So it's like people, families are in a holding pattern, essentially, it sounds like.

Jamie Brodnax: 4:09

Yeah, so we have basically been given the proposal, which a lot of people are taking as a warning, um, where the state has given their proposed budget, which included DDA having about $150 million less than they would need to continue services exactly as they were in the 2026 fiscal year. So with those proposals came DDA proposals of how to adjust their spending to match the funding that they're proposed to receive from the state. Now, last year, similar situation occurred, and then additional funding was provided beyond what was initially proposed, so the budget cuts weren't quite as severe as they were originally proposed. That's what we're hoping. Four again this year. But we never know it could be more severe. It could be less the budget cuts could target, you know, the areas that they're proposing to target, or it could expand beyond that. It's really hard to say for sure until we get those things in writing from DDA.

Meghan Smallwood: 5:21

So in terms of self directed services, what kind of possible areas could be impacted?

Jamie Brodnax: 5:28

So the three biggest areas right now are putting an overall budget cap on PCP approved funds of half a million dollars, which I know sounds like a lot of money, and it is a lot of money, but it it also is, those are the people that have the highest level needs,

Meghan Smallwood: 5:49

Right.

Jamie Brodnax: 5:50

And so it's really sad to think that the people with the highest level needs are the ones being targeted to potentially lose some of those really important services that they need to say to stay safe and healthy, living the life of their choosing and not being forced into services that are against their wishes. The other areas that are being targeted are both related to pay and wages. DDA is proposing to do a pay rate cut as far as what self directed individuals are allowed to pay their staff and as their hourly wage. Those initial proposals are quite significant. In the initial proposals to align with what the Bureau of Labor Statistics has shared is the average pay for people in similar services. We're looking at six to $11 an hour being cut from personal supports and Community Development Services, and about $2 an hour for respite services those if the $11 cut were to come to personal support services, that is a 30% decrease in an yearly full time wage. Wow, that. It's more than significant. That is a life changing cut. On top of that, we have some individuals who have a higher level of need and in turn, want to pay their staff a wage beyond what DDA has set in those limits, and that's called having a wage exception. It is being proposed that not only is that wage exception potentially going to be taken away, then on top of that, those same people that lose that wage exception would then have to undergo the same budget cuts as everyone else. So for example, if you have a staff who is supporting a person with a higher level need, maybe they have a wage exception that has given them $5 more than what the maximum is in that service. DDA is proposing to take away that $5 an hour and then also implement whatever level of budget cut that everybody else experiences. So for some people, that could be more than 30% we're talking potentially even up to 40 or 50% of their pay gone.

Meghan Smallwood: 8:21

That's crazy. I mean, at that point, it's like, where did the freedom to, you know, make your own choices for staff and how you do everything go?

Jamie Brodnax: 8:33

Yeah, and it's been a challenging time to have this conversation with families. And then also, families are currently reaching out to their legislators and talking to their senators and asking for help. And we're getting a lot of kind responses, but also responses that are going around the topics a little bit and really pushing for provider based services over self-direction, which is disheartening, particularly because self-direction is not only just a choice for some, but a lot of people in self-direction ended up in self-direction because provider agencies were not able to provide the support that they need it, right? Yeah, and I think that's where there's a miss when it comes to how it's being looked at, because it is a great choice, and it's a choice that I strongly support. I think self-direction is wonderful, but it's also the only choice for some families that are now going to be put in a position to not be able to afford to hire the level of care that they need to stay safe in their community.

Meghan Smallwood: 9:43

Yeah, and that was one, like, positive when I'd be talking to families who are very nervous about their student, who had a lot of needs and did not feel like, just by, you know, going out and visiting different programs, that there was any option out for them, out there for them. And the appeal of having a self directed budget was that they could kind of, like persuade people to come and work because they offered a better rate for salary and, you know, advantages like that. But it's got, you know, it just that's very discouraging. And I feel like it was just a couple ago that it seemed like everyone was kind of moving more from their traditional way to self directed, and now the pendulum seems to be swinging the other way.

Patrick Cadigan: 10:23

Jamie, one question that I have, and forgive me, because when it comes to this, I literally am a lay person. So let's say what I heard you say was, is that there is a proposal now for a budget cap on PCP approved plans. And when we say that, we mean person centered planning plans. So it sounds to me like whereas before, you would sit down and you would create the plan, and then you would figure out the budget, now it sounds like they're going at it in the opposite direction, that you would have to set a budget first and then figure out the person centered plan.

Jamie Brodnax: 10:59

So they haven't really shared the details on how they're expecting teams to not exceed this $500,000 cap, okay? And I think that's part of the confusion, especially for the individuals who have already exceeded that, and trying to figure out, is it going to be the team's responsibility then to look at services and potentially make our own service cuts and not request things that the person needs, or is it going to be on DDA responsibility? Then to review the plan, and they're choosing what the person can and cannot have. It's also been discussed if is there actually going to be service limitations, or are we just going to see a decrease in overall funding to where it's nearly impossible to have a budget that exceeds half a million dollars, if the funding associated with each of those services lowers, and I think that that's a possibility, because if they're lowering the amount that you're allowed to pay your staff, it would make sense for them to lower the funding also associated with that service, because one of the things that they've brought up in a lot of the meetings that they're having is that people are not using their full budget. Most individuals use less than 60% of the funding that's approved in their PCP. Oh, I didn't realize that. I actually didn't either, until I just recently read the budget report that they put out for the 2026 fiscal year and then the proposals for the 2027, fiscal year.

Meghan Smallwood: 12:44

Interesting because I've always told parents too, like, if it was not enough on the budget, you can always go and amend or appeal, you know, and ask for more and but it's interesting to hear that many don't even get to that point.

Jamie Brodnax: 12:55

It is; and I think that there's a couple reasons that really kind of result in that. One is the delays in PCP approval.

Meghan Smallwood: 13:04

Yeah.

Jamie Brodnax: 13:04

So I have personal experience with families who sometimes don't get to access the first several months of their budget because they're waiting on it to be approved.

Meghan Smallwood: 13:14

Yeah.

Jamie Brodnax: 13:15

Then we also have the issue of dealing with the FMS agencies and things being denied, invoices, reimbursements, those IFDGS activities, it's very difficult right now to get things approved and paid. So those delays are resulting in people not pursuing it, which is leaving money left over. You have the regular reasons too, of like, people using paid time off, you know, vacations, respite, sick days, all of those things, of course, result in funding not being used.

Meghan Smallwood: 13:51

Yeah, and I was gonna say, if this like, you're talking about having, like, DDA approve things, Patrick, I think you were the one who said it like approving the act, the different services and things more closely, like, I'm just thinking of delays, even more delays over time, with everything you know, it's already bad enough, because the person who is on top of it and getting everything in and waiting for that first day you know, of funding to start, and it's still months after, you know, July 1, it just it blows my mind to think it could go even further or even longer.

Patrick Cadigan: 14:28

Yeah, to throw out like a clarifying piece of that there was a former student that I was aware of, that I had become aware of recently, and the family had reached out to the school because they were concerned that they had not been approved, and so effectively, this person was sitting around doing nothing, and they really couldn't do anything until their budget was approved, and it wasn't intention. Emotional. It wasn't it was just, you know, my understanding, because I had reached out to the coordinator community service who reached out to the family, reached out like there were, there were. So there was a lot of people advocating for this individual, and yet they were met with silence. In fact, now that I'm talking about that, we remember that when we had had our conversation with Martha Goodman, who had created the MIRA tool, she also talked about that, that these just being met with deafening silence because there's, you know, there's no one there,

Jamie Brodnax: 15:36

Yep.

Meghan Smallwood: 15:37

Yeah, and I know we've had families that exited last year that in the fall, like the mom has to work, she had to private pay to have someone come and work with her daughter.

Patrick Cadigan: 15:49

Oui! Oui, oui, oui. So let's see that would be changes to individual budget, reduction in allowable services, caps, limits on certain expenditures. Can you go into more about the administrative changes, like, what does that look like?

Jamie Brodnax: 16:10

Are you referring to the day-to-day administrator changes?

Patrick Cadigan: 16:15

I could be. I could be talking about that.

Jamie Brodnax: 16:20

Okay, day-to-day administrator and support broker are separate roles. However, it seems as though DDA is trying to phase out the day to day Administrator role. Last year with the waiver updates, the day to day Administrator role was significantly reduced and the roles of the day-to-day administrator were also significantly reduced. It went from being pretty much a role that could be a full time position on a team to now being a role that is limited to 10 hours per month. It also went from being really what you would think of as a day to day administrator, role, somebody to help with scheduling, making appointments, um, taking care of the employees, schedule, doing all of that background work to keep things running smoothly, to now it is very specific to assisting a person with scheduling home maintenance, snow removal, landscaping needs or home repairs. Can also include making medical appointments, but that is it. Wow, and the person who is the day to day administrator cannot have any other role on the team, so you are limiting someone who is once a full time ish position to 10 hours per month. There's also a brand new process to get that approved, where previously it was a role that anyone could add to their team. You were would pay for it with your unallocated funds, or what you might sometimes hear called cost savings, and there were no restrictions. It was even a role that could overlap other services, because it is a background role that is no longer the case now. It is a role that DDA has to approve each team to have. There are very specific limitations. There is a process called a decision tree that the team has to get together and complete to basically justify why this role is needed, why the person, their natural supports and their hired supports cannot meet these needs, and then DDA will approve it. However, they do now provide the funding to pay for this role for those 10 hours a month if it gets approved.

Patrick Cadigan: 18:58

Yeah, but still, 10 hours a month does not sound like a lot like, you break that down into four weeks. I mean, that's what, you know, two two and a half hours, yeah?

Meghan Smallwood: 19:08

Yeah. That goes quick.

Jamie Brodnax: 19:10

It does. And a lot of people are questioning, kind of, what was the point of the role in the first place?

Meghan Smallwood: 19:17

Yeah.

Jamie Brodnax: 19:17

It was something that was introduced very quickly. And a lot of people, especially individuals who have aging parents, looked at this role as a way to help bridge between the parents being the person who are providing the support to the person receiving services, having someone outside of their parents who can provide the support and continue doing so when the parents are no longer able to do it. Now, that's not the way that it's set up. It's it's very much a minimalized role, mainly focused. For people who live independently, which is not the majority, right?

Patrick Cadigan: 20:05

Well, and hearing you talk about it from that perspective, like, again, when you talk about, you know, older family members who were caring for individuals, like, just from the technology side of things, like, because I do remember that, you know, we've had a conversation both online and offline, about the challenges that with getting paid and because of the changes that they had made to that system. And so it's, you know, at one point they had made, they did essentially an upgrade, and they brought everything online, but then that presented challenges to, you know, those people who are maybe not necessarily the most technologically adept. So, yeah, that's wild.

Jamie Brodnax: 20:47

Yeah.

Patrick Cadigan: 20:48

So this is where we're going to pause our discussion with Jamie Brodnax, but make sure to come back in two weeks time as we continue our discussion, as we talk about some of the potential changes to self directed services.

Meghan Smallwood: 21:12

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