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Letter to the Editor: Funding cuts threaten care of clients with special needs

December 22, 2014


Published in The Herald-Times on Monday, December 22, 2014.

This guest column is by Leslie Green, CEO of Stone Belt Arc.

Stone Belt and other Indiana providers are in the midst of a significant care gap crisis. In my 35 years working in this field, I have never been as concerned as I am right now. We have insufficient numbers of staff to meet our obligations to our clients.

Why is this happening? In 2010, in response to the downturn in state revenues, Family Subsistence Supplemental Allowance (FSSA) cut Medicaid reimbursement rates for the majority of our services. Almost all of our clients receive Medicaid due to their disabilities. In addition to covering basic health care services, it also reimburses providers for long-term services and supports. Medicaid is what enables our direct support workers to help clients increase their self-sufficiency and independence.

The total loss of revenues to Stone Belt following the 2010 cuts was about 5 percent. We were able to preserve all programs to clients, though many now get fewer hours of service, but we could not preserve the salaries and benefits to staff. Salaries were cut, we eliminated our contribution to employees’ 401(k) plans, and we’ve had to switch to a high-deductible health plan — deductibles that very few of our employees can afford on the wages we are able to provide.

National studies show that 40 percent of those providing direct support to people with disabilities are receiving public benefits themselves, just to make ends meet.

And while the economy has improved, for Indiana disability service providers it means more competition for labor; we can’t recruit and retain enough staff to meet client needs. In fact, currently, we are competing for employees with the fast-food industry. As of today Stone Belt has openings for the equivalent of more than 45 full-time positions, about 12 percent of our workforce, most of whom we need to provide direct supports to our clients. Of those working, we can expect 31 percent to leave in the next year.

As a result, we are sometimes operating with skeleton crews to care for clients’ intensive health and safety needs. Clients face disruption and must continually see staff come and go. Dedicated staff members leave jobs they love. Our managers are filling in, providing direct support to clients, but it means less time for supervision and oversight.

In short, the clients we support are at risk. Furthermore, there are dozens of people with disabilities who have asked us to serve them, but we have little or no capacity to bring them on. Indiana has made progress in providing funding to decrease the waiting list for services, but it will serve no purpose if we have insufficient staff to provide those services.

Indiana needs to fully restore the Medicaid reimbursement rates that were cut from the Medicaid Waiver and Intermediate Care Facilities funding in 2010 and create a system that accounts for inflation for the years to come. As Indiana’s population ages, maintaining a workforce to provide safe and effective services for some of Indiana’s most vulnerable citizens will become more challenging.

This is a social justice issue for our staff and the clients they support. We are calling upon the governor and the Indiana General Assembly to restore the rate cuts and put Stone Belt and similar organizations on a sustainable path. We are urging clients, their families and our staff to make their voices heard with policy makers on this vital issue. We hope other citizens will join as well. More information on what you can do to take action can be found at stonebelt.org/advocacy.