Counties are the contractual provider and monitor of funding for individuals with Intellectual and Developmental Disabilities (I/DD) from the Developmental Disabilities Administration (DDA) for individual supported employment and community inclusion (also known as community access) services. Supported employment is a program that provides paid competitive employment opportunities for I/DD in integrated work settings. Community inclusion is an individualized service that provides I/DD with opportunities to engage in community-based activities that support socialization, education, recreation, and personal development. The rates for these services were set 10 years ago and have not been increased, say for a small, temporary bump to address increased costs related to the pandemic, since then. While this small adjustment addresses the pandemic-related expenses, there is an urgent and ongoing need to bring the hourly rate into alignment with the increased costs of doing business since the rate was established 10 years ago.
The urgent need for increased rates, also identified by the Community Employment Alliance (CEA) which serves 63% of individuals statewide receiving Individual Employment and Community Inclusion services, is partially due to a staffing crisis. Without an increased rate, providers are unable to offer a competitive, livable wage to recruit and retain a qualified workforce. A reduced workforce threatens our robust services for those with I/DD with consequences including, but not limited to, individuals not reaching goals outlined in their services plans, individuals not being able to start new jobs, delays in job searches, reductions in work schedules, the potential loss in skills, and loss of community connections.
There are many other factors that have driven up costs for direct service delivery. The Consumer Price Index (CPI) averaged an increase of 2.3% annually according to the Bureau of Labor Statistics. The minimum wage in Washington State has increased from $8.55/hour to $14.49/hour, and higher in the Seattle area which will reach $17.27/hour in 2022. Contractual expectations have increased and now include data security requirements, HIPAA compliance, accreditation, diversity, equity, and inclusion training and performance measures, to name a few. There’s been an increased need for technology for effective and efficient community-based services, remote service access, cloud-based service documentation and data management systems, technology consultants, and cyber security insurance. Federal mileage reimbursement rates have increased from $.51/mile to $.575/mile. Administrative time has increased for activities such as tracking hourly service levels and submitting additional hours requests (changed from a service range to an hourly system in 2012), requesting extensions on County Service Authorizations (annual expiration dates added), and additions to policies and contract monitoring expectations.
While DDA’s rate for Individual Employment and Community Inclusion has remained static over the last 10 years, the Foundational Community Supports (FCS) program, administered by the Health Care Authority, is currently set at $108/hour, based upon a Department of Social and Health Services (DSHS) Research and Data Analysis FCS Rate Study. Ironically, FCS-supported employment services mirror DDA Individual Employment services with activities that include job development, job placement, employer negotiations, job coaching, and follow-along supports, yet provide a higher reimbursement rate. Furthermore, DDA serves a population that has high acuity levels and requires a higher level of support than those served through FCS, yet the DDA population is reimbursed at a lower rate.
Based on all of this, WSAC has asked DDA to:
- Administratively increase the Individual Employment rate lid to align with the FCS program’s rate reimbursement for supported employment services.
- Increase the Community Inclusion rate lid in alignment with the CPI increases over the last ten years.
- Counties be provided permission to enact the higher rate lids for the current fiscal year (July 2021-June 2022) if sustainable within the current budget allocation.
- Implement a regularly scheduled rate adjustment in alignment with DDA’s budgeting cycle, consider the cost of living increases, using the CPI or other measures.
Despite our requests, DDA has not been willing to administratively increase the rate lid.
As an alternative, we have turned to legislative champions to pursue this request. Sen. Braun has outlined in his bill, SB 5790 which will be heard Friday, January 28th, our requests to increase rates and provide an ongoing increase in these rates using CPI. We have bipartisan support for the bill. The difficulty we face is the cost associated with increasing rates, which we have yet to see as the fiscal note has not been published. But we also know that without an increase, we will see a decrease in providers which means we can serve fewer I/DD. This is an important bill for our I/DD community and we hope it moves through the process with little resistance.
