The idea of a “perfect storm” is that in rare circumstances, a combination of independent factors comes together in such a way to create a calamity far worse than the sum of its parts. In fact, in the true-event-based book and film “Perfect Storm,” (spoiler alert!) the ship goes down and everyone dies.
Fortunately, most of our real-life perfect storm situations do not have consequences that result in loss of actual life. A true, unmanaged perfect storm can be destructive in other ways.
The Colorado system that provides services for people with intellectual and developmental disabilities is heading into just such a tempest. As with any perfect storm scenario, there are several factors contributing to the impending crisis.
The biggest ongoing factor is that the rates established by Medicaid to pay providers of IDD services have failed to keep up with costs of providing those services. The historically low rates were reduced substantially in response to the 2008 recession and still have not been restored to their pre-recession levels. The average hourly cost of an IDD service in Colorado is $20.20, yet some of the services are reimbursed at rates as low as $14.92 per hour.
As rates fall or stagnate, the costs of doing business continue to rise. Health insurance costs alone have risen dramatically in the past few years, with many IDD providers absorbing a 30 percent increase in premiums in 2017 alone.
The increase in the Colorado minimum wage is great news, but it will also put pressure on IDD providers to raise wages within a rate structure that is already insufficient. Even providers that already pay over the $12-per-hour target will realize financial pressures. To be competitive in the labor market and ensure that people with intellectual and developmental disabilities receive quality care, providers need to be able to pay more than minimum wage.
At the same time that financial pressures are growing, the IDD system is also experiencing a major overhaul at a national level. As with the minimum wage increase, the intended outcomes are noble. The results of the system changes will ensure that IDD services are more integrated, more person-centered and allow for more choice. However, there are costs associated with reaching those positive outcomes, and the current Colorado system has no means to pay for those costs.
We are already seeing the impact of the impending storm. In 2016, Alliance Colorado, a professional organization for providers of IDD services, collected data on access to services. The results showed that during the sample period of July to October 2016, 69 percent of services needed and authorized for people with IDD across the state were not provided because individuals were unable to find agencies willing to provide services for the rates established by the state.
Colorado may be struggling to afford the costs of providing quality services to individuals with intellectual and developmental disabilities. But the costs of a sunken system are more than people with disabilities can bear.
Tara Kiene is president/CEO of Community Connections Inc.