“We’ve seen this coming, so it’s no surprise,” said Dr. Pamela Combs, superintendent of the Montgomery County Board of Developmental Disabilities. “We’ve managed around it and tried to hold it off as long as possible.”
The county’s board of developmental disabilities provides service planning and coordination to adults and children with developmental disabilities, as well as oversight and assistance to service providers.
Combs said a number of factors led to the financial shortfall, including a doubling in demand for the agency’s services since 2009, a continual loss of revenue since 2009, an increase in payments to the state of Ohio to cover the cost of services, an increase in waiver costs, and an increase in the cost of care due to closing of state Developmental Centers, including the Montgomery Developmental Center, which was previously in Huber Heights before it closed in 2017.
“Since 2010, the number of people we’ve served has doubled, combined with that longer life expectancy, and we serve more children through early intervention,” Combs said, adding they have also come up against increased costs and providing more services. “In 2019, we really started taking note.”
Credit: JIM NOELKER
Credit: JIM NOELKER
Reduced revenues
The board is preparing for a deficit in 2024, pulling reserve finances previously set aside in capital funds to use for their operating expenses, as well as looking at their operations in attempts to downsize.
The agency lost revenue in 2018 when it closed a day service and transportation service that represented a loss of $7 million annually. This closure followed state guidelines toward community integration of those services, along with requirements from the Centers for Medicare and Medicaid that said case management providers could not also provide those individuals with direct services, saying it was a conflict of interest.
“Now we pay providers to offer that service,” Combs said. “Then with the closing of the (Montgomery) Developmental Center, a lot of those services now happen in the community, which is better for the people we serve often because they’re in the community, but it costs more.”
Increased costs
The board is also paying more to the state for Medicaid waivers, which are one way individuals with developmental disabilities pay for services. The county pays 37% of the cost of those waivers, previously paying 27%.
“It’s a 10% increase in the amount that we pay for every dollar spent on Medicaid,” Combs said. That equates to approximately $18 million spent per year on their match for Medicaid, she said.
The state is also implementing a 6.5% increase in waiver costs for a wage increase for direct care professionals. This increase will be retroactive to April 2022 and is expected to cost approximately $2 million in state fiscal year 2023, the board said.
The board’s annual budget has gone done since 2019, which was approximately $53.1 million in 2019 compared to approximately $46.5 million in 2021, but the source of the funds has been increasingly from local sources. Approximately 63.5% of the board’s funds in 2019 were from local sources, including 19.8% from federal funds, 11% from state funds, and 5.5% from other sources. By 2021, those percentages changed to approximately 73.8% from local funds, 19.4% from federal funds, 5.8% from state funds, and 0.9% from other sources.
ARPA funds coming in
The majority of the local funding for the agency comes from the county’s human services levies. The Human Services Levy Council will also be providing additional funding to the Board of Developmental Disabilities Services in addition to the $17 million in ARPA funds.
Montgomery County officials said funding from ARPA and funding received from the Human Services Levy Council may fluctuate over the next two years, but this is the county’s initial plan to address this financial shortfall.
“The $17 million in ARPA funds we are utilizing for this deficit is for expenses we know are directly tied to the pandemic,” said Montgomery County Administrator Michael Colbert. “We know those expenses meet the requirements the federal government has in place governing the use of ARPA funds.”
The county administration will work with the Board of Developmental Disabilities Services and the Human Services Levy Council to determine appropriate future funding and monitoring the board’s fiscal plan, said Montgomery County assistant county administrator for human services, Geraldine Pegues.
The Board of Developmental Disabilities Services was originally set to receive $1 million in the county’s previous ARPA plan, but the county administration said those plans were made at a time when there was not a fiscal emergency. The previous $1 million was earmarked for iPads for families, remote access, adult changing tables, and facility and technology updates, according to the county’s ARPA plan.
The county’s current financial plan calls for using that funding in 2024 and 2025, but they have until the end of 2026 to spend the funding and adjust plans as needed.
Plans for downsizing
The board said they do not expect their services to be impacted by the fiscal emergency, but they do plan on closing its Southview Center location on Thorpe Drive in Dayton. The board and county plan to auction the facility, as well as some of its contents.
“We are facing the challenges this shortfall presents, and believe these actions will have minimal impact on those who require services,” Combs said.
Other initiatives include an increase in billing for Medicaid mental health services, securing federally funded housing vouchers, seeking additional state waiver-enhanced Medicaid match funds, and requesting the state cover the recently imposed 6.7% developmental disabilities services match increase in 2024.
Gov. Mike DeWine’s office on Wednesday said that since it learned of the Montgomery County Board of Developmental Disabilities Services’ determination of fiscal emergency, the state has been in contact with the county board “to better understand their situation and work on a path forward.”
The board also plans to utilize community-based resources and needs-based waivers. Hiring for the board will also be “mission critical,” the board said.
The Northview facility, located at 8114 North Main Street in Dayton, will remain open.
“Sustaining the high-quality services delivered to people with developmental disabilities is critical, as they ensure their safety and quality of life,” said Madeline Iseli, president of the Montgomery County Board of Developmental Disabilities Services. “I see the positive impact these services have on my own sister. It makes me appreciate the partnership the board enjoys with Montgomery County and our collaborative agencies and providers through the county, as well as the support of Montgomery County residents.”
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