Maryland, My Maryland

 From the Balmer Sun, Maryland ‘fudged the numbers’ on disability budget cuts, lawmaker says

When Maryland lawmakers slashed $126 million from the state’s disability budget earlier this year, they justified the move with a dire warning: The state’s waiver program for home and community-based care was at risk of federal termination unless the budget was reined in.

But advocates, and a state lawmaker who proposed a last-minute amendment to reverse the cuts, now argue that the state’s fiscal alarm was manufactured. They say that by drastically recalculating the cost of institutional versus community care, state officials narrowed the “cost neutrality” gap, creating a mathematical illusion of crisis to justify sweeping cuts to services for thousands of vulnerable Marylanders.

Federal officials appear to be contradicting the state’s narrative. The Centers for Medicare and Medicaid Services (CMS) told Spotlight on Maryland it has never issued any notice indicating that Maryland’s waiver was at risk of termination due to cost-neutrality concerns. The dispute centers on the Developmental Disabilities Administration (DDA) Community Pathways Waiver, which provides services to Jennifer Gallatin and thousands of others. While the state insists the recalculations were a necessary correction of faulty accounting from the previous administration, critics charge that the numbers were intentionally “fudged” to balance the state budget at the expense of a population they knew lacked the political muscle to fight back.

“They’re trying to suggest… that the entire waiver is at jeopardy, you know, we risk losing the entire thing. No, we don’t,” said Jessica Gallatin, who cares for her disabled sister, Jennifer, along with Jessica’s three kids, at home in their single-wide trailer in Cecil County.

What is cost neutrality? Under federal rules, states participating in Medicaid waiver programs must demonstrate “cost neutrality,” meaning it cannot cost more to care for someone in a home or community setting than it would in an institution.

For years, the math provided a comfortable buffer. The state projected institutional care costs $333,000 per person annually, compared to $164,000 for home and community-based waiver services. But last year, the state drastically altered those estimates, dropping the cost in an institution down to $217,000 and raising the cost of the waiver up to $182,000. The result was a shrinking of the cost gap from $169,000 to just $35,000.

After that, cost neutrality became a key talking point for Democratic lawmakers in justifying budget cuts to the Developmental Disabilities Administration, or DDA. “The cost neutrality provision is — we are up against it,” said Appropriations Committee Chair Ben Barnes, a Democrat representing Anne Arundel and Prince George’s counties, during a March floor debate. He explained that additional cost growth under the waiver could lead to the state losing its waiver altogether, representing $1.7 billion of federal funding.

I confess I don't understand this fully, but it sounds like Gov. Moore is trying to balance the states budget (a good thing) by screwing the disabled (a bad thing).