Lee Chase, executive director of the nonprofit provider of developmental, vocational and residential services for adults with intellectual and disabilities, said the Dawn of Hope board of directors voted Thursday to discontinue the service because of more than a decade of increasing costs and stagnant reimbursement.
According to Chase, the state Department of Intellectual and Developmental Disabilities has not raised its daily per-client reimbursement rate for day program transportation since 2004, when it set the the rate $7.07.
After 14 years of increases in the costs of gasoline, driver wages, insurance and vehicle maintenance, “The daily (per client) cost is more than $24. We receive $7. So we lose approximately $17 (per client) per day.” he said. Last year the service cost Dawn of Hope $230,000 compared to $65,000 it was reimbursed.
“It’s something the board hated to do, but it’s because the rate has not kept up with the cost,” Chase said. “And it’s because we are very different from most agencies in that we have 90 to 100 people who are in only the day program. Everybody else only has day services for people who are in their residential program. And we are one of only five agencies in the state with a multiple-county area. Our clients live farther away.”
Chase said Dawn of Hope, DIDD representatives and representatives of other local agencies providing handicap-accessible transportation met with the families of the day program service recipients last week to discuss other options that might be available to them.
“As part of this process, we will be contacting each individual’s family and determining what their program needs are. Some people only come once a week and it may be feasible for their family to bring them that one day,” he said.
Transportation for people who take part in both the residential and day program at Dawn of Hope will continue to be provided by their in-home assistants who are assigned smaller vans that do not require designated bus drivers.
“We do have some agencies that provide residential services to folks that we provide with day services. We haven’t talked to those agencies, but in all likelihood they will start taking their folks to the day program.
“We have some people (for whom) we will attempt to negotiate a contract with NETrans,” the First Tennessee Human Resource Agency rural bus service for people with disabilities.
“There will be some who choose not to continue in day program and we will work with DIDD to see if there are any in-home assistance DIDD can provide them. Some will discontinue day program altogether,” he said.
Monday’s halt to day program transportation comes just three months after Dawn Hope closed its sheltered employment workshop because of sweeping changes in Medicaid rules that will end reimbursement for services segregated from the non-disabled community beginning in March 2019.
After two years of transitioning the day program to provide more community-based opportunities, Chase said the program based at Johnson City’s former Stratton school is in compliance with the non-segregation rules and he is hopeful it will not be impacted by next year’s full implementation of the new rules. Currently, the day program serves a total of 160 people with intellectual and developmental disabilities.
“Right now we are meeting all the particulars of the plan set out by the state and we have been deemed a compliant agency by CMS (Centers for Medicare & Medicaid Services).
“We use the Stratton facility as a hub for our community-based program. As long as we continue to provide people opportunities out in the community, I hope that will allow us to continue to use that facility as a hub. With the government, you never know. They have been known to change their minds.”
While Dawn of Hope’s significant increase in community-based service delivery has brought the day program into compliance with the new requirements, not all of its families are happy with the changes.
At last week’s meeting on day program transportation, Chase said there were client families who told the DIDD representatives in no uncertain terms that while the government emphasizes client choice in program planning, it ignores “what people really want is to come to the facility to be with their friends rather than being transported all over the place.”
Email Sue Guinn Legg at [email protected]. Follow her on Twitter @sueleggjcpress. Like her on Facebook at facebook.com/sueleggjcpress.