ASHLAND – In an update to county commissioners Thursday, Ashland County Board of Developmental Disabilities superintendent Dave Ashley outlined “radical changes” the board has been making to meet the needs of individuals while complying with new federal laws and dealing with the community’s growing needs.
When Ashley started in the role in April 2016, he said, the board was projecting that it would spend $1.2 million more then it brought in that year.
“We made some pretty radical changes along with some mandated programmatic changes that had not been implemented prior to that time … and we came in at deficit spending of $603,000, so we were able to cut that deficit spending in half,” Ashley said.
In 2017, the board began implementing a new strategic plan and ended up spending only about $12,000 more than it brought in for the year. For 2018, Ashley expects significant drops in both revenue and expenditures with deficit spending of around $109,000.
Ashley explained what’s changed, not only for Ashland County’s board of DD but for boards of DD across the state and nationally.
“Federal law mandated that county boards, because we receive Medicaid dollars, get out of direct services,” Ashley said.
Traditionally, Ashland County Board of DD staffed and ran D-R Services, an adult sheltered workshop that operates out of a building at 816 Clark Ave. But that setup is now considered by the federal government to be a conflict of interest because the board would be both a service provider and a funder of those services, directing Medicaid money to its own program.
Another federal mandate requires the board to provide a choice for the individuals it serves, so people can choose a service provider that meets their needs and desires.
“What happened over the years is there was no change in our programs, so as individuals chose other programs, we began funding those programs as well as funding our own programs. That’s why our expenses were up so high and we were no longer able to maintain our expenses based on our revenues,” Ashley said.
So at the start of 2018, D-R Services split off from the board of DD. D-R Services still provides the same services, but the staff is employed directly by D-R rather than by the board of DD. D-R Services receives 60 percent of its funding from Medicaid but also receives the 40 percent local share of its funding from the board of DD.
“That’s why you see the drop in revenue because we’re no longer billing directly for Medicaid services, but you also see a drop in the expense because we don’t have that staff overhead,” Ashley said.
According to Ashley, the changes have not had a noticeable impact on the services adults with disabilities receive.
“It was a slow phase in, and it went very smoothly,” he said. “The individuals we serve didn’t really even notice a difference. They showed up after Christmas break and did the same things they always did. It’s just a different business model, which ultimately will save money.”
In addition to state and federal funding, the board of DD has local funding from three property tax levies — a 1.3 mill continuing levy that has been in place since 1981, a 2.1 mill levy that was renewed by voters last November and a 1.5 mill levy that, if approved by the board of DD and the county commissioners, will be up for renewal this year.
“We’ve righted the ship very aggressively, but we look at a two to three percent increase in enrollment on an annual basis,” Ashley said. “One thing we’re dealing with, and actually the whole community is dealing with, is the intensity of services needed for younger kids that are coming in, and that’s a result of many of the social issues that are going on throughout the country, opiates being one of the biggest factors.”
Compared to 10 years ago, Ashley said, the boards of DD are seeing a significant increase in the number of young children who need intensive and costly services. Younger children are frequently being referred for intensive stabilization programs that previously would have been recommended for people 18 years and older.
Ashley said the average annual cost for an individual receiving residential Medicaid waiver services is $51,000, so the earlier an individual begins receiving those services, the greater the cost over the lifetime. Meanwhile, life expectancy is rising for individuals with disabilities.
Ashley said his goal moving forward is to focus more resources on early childhood interventions that can prevent individuals from needing long-term services as well as on transitional services for preteens, teens and young adults to help them seek employment and integrate into the community.
