Reduction List: Case Management Matters

Posted by on Jun 16, 2017

The second half of June has arrived, and with it, the legislative session’s crunch time. Budget negotiations turn to budget deals, and our elected officials make hard decisions. As you will recall, Oregon’s Joint Ways and Means Committee Co-Chairs released a Targeted Reduction List at the end of April, which outlined a more detailed proposal for reducing costs to the 2017-2019 budget. Our legislative leaders have been warning us for months now that, without new sources of revenue, there will be cuts.

The Targeted Reduction List proposes to reduce funding to case management for people with intellectual and developmental disabilities. To understand why that matters, we need to take a look at what case management services really are, and who is making use of them.

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What is case management? Thousands of adults with IDD receive case management services while living in their own or family homes all over the state of Oregon. At the Brokerages, we call our case managers Personal Agents. “Case management” is an old term, not very useful in understanding the nature of the actual work being done. Case management is whatever extra support you need to access the services available to you, plan for short and long term life goals, maintain the benefits you rely upon, and navigate a changing landscape of social services. A good case manager helps you figure things out. They are advocates of the life you choose for yourself, and offer support and encouragement to achieve goals. As you might imagine, this looks different for everyone. A person living in their own with minimal family support will have different needs from a person living at home with a full family life. Case management in the community, as envisioned by the Brokerages for 17 years, is meant to fill in the gaps and offer new ideas and resources to enrich your life.

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The “typical week” of a Personal Agent case manager . . . does not exist. Each week is very much led by the needs and changing priorities of the roughly 45 people he or she serves. Monday may start with a 7:00am call from a customer facing an eviction notice, trying to help them figure out the next steps and arrange support to look for housing options. Hours will be spent returning phone calls, gathering information, documenting services, and scheduling meetings. Tuesday might be filled with documentation, catching up on required progress notes and forms. Over the past 4 years, case managers have seen required forms and paperwork grow exponentially. Wednesday could be a staff meeting day, a chance to connect on upcoming changes, receive training on new information and practices, and to get help from coworkers and supervisors. Thursday and Friday may be out in “the field,” conducting ANA assessments and holding ISP meetings at people’s homes, attending a court date with a person who is in trouble with the law, meeting another customer to help her straighten out her Medicaid renewal paperwork at the local office, visiting another person in his new job.

This is the work of people’s lives, and it never stops. There is always more you would like to be able to do. As quickly as you cross items off of your to-do list, you add three more.

Who are these people being served, supported, and assisted? For Brokerage Personal Agents, our customers are as diverse as humanity. All are over the age of 18, and all have a formal diagnosis of intellectual or developmental disability. Beyond that, there is a wide spectrum of living situations, cultures, beliefs, likes, dislikes, lifestyle choices, needs, and wants. Getting to know each person and how they want to be served is part of the art of case management. Not every person in these services will experience a life crisis that they will need help with–the death of a primary caregiver, loss of housing, serious illness or injury, for example. Other people will need intensive help dealing with all of these, and more.

How are Brokerages funded for case management services? To save money, the state of Oregon contracts out case management services for adults with IDD to community providers at Brokerages and Community Developmental Disability Programs (CDDPs, often counties). The current funding process starts with a time-study at local Brokerages and CDDPs to determine how much time it takes to do the work. Next, DHS staff turn those time measurements into personnel calculations, developing a Workload Model that details how many full-time employees (FTE) it would take the state to provide this service. After plugging in current compensation rates for state employees, and total number of individuals served by each agency, the state comes to a dollar amount (a model budget). Rather than paying full price, the state contracts out these services to Brokerages and CDDPs for no more than 95% of that model budget. Currently, Brokerages and CDDPs are compensated at the full 95%.

With the funding shortfall currently under discussion in Salem, case management is unlikely to be funded at 95% for the 2017-2019 biennium. From 2015 to 2017, the DHS time study shows that Brokerages and CDDPs added roughly 20% additional work hours to their jobs, without any additional compensation. With the changes coming to the needs assessment tool, and uncertainty surrounding the Affordable Care Act and its K Plan, 2017-2019 looks on track to require more work of case managers in Oregon, not less.  The case management work that Brokerage Personal Agents perform is stabilizing and essential to the lives of Oregonians. When there is adversity and change, we all require more support, not less. For these reasons and many more, the Oregon Support Services Association urges our legislative leaders to prioritize funding of IDD case management services.

If these changes may affect you or someone you care about, you can contact your local lawmakers to let them know. Consider emailing your story to our legislators on the Joint Ways and Means committee, found here, and to your own local legislators. Go to the Oregon State Legislature website and scroll down to the lower right-hand side to see the field entitled “Find Your District and Legislators.” Once you know who to talk to, you can email, call, or request an in-person appointment to discuss your concerns. The way to make your best impression is to calmly and succinctly share how these reductions would affect you in your life. If you choose to email, try to keep your story to less than one page, and include the ways in which you use IDD services, and what your life would be like without them. Our lawmakers are doing their best to find ways to save money and keep the critical services and resources that people need. By providing a brief explanation of how this would impact your life, you are giving him or her the context needed to make an informed decision about the budget.

For fantastic advocacy tips and great information, we also recommend following the IDD Coalition’s GO! Bulletin, a product of the GO! Project. You can find the Go! Bulletin, lots of resources for legislative advocacy, and fact sheets at the IDD Coalition website.