Federal rule changes threaten the jobs of roughly 400 employees with the Montgomery County Board of Development Disabilities Services as the agency transitions clients into private services.
By 2024, the county board must phase out its adult day services, employment services and non-medical transportation programs for clients with intellectual or developmental conditions who receive federal waiver funds.
The change will impact hundreds of local residents with disabilities, their families and service providers.
In coming years, it also could mean job losses for 320 workers with the county board’s adult services program and 87 in its transportation program.
“The transition of our staff will be handled professionally and compassionately, with services … to assist in the transition,” said Nancy Banks, superintendent of the Montgomery County Board of Development Disabilities Services.
Banks said the county board wants to ensure that what will be an emotional and challenging process goes as smoothly as possible for clients, family members and staff.
A new rule enacted by the Centers for Medicare and Medicaid Services forbids organizations that provide direct services to individuals with disabilities with federal waivers if they also provide those clients with case management.
Waivers give people with developmental disabilities who are eligible for placement in an Intermediate Care Facility an opportunity to live in the community and still have a portion of the cost of their care paid by the federal government.
The agency says there is an inherent conflict of interest when boards in charge of coordinating clients’ services also provide services. The main concern is boards have an incentive to steer clients to their own programs and services to increase business.
In the future, the Montgomery County Board of Development Disabilities Services primarily will handle the case management for people with disabilities with federal waivers. It also will provide mental health, safety and protection, behavior support, early intervention and recreation services to eligible individuals.
The board must end direct services by 2024. Private providers must take over service delivery.
This will be a big change for many people with developmental and intellectual disabilities.
And the transition also may result in the laying off of hundreds of board-employed staff as clients are moved into private placements.
Banks said the county board will assist employees who face layoffs with interview skills and job search guidance.
Joe Tuss, Montgomery County administrator, said, “We are going to do the right thing by the employees who have worked and served the DDS board in the areas of operation that we privatize.”
The board can continue providing direct services to clients who do not have waivers. However, Banks said there has been no decision made about that.
The number of employees impacted by layoffs will in part be determined by whether the board still provides services to non-waiver individuals, Banks said.
Seniority will help determine who is laid off. Layoff considerations for supervisors and managers will include performance evaluations, work record and skill sets.
The board hopes to have a final transition plan completed in the next two months or so, she said.
The transition will lead to a greater choice of providers and greater diversity in programs and opportunities, while also allowing individuals with disabilities to become more involved in their communities, Banks said.
Most board clients have waivers.
The agency serves about 635 people with waivers at its day services facilities and 69 with waivers in work enclaves. Also, there are 414 clients with waivers who receive bus transportation and 45 who participate in the community employment program.
The board’s clients without waivers include: 253 individuals in day services facilities; 178 in transportation services; 65 in the community employment; and eight in enclaves.
Though public sector job losses are expected, the change should create new private sector positions.
The county board is working to grow the number of private providers and increase the capacity of existing providers, officials said.
The board’s goal for 2016 is to increase capacity by about 20 percent.
The board is facilitating meet-and-greet events so clients and their families can learn about private services available. The county is offering tours of private facilities.
“They do a short presentation, each provider, and then we put them in rooms where they can meet one-on-one in private with individuals so they can talk about their needs, what they’re looking for, that kind of thing,” said Mitchell Snyder, provider development manager.
Snyder will focus on assisting existing providers accommodate more clients and bringing new clients to the county. The county has about 25 private providers, he said.
And some board programs are looking at privatizing to remain in operation.
MONCO Enterprises Inc., a nonprofit affiliated with the county board, is evaluating switching to private ownership so it can continue providing employment opportunities to people with disabilities.
Banks said a private provider has shown interest in the Spire Arts vocational program, which assists people with disabilities create and sell their artwork.
The board will become a resource for private groups by offering training and guidance on developing quality programs, officials said.
“You’re going to have more comprehensive case management activities that provide supports to the private providers,” said Tuss.
The final deadline for the transition is 2024. But benchmarks must by met before then.
By 2020, no more than 30 percent of people receiving waiver services can receive adult services or transportation through local county boards.
At the start of this year, the Montgomery County board stopped accepting new clients into its programs for day services, employment and transportation.
These changes have been talked about for years, but the hardships involved in the process are now tangible, officials said.
“To see this in black and white is very sobering,” said Montgomery County Commissioner Judy Dodge. “My heart aches for the families.”