Disability and Aging department seeks funds to cut wait lists, boost direct-support pay and senior nutrition

The Department of Disability and Aging told the Finance, Ways and Means Committee on March 5 that it seeks funding to expand supports for Tennesseans with intellectual and developmental disabilities and for older residents, including funds to reduce wait lists, raise provider rates and formalize a farmers-to-senior-centers food partnership.

Commissioner Brad Turner introduced the department's team and said the department's requests include recurring funding for a DCSDDA partnership to expand support services and care coordination for children with IDD in Department of Children's Services custody; a two-percent rate increase for Tennessee Early Intervention System therapy rates (TEIS); senior-nutrition funding intended to address about 1,800 people on a wait list and increase rates for both congregate and home-delivered meals; and rate increases of 2 percent for direct support professionals (DSPs) and for independent support coordinators.

Deputy Commissioner Andy Kidd described program details. He said the DCSDDA partnership will use private independent support coordinators to help foster families care for children with IDD, and that the department has seen a substantial increase in stability when those supports are available: "previous to engagement, it was about 15 or 20 percent of those kids made it a year. Now it's about 85 percent," Kidd said. He said nearly 1,000 children have been served so far and that the appropriation discussed would allow the department to serve roughly 1,600.

Kidd said the senior-nutrition request is a partnership with area agencies on aging and disability to address the wait list and raise meal rates, and he described a new partnership with the Department of Agriculture to connect Tennessee farmers with senior centers and Meals on Wheels programs to provide fresh fruits and vegetables to older Tennesseans. "We're working very closely with the Department of Agriculture to make sure that we empower Tennessee farmers to continue to be able to produce, in their areas to serve people," Kidd said.

Committee members pressed on capacity, procurement and program design. Leader Cochran asked about a $22 million recurring request for five new positions and wraparound supports for foster and adoptive families; department staff said 795 children were currently enrolled in the related program, with a total of about 1,000 slots, and that department officials would provide exact fiscal-year spending figures later. On barriers to family participation, department staff said training and HRA vendor processes initially created hurdles but communications and training improvements had reduced those problems.

Members also questioned use of state community-home beds. Committee discussion said the department had 44 community-home beds historically built to support adults with acute medical needs; staff explained some beds have been repurposed to meet other unmet needs, including beds used to support children with high acuity. Officials said only three residents moved when the department asked families if they could move to create capacity. Committee members asked about the Harold Jordan Center, which implements provisions of Jillian's Law; the department reported five people were currently at the center due to that law, under 15 referrals had been made since July 1, and an estimate to staff 12 beds at the Harold Jordan Center would be "a little bit under $2,500,000" annually, department officials said.

On START homes and teams intended to stabilize people in crisis for short stays, department staff said contracts with private providers are still being completed and none of the $1.5 million appropriated for homes has yet been spent; the START homes were designed for short-term stabilization of about 30 days. The Katie Beckett program remained popular: staff said roughly 4,400 people were enrolled or had inquired, and the program's flexibility had reduced institutional moves for some children, though staff acknowledged occasional reimbursement delays that can impose hardship on families while they await reimbursement.

The department described a modest wage increase for DSPs from an average of $15.37 to $15.68 per hour under the proposed rate changes. Officials also flagged that some reductions and utilization dollars reside in TennCare's budget rather than the department's lines.

No formal committee votes were taken on the department's budget presentation during the March 5 hearing; members asked for additional fiscal detail and follow-up on several line items.

Speakers and attributions in this article reflect committee roll-call and the department's statements during the hearing.