House Bill 1918: Fast Facts
November 12, 2019

By Caleb Sisak , Budget Analyst | 5 years ago
Health & Human Services Analysts: Aniam Iqbal - Budget Analyst , Mara Perez - Senior Budget Analyst

Background

On August 14, 2019, the Department of Human Services (DHS) announced a three-year closure plan for Polk State Center in Venango County and White Haven State Center in Luzerne County. These centers, operated by DHS, are public intermediate care facilities for individuals with intellectual and developmental disabilities providing 24-hour residential services. Presently, these two state centers serve a combined 306 individuals and have 1,179 employees on staff.

House Bill 1918 prohibits DHS from proceeding with the closure plan for Polk State Center and White Haven State Center until such time as all waiver-eligible individuals are able to be moved off the waiting list into community-based settings. There are over 13,000 individuals currently on the waiting list – including the Emergency, Critical, and Planning lists.

Brief History of the State Centers

The state center system has been in place since the early twentieth century with upward of 13,000 individuals housed at 23 facilities at its peak. Over time, the philosophies and policies guiding the services for these individuals has shifted dramatically leading to changes across the system along with a greater emphasis on offering services in a community setting. These shifts dramatically reduced the number of new admittances to state centers leading to declining censuses and increased per capita costs. All but four state centers – including Polk and White Haven – have been closed; the last closure was Hamburg State Center in August 2018.

Brief History of the Waiting List(s)

DHS operates three Medicaid waivers that provide community-based services: consolidated, person/family directed support, and community living. These waiver programs support a wide range of services, including in-home and community support, transportation, accessibility adaptations, assistive technology, specialized therapy, shift nursing, education support, supported employment, and behavioral support.

Due to limited funding, there are fewer waiver spots than there are eligible enrollees. As of May 31, 2019, there were 13,015 total people on the county waiting lists for various home- and community-based services, including:

• 5,331 – Emergency (urgent need for services in the immediate future)
• 4,690 – Critical (will need services within two years)
• 2,994 – Planning (will need services within 5 years)

In June 2019, DHS provided cost estimates to provide services to all individuals on the intellectual disability waiting lists – effectively eliminating the waiting lists. The total state and federal funds needed to clear the waiting list (including Emergency, Critical, and Planning lists) would be $1.2 billion annually – with about $558 million from the state.

Several important considerations about the waiting list(s):

• Many individuals on the waiting lists are receiving some services, but they are not receiving the full complement of community services for which they are authorized.
• DHS and the counties that manage the waiting lists hold a number of slots open, so that individuals that have a significant shift in status may receive services quickly.
• The waiting lists are fluid with individuals moving between the various lists due to changing circumstance, as well as individuals newly added to the lists.
• The waiting lists are not directly connected to the state centers – these individuals are seeking services in the community.