Disability community left with heads ‘spinning’ from sudden delay of proposed wage cuts

People who provide services for those with developmental disabilities learned Tuesday that wage cuts planned to start the next day were instead postponed for a few months.

While advocates welcomed the delay, some say it’s “just kicking this down the road” and creates confusion and raises concerns for what comes next.

“Our heads are spinning,” Shari Dexter, one of the co-founders of Concerned Citizens of Self-Direction Maryland, said Thursday.

She was one of thousands of families across the state who learned on June 30 that “devastating” wage cuts that were supposed to start July 1 were suddenly on hold until fall.

The wage reductions and other “cost containment” measures are part of a $126 million cut in state funds to the Developmental Disabilities Administration, which administers the Medicaid waiver that covers the behavioral and health care needs for around 19,000 Marylanders.

The waiver covers two different options for receiving those services. Some waiver recipients receive care through a brick-and-mortar community provider, while others self-direct their services by hiring their own staff and managing a budget for their service, funded by the waiver.

But due to “unsustainable” growth in enrollment and spending, lawmakers slashed funding for the DDA last year and this year. The waiver is jointly funded by state and federal dollars, so the $126 million reduction in state funding this year equates to more than $250 million in cuts to the agency factoring in federal match dollars.

That’s on top of last year’s cut of $164 million.

The funding cuts this year include reductions to community provider rates, elimination of pay bumps for self-directed staff working in specific situations, and limits on hours for family members who work as staff, among others. Some of those policies will need federal approval before they can be implemented.

State officials have received almost 1,000 public comments on the proposal since April, according to the Maryland Department of Health.

The Maryland Department of Health, which oversees the DDA, suggests that plans to implement the cuts will continue to “evolve” as conversations with federal officials and the developmental disabilities community continue.

“MDH is committed to the sustainability and program integrity of the DDA Community Pathways Waiver program and to supporting the health, safety, and independence of waiver participants,” the department said in a written statement Thursday. “Our implementation of FY 2027 budget requirements will continue to evolve in response to federal guidance and feedback from the stakeholder community and legislative and federal partners.”

But the delay could result in fewer savings than anticipated by the proposed cuts as required in the state budget.

Advocates like Laura Howell, CEO of the Maryland Association of Community Services, are concerned about where lawmakers would make up the difference.

Budget cuts, looming deadlines put family caregivers in a ‘complete tailspin’

“It means that the state will not be realizing the savings of $22 million in general funds with this delay,” Howell said. “Obviously, we would be very concerned if there was an effort to … recoup those funds through different cuts, given all of the painful discussion that was had just to get to the place where we are now with what the legislature passed this session.”

State officials had instructed community providers and people with developmental disabilities to notify staff that they would be paid less for their services starting in July. Dexter, of Concerned Citizens of Self-Direction Maryland, said that had already caused repercussions. 

“People have lost staff,” Dexter said. “We’ve had reports where the participant’s team, where they’ve lost staff. Where people have said ‘I can’t do it at this rate.’”

With discussions of a special session coming up, Dexter is urging lawmakers to use the opportunity to take another look at the DDA budget cuts and work out something different.

“It’s very hard when you have people who are very complex. Whether that’s physically or behaviorally, to get staff that truly can work with them is not easy,” she said. “There’s a lot of confusion about what comes next.”