COFAR blog

Continuing an ongoing pattern, Governor Baker’s proposed state budget for the coming fiscal year is far more generous to corporate provider-based programs overseen by the Department of Developmental Services (DDS) than to DDS state-run programs.

Last week, Baker unveiled his $44.6 billion state budget plan, which would provide $2.15 billion in funding to DDS-related line items.

We’ve been concerned for years that the Legislature and a succession of administrations have underfunded DDS state-run budgetary line items — a trend that only encourages further unchecked privatization of those services.

Some key details of our analysis of Baker’s proposed budget for DDS are below:

State-run program line items

A key state-run program to start with is the DDS network of state-operated group homes.

Under Governor Baker’s Fiscal 2021 budget, the state-operated group home line item would be increased by $6.4 million over the current year, which is only just above the rate of inflation. The increase would bring the state-operated group home line item to $237.8 million in Fiscal 2021.

State-run group homes provide a critical backstop of care due to their low staff turnover and relatively low per-client abuse rate. Yet, data also show the number of residents in state-operated group homes has been dropping as the administration and Legislature have targeted more funding to the much larger network of corporate provider-operated group homes. DDS also does not routinely offer state-run group homes as a residential option to individuals.

Meanwhile, the state-run developmental centers line item would be cut in the coming year, continuing the pattern over the past decade. The developmental centers also provide an important backstop of care for some of the most profoundly developmentally disabled residents of Massachusetts.

Under Baker’s Fiscal 2021 budget, the cut in the developmental centers line item would be $560,000, which would amount to an inflation-adjusted cut of almost 3%. That would drop the line item to $104.3 million in Fiscal 2021.

The DDS administration line item, which includes critically needed DDS service coordinators, would actually get a modest increase under the governor’s budget. That line item would be raised by $5.3 million over current-year funding, to $80.2 million. That would amount to an increase of 4.6% when adjusted for inflation.

But among those three state-run program line items (state-operated group homes, developmental centers, and DDS administration), the average overall increase from the current year would be less than 1% when adjusted for inflation.

Moreover, since Fiscal 2012, those three line items will have been cut by an average of about 1.3% in inflation-adjusted terms. The developmental center line item alone will have been cut by $73.5 million, or more than 40%, since Fiscal 2012.

The two charts just below illustrate the trend lines since Fiscal 2012 for key state and provider-run programs in the DDS system.

The corporate provider line items

In contrast to the state-run programs, three key provider-based line items — corporate provider group homes, provider-run day programs, and transportation services — would be increased on average by 4% from the current fiscal year, under Baker’s budget. Since Fiscal 2012, those three line items will have been increased, on average, by almost 90%.

Baker’s Fiscal 2021 budget proposes increasing the provider group home line item by $9.5 million, to $1.287 billion. That is a relatively small increase, given the size of the line item, and actually would amount to a cut of 1.7% when adjusted for inflation. However, funding for that line item has risen dramatically since Fiscal 2012. If Baker’s budget proposal is enacted, funding for provider group homes will have increased by $407 million, or 46%, over the past 10-year period.

Meanwhile, other provider-based line items would be increased by significant amounts next year, under Baker’s budget plan.

Under the governor’s budget, the provider-run transportation line item would be increased by $3.8 million, to $33.3 million over the current year, which is more than a 10% increase when adjusted for inflation.The provider-run day program line item would be increased by $14.4 million, to $253.9 million. That would amount to a 3.5% increase over the current year.

Since Fiscal 2012, the provider-run day program line item will have been increased by 75%, and the transportation line item by 146%, if the governor’s Fiscal 2021 budget is enacted.

Chart shows some clear trends

These funding trends can be seen in the two charts above. For instance, the first chart shows the opposite directions in which funding has gone regarding provider group homes and state-run developmental centers. We’ve long expressed concerns about the closures of four of the state’s six remaining centers between 2008 and 2014.

At nearly $1.3 billion, the provider group home line item now dwarfs every other DDS line item in the budget.

Similar trends can be seen in the second chart for other provider versus state-run line items. For instance, funding for state-operated group homes peaked in Fiscal 2016 at $238.3 million, in Fiscal 2021 dollars. Baker’s proposed funding for Fiscal 2021 for state-operated homes is still less than what was appropriated by the Legislature in Fiscal 2016.

Meanwhile, funding for provider-run day programs caught up with the funding level for the state-operated group homes in Fiscal 2019 and surpassed the latter line item in the current year. Baker’s proposed Fiscal 2021 budget would continue that upward trend for the day program line item.

While the combined state-run DDS administration and service coordinator line item would get a 4.6% increase next year under Baker’s plan, the funding trend for that line item has been essentially flat after peaking in Fiscal 2016 at $77.4 million.

In contrast, the provider-run transportation line item, while dipping slightly in Fiscal 2017, has continued to rise since then.

Other DDS line items

Overall, the DDS budget would be increased by just under 0.2% under the governor’s Fiscal 2021 budget proposal. It reflects a mixed level of increases and cuts for a number of other line items that don’t fall as clearly into the state-run or provider categories, but are a combination of the two.

The Turning 22 line item would get a very small increase of under $2,000 under the governor’s budget. That would amount to an inflation-adjusted cut of 2.4%. Interestingly, Baker’s budget message touted that he has been “fully funding” Turning 22 for the past four years.  It’s not clear on how that squares with the actual budget proposal.

Respite and Family Supports would be increased under the governor’s budget by $7.8 million, or 8.4%.

The Adult Autism line item would be increased by $7.8 million, or 22.5%.

Disabled Persons Protection Commission (DPPC)

The DPPC line item is not under the DDS budget, but the DPPC performs a key role as the state’s only independent agency that investigates abuse and neglect of disabled adults. Yet this agency is chronically underfunded.

Baker’s Fiscal 2021 budget would increase the DPPC line item by a very modest $129,000, which would amount to an inflation-adjusted increase of well under 1%. Since Fiscal 2012, DPPC’s budget will have been increased by 94%; but the agency is still unable to afford more than a handful of staff to investigate abuse complaints, and must hand most of those investigations off to DDS and other line agencies to investigate.

We hope, in upcoming meetings with key legislators, to impress upon them the importance of a more equitable funding allocation between state-run and provider-run programs.

If current trends continue, state-run services will continue to wither away through declining funding and attrition, and we will end up with a fully privatized system of DDS-funded services. We are concerned that that is a prescription for a race to the bottom in care.