Advocates gathered on a cold, rainy Thursday to push back against steep cuts to the Developmental Disabilities Administration. (Photo by Danielle J. Brown/Maryland Matters)
Despite being “extremely thankful” that state leaders worked with them to reduce cuts to the Developmental Disabilities Administration, advocates say this year’s budget is still a “painful” proposal to a community that already absorbed steep cuts last session.
The budget unveiled Friday by Senate leaders includes a $126 million cut from the DDA budget — down from $150 million proposed by Gov. Wes Moore (D) — and, perhaps the biggest win, news that state lawmakers will not cap the total amount of state funding a single person can get for their unique health needs.
But that’s about where the bright side of the fiscal picture for the DDA ends for fiscal 2027.
“This is completely unacceptable and will cause widespread damage to people and put people at risk of losing their staff,” said Patti Saylor, a nurse who works with those with disabilities. “Individuals and families are stressed beyond comprehension.”
But it’s the grim reality for the state agency facing unsustainable spending growth year over year, and lawmakers facing a budget shortfall of $1.6 billion in fiscal 2027.
According to state analysts, about 19,100 people received services through the Medicaid waiver in fiscal 2025 to cover expenses for the unique health care needs that can occur with developmental disabilities. The DDA administers the waiver using state and federal dollars.
Of that number, there were 15,190 who were enrolled with a community service provider while 3,968 were enrolled in self-directed services, in which the individual directs the staffing and care for their health and medical needs.
Developmental disability advocates gather for one last rally before Senate budget decisions
Advocates note that the proposed $126 million cut will result in total reduction of around $252 million, since it will mean the loss of matching federal dollars under the Medicaid waiver that covers developmental disability services.
One bit of good news for advocates: The Senate version rejected a proposal to set a $500,000 cap on how much state funding a person with a DDA waiver can receive in a year for their “personal budget,” which varies greatly depending on need.
Ande Kolp, executive director for the Arc of Maryland, said it was a “relief” lawmakers removed the proposal.
“It’s obvious they heard us about how concerned we were that the proposals they originally put on the table would impact the most vulnerable people,” she said. “The people with the most complex needs.”
But the remaining “cost containment” options moving forward in the Senate budget will continue to knock down wages and payments for providers.
Here’s where the cuts to the DDA stand under the Senate’s version of the budget.
Decrease in state funding for services
The Senate budget issues a sweeping reduction to how much the state reimburses providers for services under the Medicaid waiver – part of the compromise to remove the proposed cap on personal budgets.
The DDA contributes different percentages based on what service is provided. The Senate budget proposes to drop payment rates by 2% or more across most services – leaving providers to scramble to make up the difference through charitable donations or make changes to available services.
Ande Kolp, (Executive Director for The Arc of Maryland),
Mat Rice (Executive Director for People on the Go of Maryland). (Photo by Danielle J. Brown/Maryland Matters)
While the rate decrease is technically across services through both self-directed and community provider models, that cut is going to more severely impact the community providers, such as the Arc, due to differences in how the personal budgets are built.
“These are going to be very painful,” Kolp said.
Meanwhile, the Senate budget proposal carries over Moore’s plan to conduct greater enforcement of “dedicated hours policies” which refers to community provider staff who provide one-on-one support due to an individual’s high medical or behavioral needs.
State officials believe it can save state dollars through “better enforcement” of dedicated hours policies, which will likely result in fewer people qualifying for those additional supports.
Lower wages for self-directed plans
The Senate’s proposed budget reduces the amount that self-directed individuals can pay their staff. This includes family members who act as direct service personnel as well as nonfamily employees.
“These are the very same staff people that took a cut in their paycheck last year,” Saylor said. “They’re going to be asked to take another significant cut in their paycheck — We know that they’re going to leave.”
Self-directed waiver recipients are currently allowed to provide a boost in the wages to direct-support personnel to account for the intense caregiving services often needed for people with developmental disabilities – referred to as reasonable and customary wages.
Moore’s initial proposal was to drop all providers of reasonable and customary wages to a level similar to wages set by the U.S. Budget of Labor Statistics for similar jobs. The Senate’s proposal would still drop family employees closer to the BLS wages, but nonfamily employees would receive a slightly higher wage, though the specifics are still getting worked out.
The Senate’s budget language also eliminates the wage boost for unlicensed providers — people like camp counselors and art instructors — who can currently provide services for self-directed individuals but are not held to the same standards as licensed providers.
How did we get here?: Analysts, officials unsure how disability agency overspent
Moore’s proposal to eliminate a different pay boost for self-directed providers, referred to wage exceptions, carried over into the Senate budget proposal.
The Senate budget proposal also adds restrictions on how many hours family members can operate as support staff before looping in an outside provider – saying that a single family member can only receive payment for 40 hours of services a week and capping all hours that any family member can work as a provider to 60 hours each week.
“We shouldn’t even be talking about cuts to the disability budget at all,” Saylor said. “People are doing the very best they can to stay safe and healthy and in the community, and it’s becoming impossible with the threats of the DDA cuts.”
The budget still needs approval by the full Senate before it heads to the House of Delegates for consideration or potential changes. But Senate Budget and Taxation Chair Guy Guzzone said the current cuts as proposed by the Senate Budget and Taxation Committee were worked out in conjunction with House budget leaders, the Moore administration and advocates with the community.
Guzzone called the Senate’s budget package “best of the worst” options for cuts at the DDA.
And fiscal woes at the department are not yet resolved. Guzzone said there are plans to boost financial oversight positions within the department and to use artificial intelligence programs to “find anomalies.”
“We’re going to be enhancing CFO positions in a number of places” including the DDA, Guzzone said. “We’re going to be hiring some more consultants, actuaries and having the benefit of the increased knowledge on that.
“You’ve got thousands of people that are beneficiaries of this, and each one of them has a different setup on what kind of services they receive. And then you’ve got that changing over time,” he said. “So with all that movement going on, we’re going to use machine learning look at that information and find anomalies.”
YOU MAKE OUR WORK POSSIBLE.
Originally published at Marylandmatters.Org