Opportunity
For over a decade, we worked with project partners (Burns & Associates and Davis Pier Consulting) and numerous states and Canadian provinces to reimagine the way they provide supports to people with intellectual and developmental disabilities. Personal Supports Budgets—individually tailored, needs-based service budgets—were key to these efforts; using this framework, policymakers applied limited funds more effectively and efficiently while also promoting self-direction in community supports and services.
Our clients included the following U.S. state agencies: North Carolina Division of Medical Assistance, Department of Health and Human Services, Georgia Department of Behavioral Health and Developmental Disability, Oregon Department of Human Services, Oregon Developmental Disability Services, Idaho Attorney General, Department of Health and Welfare, Hawaii Developmental Disabilities Division, Maine Office of Aging and Disability Services, Virginia Department of Behavioral Health & Developmental Services, Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, and New Mexico Developmental Disabilities Supports Division. In Canada, our clients included: Alberta Seniors and Community Supports, Persons with Developmental Disabilities, Manitoba Family Services, Community Living disAbility Services, and Nova Scotia Department of Community Services.
Approach
Promoting self-direction
A Personal Supports Budget is a preset budget amount or number of support hours allocated to each person based on their assessed support need. The amount may be a fixed number or range related to the assessed level of need. During annual supports planning meetings, individuals can use this allocation to craft some of their own mix of services, helping them take charge of their lives and pursue their goals.
Promoting transparency
Personal Supports Budgets also give people with intellectual and developmental disabilities more information about all the available supports and services and how they can use their budget to choose the services they want. Often their choices for services are expanded, with governments choosing to add services to promote community inclusion, peer support, and support for self-direction. Finally, individuals can request services above and beyond their supports budget when those are necessary.
Merging formalized needs assessment and exceptions processes with person-centered planning, Personal Supports Budget frameworks help governments better understand their service populations and support more person-driven services.
Modernizing systems
We helped governments to better spend the limited funding they have. Governments can be overwhelmed with the competing challenges of managing with reduced or stagnated funding and the desire to improve the services and supports they offer to people with intellectual and developmental disabilities. The Personal Supports Budgets approach helped governments to do both.
Our Personal Supports Budgets framework helped governments to:
- Expand future service options including options for community inclusion, peer support, and self-directed services;
- Discontinue legacy services that aren t improving the lives of the individuals served;
- Understand service costs (making them more predictable and more applicable to future service recipients and future service needs);
- Stabilize the cost of services;
- Better align individual funding to needs;
- Promote alternatives to paid support;
- Provide services in the least restrictive settings; and
- Implement a model that can be adjusted with changing needs over time.
Promoting meaningful change
In the process of reimagining their system, governments reexamined the values and rationale behind their legacy system and made adjustments to bring it into line with their present values. This alone provided a valuable opportunity to bring stakeholders together, created a shared vision for the future, and funded what they value. It often resulted in meaningful changes for people with intellectual and developmental disabilities, including:
- Acquisition of additional public funding for supports and services;
- Expansion of services to individuals on waiting lists;
- Delivery of a more robust range of services;
- Provision of funding for individuals moving from institutions to communities;
- Distribution of fair and consistent funding across service recipients and providers; and
- Improved rates for providers.
Impact
Personal supports budgets enable governments to align supports to needs, offer more community-focused services, improve transparency and self-direction, expand services to more individuals, and set a path forward in an uncertain fiscal future.