The Cost of Serving Infants and Toddlers under Part C. EIEC Webinar Series Association of University Centers on Disabilities June 28, 2010

Transcription

1 The Cost of Serving Infants and Toddlers under Part C EIEC Webinar Series Association of University Centers on Disabilities June 28, 2010

2 Jean Johnson, DrPH Center on Disability Studies College of Education University of Hawai`i Susan Brown, MEd Part C Coordinator Department of Health State of Hawai`i

3 Background Worst recession since the 1930s 48 of 50 states face budget shortfalls Part C programs vulnerable with some states reducing eligibility Some states considering opting out of Part C Little published information available on the cost of Part C services

4 Status in Hawai`i - June 2009 Decreased funding for early intervention Eliminated at-risk eligibility Reduced biological-risk eligibility Considering further reductions in eligibility Information needed on cost of serving infants and toddlers based on number and percentage of delays to support informed decision-making

5 Description of Hawai`i s Part C 14 contracted programs, five state programs 50 other contracted providers Care coordination provided by program social workers Medicaid carve-out for services No family cost participation No private insurance billing

6 Part C Expenditures in Hawai`i FY 2009 Source Amount Percentage Part C General Funds $16,638, Part C Federal Funds 1,883, Medicaid Carve-Out 980, CSHNB General Funds 199, TOTAL $19,702,

7 Purpose of the Study To determine to the greatest extent possible the full cost of serving infants and toddlers under Part C.

8 Literature Review Tom Parrish Unit Cost Study, Hawai`i, 1999 Overall annual state cost: $7,121 Five state programs annual cost: $11,192 Contract programs annual cost: $6,392 National Expenditure Study (NEILS), Average annual expenditure: $12,708 Average monthly expenditure: $916

9 Average Total Cost and Months of Services in NEILS

10 Questions - Cost Study Cost of serving children based on numbers and percentages of delays Cost of care coordination services Local and state-level administrative costs Percentage transportation cost represent of total service cost Cost of serving Medicaid-eligible children Cost of serving children with an autismspectrum diagnosis

11 Methodology Eligibility data for children enrolled in June 2009 Costs for direct services for March, April, May 2009 averaged for monthly cost, annualized April program administrative costs annualized April fee-for-service cost for annualized Guesstimation (imputation) procedures used when exact cost could not be determined Access file to SPSS for calculations

12 Question? What were the characteristics of the infants and toddlers included in the study? June 2009

13 Number of Infants and Toddlers Contract Providers 1, % State Providers Total 2, % (NEILS) (2,195)

14 Demographics Autism 67 of % Medicaid 332 of 2253* 14.7% Gender* 64.9% Male (1467) 34.0% Female (769)

15 Age at Time of Enrollment

16 Areas of Delay Area of Delay Number Percentage Cognitive 1, Speech-language 1, Gross motor 1, Fine motor 1, Social-emotional Self-help 1,

17 Number/Percentage of Delays Number/Percentage of Delays Total N % POS State N % N % No delay Single delay < 25% Single delay between 25-50% Single delay > 50% Two delays, both < 25% Two delays, both not < 25% or > 50% Two delays, both > 50% Three or more, all < 25% Three or more, no more than 2 > 50% 1, Three or more, with three over 50% Six delays > 50% Total 2, ,

18 Number of Delays

19 Question? What is the cost of serving children based on numbers and percentages of delays?

20 Total Annual Mean Cost by Numbers and Percentages of Delay Numbers and Percentages of Delay Means No delay $ 7,032 Single delay <25% 7,074 Single delay between 25%-50% 7,334 Single delay >50% 8,268 Two delays both <25% 7,089 Two delays both not <25% or >50% 7,656 Two delays both >50% 7,958 Three or more all <25% 7,665 Three or more, no more than two >50% 8,712 Three or more, at least three >50% 10,401 Six delays >50% 8,398 MEAN COST FOR ALL DELAYS $8,352

21 Question? What is the cost of providing direct services?

22 Cost by Discipline per Child Discipline Monthly Means Occupational therapy $ Physical therapy Speech-language pathology Teachers Para-professionals Others Total Monthly Mean $225.94

23 Annual Cost of Direct Services Services by discipline (POS) $2,705 Services by discipline (State) 3,830 Statewide average by discipline $3,268 Statewide fee for service cost $1,143 Average Annual Direct Service $4,411 (per child)

24 Question? What is the cost of providing care coordination services?

25 Care Coordination Costs NEILS: Included in total service cost Roberts (2005): Annual costs varied from $896 to $2,318 depending on model Current Study (Hawai`i) Average Annual: $772 (per child)

26 Administrative Costs How much does local and state-level administrative cost contribute to the total cost of serving infants and toddlers under Part C?

27 Administrative Costs No published report identified state costs NEC*TAS: Report for New Jersey, showing 19% for state-level administration Current Study (Hawai`i, 2009) Annual Local: $1,754 (per child) Annual State: $1,896 (per child)

28 Annual Cost by Cost Item (Equates to resource cost ) Direct Services 49.9% Care Coordination 8.7% Local Administration 19.8% State Administration 21.6%

29 Question? What percentage of the cost for services is for transportation?

30 Transportation Cost Average monthly service cost $ Average monthly transportation Percentage of transportation to total discipline service cost: 28.37

31 Question? From the cost data, can we project the amount of services a child and family received?

32 Amount of Services Monthly service cost: $ Transportation time: Balance: $ Average hourly cost: $55.16 Average hours per month: 2.93 hrs

33 Question? What is the cost of serving Medicaid-eligible children?

34 Medicaid/Non-Medicaid Profile Number/Percentage of Delay Medicaid Eligible % Medicaid Ineligible No delay Single delay < 25% Single delay between 25-50% Single delay > 50% Two delays, both < 25% Two delays, both <25% or >50% Two delays, both > 50% Three or more, all < 25% Three or more, no more than 2 > 50% % Three or more, three over 50% Six delays, all > 50%

35 Cost of Serving Children Receiving Medicaid Mean Minimum Maximum Medicaid 8, , , Non- Medicaid 8, , , Current carve-out reimbursement: ($ monthly) = $2,247 annually

36 Question? What is the cost of serving infants and toddlers with an autism-spectrum diagnosis?

37 Autism/Not-Autism Profile Number/Percentage of Delay ASD % Not ASD % No delay Single delay < 25% Single delay between 25-50% Single delay > 50% Two delays, both < 25% Two delays, both <25% or >50% Two delays, both > 50% Three or more, all < 25% Three or more, with no more than 2 > 50% , Three or more, three over 50% Six delays, all > 50%

38 Annual Cost of Serving Children with an Autism Spectrum Diagnosis Annual Program Cost Mean Maximum Autism Diagnosis 31, ,440 All Other Children 7,645 32,747

39 Question? What is the cost of early intervention services for the total period of eligibility?

40 Lifetime Part C Costs NEILS $15, month Hawai`i $13, months

41 Question? How do the cost data from this study compare with other known Part C cost data?

42 Comparison of Annual Cost Data With Other Annual Cost Data Location/Date Annual Adjusted Part C Average, ,098 10,059 NEILS, ,708 14,930 Hawai`i, ,121 9,231 Hawai`i, ,352 8,352

43 Significant Findings Two-thirds of children have significant delays of three or more. The cost of transportation consumes more than one-fourth of service expenditures. Children receive on the average fewer than three hours of service per month. Overall administrative costs amount to 41.4% of total program expenditures. The cost per child in Hawai`i is lower than it was a decade ago!

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45 These findings mean Fiscal concerns push states into serving fewer children Serving fewer children in Hawaii has moved our state from a prevention model to a deficit model Lack of early intervention services results in more children in preschool special education. Long-term, this results in increased costs to society and increased burdens to children and families.

46 Question to Ponder Are we meeting the purpose and intent of Part C?

47 For more information: Jean Johnson Sue Brown

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