OKPOLICY.ORG
Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1991. He currently practices law in Tulsa and represents clients at the Capitol. You can sign up on his website to receive the Capitol Updates newsletter by email.
Last week’s Oklahoma Healthcare Authority (OHCA) planning retreat provided a wealth of thinking about how to work through the next few years. It seemed to be pretty much a consensus that problems are increasing and resources to deal with them are decreasing. A good number of the endeavors that are thought to be necessary to make life better are finding themselves sort of in the ditch-or on the edge about to fall in. You name it — mental health, addiction, health outcomes, hospitals, education, higher education, corrections, courts, roads and bridges, services to children, the disabled, the elderly — and we seem to be slipping. Excellence is hardly a realistic goal. Predictions are that this won’t get better anytime soon. So, if you’re among those whose life is about helping to meet one or more of these needs, what lies ahead?
Sen. AJ Griffin, one of the best policy thinkers in public life in our state, was on an OHCA panel and had this to say to state officials: “For the first time we’re going to have officials looking at blended funding. You’ll have to work together to do that. It’s funding based on outcomes. We’ll hear more about that. We’re not going to have more money. We’re going to have to apply those dollars differently. We can spend every dime we get on healthcare and still not meet all the needs. Next year is going to be tough.” No doubt she’s reflecting the thinking of other leaders in the legislature.
Dr. Terry Cline, Director of the Oklahoma State Department of Health and Secretary of Health, said “I’m of the firm belief that unless we change the way of payment in our state we won’t be able to affect change and outcomes. We’re putting millions into healthcare but are we getting the outcomes? No we’re not. I think we have the opportunity for payment reform.” Talking about our schools Dr. Cline said, “[School officials] say they can’t focus on health because they have to focus on academics, and no surprise, academics increase when kids are healthy. Necessity is the mother of invention.”
This is probably unwelcome information to service providers that have seen their rates stagnate or decline due to budget cuts. Or to state employees who are doing the work of colleagues whose post has been left vacant to meet the cuts. But the signal here is that some sort of structural change may be on the way. Innovation is the order of the day. To keep doing services you’ll need to learn (or develop) the expected outcomes and be able to show you are meeting them. That’s tough duty in many fields where you can often do everything right and still get a bad outcome. But in the zero sum times we are living through there’s a low level of tolerance for bad numbers. Some will argue that doing more with less has passed its limit, but so far that idea hasn’t taken hold in our state.
What was the cost to Oklahoma taxpayers to have the retreat at the Embassy Suites? Seems they might have saved a lot of money by having this at a Technology Center, bank, or other place with no or low fees.
The facts about the matter of funding services, healthcare and education in Oklahoma are troubling to say the least. Providers of services to the disabled have always done more with less. For example- When two people who lived at an institution closed by Federal Courts moved into the community and got married- they had a baby. We can’t go into details, except to say that for the past 18 years neither parent was capable of raising the child on their own, they divorced and the child remains with the mother. The mother received services everyday 24 hours a day. The direct support staff employed by dd providers raised that baby, she is now 18. We were never paid for that, it was and continues to be both difficult and wonderful. The reason I point it out is, law makers and the public do not really knows what the $15.59 per hour dd providers receive actually pay for. The current cut effective 9/1/15 makes the rate $15 per hour. The 18 year old is also developmentally disabled, she now has graduated High School, receives 16 hours a week service and is still supported by her mothers 24 hour staff.
Director Lake wrote to providers, sadly telling us he has to use our funding to pay for a foster care lawsuit. I’m saying we are already helping the foster care system, and surprise, Director Lake- when you cut D’s funding, you are cutting foster care funding too. We provide respite services to foster children. DHS Director Lake and other Agency Directors have a tough job I’m sure. But so do I, and it is absolutely a slap in the face to the entire intellectual and developmental disability community of Oklahoma, that Director Lake, the Governor, and lawmakers cannot partner with those affected by their decisions. We have a voice and probably really great money saving suggestions- but we are not invited to the table, we are told we are “Special” and do great work, pats on the back are not going to make us go away. We may not be as large as the teachers but we are your neighbors and like it or not – all State Institutions for ID/DD are now closed. Parents who did not institutiluze their children are often single and aged, needing services of their own. Direct Support staff are taking care of entire families
For $8.50 an hour. Provide agencies are paying wages, administration, and thousands on the ever increasing requirements. No more be said hey we are taking .59 per hour away from every hour of service your business provides, you can stop complying with 3.5% of the expectations we have for you. In fact we get new requirements that demand administrative time, but because we already have a low wage, we have a staff crisis and our administrative staff are often out in the field doing direct care work.
OHCA Board Chairman McFall answered our request to vote no or abstain on the DD rate cut by saying we needed to go to the State Capitol. He felt our pain but could not help, he voted yes. He was our last hope.
Who will help?