the 2013 fiscal cliff, washington state budget analysis

7/30/2019 The 2013 Fiscal Cliff, Washington State Budget Analysis

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The 2013

Fiscal CliffA Systems Thinking Approach to I/D PolicyDevelopment

The problems that can result as a result of the implementation of the Budget Control Act of 2011 are

arguably unrivaled in domestic policy. Budget cuts impact policy agendas which in turn impact benefit

programs and services; these in turn impact customer service metrics and our clients quality of life.

Quality of life is not free and neither is the absence of it. The only sound policy is one that takes

responsibility for the consequences of its policies. Quality and costs are complementary metrics. Costs

are reduced through the development and implementation of sound policies that proactively respond to

the needs of the community.

Drafted by Travis Barker, MPA GCPM


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Table of Contents

The Purpose of PolicyThe ChallengePolicy & Budget PrioritiesEligibilityCommunity & Support ServicesConclusions


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over discussions to develop their balanced

budget.

The fiscal cliff of January 1, 2013 represents the point at which taxes are marked to increase

across the board unless the Federal Government can agree upon a balanced budget.

The Federal Governments goal is thus to match revenue with expenditures as well as identify

policy priorities that minimize the negative impact of their budget on the nation.

Interdependence of Policy Priorities

The different policy priorities are

interdependent upon one another. This

means that the revocation of one policy

priority area impacts the rest of the system.

For example, medical benefits & services

impacts the quality of life of a DD client

living in their own home in the community,and similarly services are dependent on

housing stability and are tailored to the

home setting (institutional versus

community, etc).

Without appropriate medical the ability to support a client in their own home in the community is

decreased. Similarly, the type of housing model available to the client determines the quality of

services provided. In turn, the type of services provided reinforces the type of housing the client

requires.

The ChallengeThe challenge of the Federal & State governments is thus to identify policy & budget priorities

that take into consideration the larger picture of service and benefit needs of the DD community.

Failure to consider the larger picture is otherwise comparable to having a home but no staff to

provide support services.

Policy & Budget Priorities

The policy & budget priorities impact

eligibility and what community based support

services and models are available.

Eligibility

Eligibility criterion to receive funding impacts

what community based support services and

models are available.


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Community Support Services

Community support services and models available in the community impact the quality of

outcomes achieve as a result of the policy priorities and budget allocations.

Staff can help by researching the policy & budget areas that are being discussed at the local

and federal levels, participate in that dialogue, advocate for the DD clients you serve, and by

voting.

Policy & Budget PrioritiesBalancing the Governments Budget

Mandatory Services & Entitlements

The Constitution of the United States identifies certain rights that are inalienable from the

person. Subsequent to the drafting of the Federal Constitution was the State Constitutions

within which inalienable rights were confirmed and expanded. Funding of services supporting

these inalienable rights is required by both the Federal and State Governments. The means by

which these rights are enforced and the level of funding allocated to these policy areas is open

to negotiation as long as these inalienable rights are protected.

Discretionary Services

The values inherent in the Federal and

State political systems expand the

support beyond the inalienable rights in

the pursuit of goals and ideals unique to

the place and time of the era.

Legislation is enacted in these

discretionary areas to enforce these

rights and obligations with the rule of

law. Funding is allocated to these policy

priorities with specific objectives in

mind. Timeframes are established

during which these policy priorities are

to be enacted and rescinded.

Federal & State Interdependence

Shared Responsibility in the Administration of Benefit & Service Programs

The Federal Governments policy agenda is realized through regional and State efforts through

collaborative sharing of funding responsibility for shared policy commitments.

- Where the State is lacking is commitment, or funding, the Federal Government is able to

entice cooperation through funding arrangements in discretionary policy areas.


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- Where the State is similarly lacking in commitment, or funding, in mandatory (non-

discretionary) policy areas the Federal Government has used a combination of funded

and unfunded mandates.

- The administration of benefit and service programs is configured according to the

requirements established in the guiding legislation.

Cutbacks in One Area Impact the Delivery & Efficacy of Administration in Other Areas

Funding shortfalls impact both Federal and State policy priorities. The Budget & Control Act of

2011 requires the alignment of revenue and expenditures in government spending.

- Although the mandatory (non-discretionary) policy priorities remain due to

Constitutional requirements at the Federal and State levels the ability to achieve quality

outcomes is delimited as a result of the budgetary shortfall.

- The challenges faced by Federal and State authorities are to continue representing the

interest of their constituencies, frequently defined as maintaining existing service

standards, despite cuts in spending.

Research and Evidence Based Practices

Realization of the national and local policy agendas represents a moving target. Research

supports the developing of tools to realize these negotiated values.

- When funding shortfalls occur the support of discretionary policy areas, including

research to identify and evaluate evolving evidence based practices, is negatively

affected.

State Funding:

History of Federal Support of State Programs, Particularly During Economic DownturnState and local governments depend on the Federal government to achieve mandatory and

negotiated discretionary policy priorities.

- In an economic downturn State and local governments are further depending on Federal

support to maintain current benefits and services. .

Reduction of Federal Support Reduces State Ability to Serve Maintain Policy Priorities

Discretionary and non-discretionary policy areas

become increasingly unsustainable during

funding shortfalls. Policy priorities are

reevaluated while lobbying efforts to maintainservices to current levels provide increased

pressures to legislators, politicians, and

organizations.

- Balanced proposals to address the

reduction in resources emphasize the


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maintenance of the constituencys

unique agenda.

- Trade-offs are required and yet no one is willing to make these trade-offs.

Reduction of Federal Funding Likely to Exacerbate Further State & Local Cuts in Services

A domino effect occurs in the identification of policy priorities as budgets are reevaluated,

reallocated, and the entire policy field is realigned.

- Maintenance of individual policy areas, mandatory or discretionary, creates a relative

imbalance that plays out through the allocation of adjustments to other policy areas.

EligibilityEligibility:

Social Security Eligibility

Social Security eligibility criterion is

modified as the baby boomer

generation ages, less children are born

to bear the financial burden of the

social security payouts, and the

financial viability of the program

becomes suspect.

Medicaid Eligibility

Medical eligibility criterion is modified

as the economic crisis increases the

unemployment rate, families seeking

Medicaid benefits increases, healthcare costs skyrocket, and the revenue sources used to fund

the Medicaid program show decreased performance.

Medicare Eligibility

Medicare eligibility criterion is modified as the number of people retiring increases, as

unemployment increases early retirement, as income decreases and the income based criterion

for Medicare is met, and as the revenue sources used to fund the Medicare program show

decreased performance.

Benefits:

Food Stamps

Food stamps represent a discretionary policy item. The funding for this area is frequently

competed for and identified for allocation to other policy priorities facing funding shortfalls.


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- The criterion of eligibility for this benefit is revaluated as a result. Studies have

replicated the general findings that food stamps and general assistance benefits

mitigate incentives to work and thus reinforce their continued use, diminish success as a

temporary fix for the policy areas identified, and create dependence.

- Food stamp benefits allow the beneficiary to spend their limited income amongst other

critical areas.

- Without food stamp benefits the non-beneficiary is required to use their limited income

on food which is likely to lack sufficient nutrition, contribute to increased medical issues,

and increased medical costs.

Startup Assistance

Startup assistance represents a discretionary policy item. Startup assistance for people with

disabilities is limited to their first move into a community based setting. The availability of this

resource is often indeterminate and requires a case by case application and evaluation process.

- Without the startup assistance the non-beneficiary is required to use their own limited

funds for housing setup, their ability to move into the community is greatly decreased

due to greater costs, and housing quality is diminished if the move is still supported to

proceed.

Prescriptions

The prescription benefit of the Medicaid and Medicare plans has been critically scrutinized as a

result of the challenges to balance the budget.

- Escalating healthcare costs, costs of medications, high utilization of non-generic

medications, and the often prescribed new medications and their associated costs make

prescription benefits one of the most expensive policy areas in government.

- In an effort to limit the costs of the prescription benefit individual eligibility criterion

has, medications covered, and individual programs that have this benefit.

- Without the prescriptions benefit the non-beneficiary may face increased medical issues

due to inability to secure critically needed medications, increased use of emergency

medical services due to postponed treatment, increased medical costs, depleted

savings, and hospitalization due to out of control medical conditions and/or

destabilization.

Medical:

Caps on Healthcare Funding

Healthcare funding is one of the most costly policy agenda items at both the Federal and State

levels.

- The suggested caps on

healthcare fund determine the


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policy agendas that are to be

pursued, the services that are

to be provided, the benefits

that are available, the criterion

of eligibility for each, and the

results that can be targeted.

Caps on Healthcare Benefits

Healthcare benefit allowances and approved procedures and treatments have been revised

during this economic recession affecting millions of people.

- Medical, dental, optical, and behavioral treatment options, to name just a few, have

been reevaluated and differentially approved depending on the benefit plan and

beneficiary characteristics.

- Caps on healthcare benefits determine the type of procedures that are allowed,

medications that will be paid for, treatment that will be covered, criterion of eligibility

to receive critical treatments that are included in the plan, as well as present with limits

to preventative care options. Healthcare benefits represent one of the key policy

agenda items that have a direct and measurable impact on quality of life.

- Although the DD community had been proposed to lose their dental, optical, and

prescription benefit coverage this has not happened yet. Other groups were not so

fortunate.

Inadequate Benefits Increase Utilization of Costly Emergency Services

The Budget & Control Act of 2011 requires a balanced budget. How this is done is open to

debate, and is being debated.

- Saving costs by excluding a medical procedure or treatment procedure/service often

results in decreased health and postponed costs, ultimately escalating in the form of

emergency services.

- No policy agenda item is realized through this effort, except financial. Housing,

healthcare, benefits, nutrition, services, and treatment have a direct impact on quality

of life; when a DD client is missing one of these factors than the other factors are

affected.

Reimbursement Rates

Accessible healthcare is dependent on the practitioners, physicians, and specialists that are

willing to accept the reduced rate for service that is set for reimbursement by Medicare and

Medicaid.

- When these practitioners, physicians, and specialists are no longer able to afford to

work with the public benefit plans the community suffers.

- Medical services become a commodity as the community is forced to search for new

providers.


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- Accessibility to services is delayed and pressure is increased on the remaining system to

do more with less.

- Customer care is postponed and neglected. Costs per unit of service again increase as

service needs become increasingly complex and critical.

- Although this mechanism for saving costs has been exercised in the past reimbursement

rates are eventually restored in order to insure the policy priority of adequate medical

care is supported.

- The rollercoaster ride ends where it started; the whole point of the exercise is thus

called into dispute.

Affordable Healthcare Act

Expansion of Healthcare Services Available

The Affordable Healthcare Act represents one of the most significant pieces of legislation since

the introduction of Social Security.

-

The nations quality of healthcare and quality of life will improve. This affects DD clients

as well as their families, neighbors, friends, relatives, and coworkers.

- The expansion of healthcare

services available impacts the

lifespan, quality of life as the

population ages, generates

more demand for the

insurance industry, generates

more demand for the medical

technology that serves the

industry, and supports thedevelopment of a more health

conscious nation.

- A healthier nation is also a

more productive nation.

Pre-existing Conditions

Pre-existing medical conditions represent a policy priority for the Affordable Healthcare Act.

- Insurance carriers identify pre-existing conditions as a policy area to avoid.

- Costs associated with pre-existing conditions are often causing the community to seek

healthcare insurance in an effort to seek critical medical treatment as well as mitigatethe costs of that treatment.

- Costs associated with the same pre-existing conditions are often causing insurance

carriers to decline a procedure.


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- These represent two very different policy priorities. Leveraging the buying power of the

entire nation is anticipated to decrease costs while increasing potential profits to

insurance carriers and medical providers.

- The continuing treatment of pre-existing conditions is necessary to take care of the

individuals health.

- The continuing support of healthcare coverage that does not reject procedures for pre-

existing conditions is necessary to take care of the nations health.

- Refusing treatment based on a pre-existing condition is tantamount to refusing housing

to a DD client who is now living on the streets.

- The rationale justifying refusal on either point fails to recognize the vision that binds

communities together and spurs technological and service based innovations to improve

everyones lives.

Increases Employer Costs

The Affordable Healthcare Act, upon initial implementation, is forecasted to greatly increased

employer costs.

- Until different mechanisms for carrying the burden of the healthcare bill are realized

these costs are likely to result in decreased staffing, collateral benefit plans, capital

investments, infrastructure & facility improvements, to name a few.

- Product and service innovation and emphasis on value will be less likely to occur

without additional, itemized, and unbundled costs been transferred to the customer.

- Similar to the priorities of the Budget Control Act of 2011, business costs have to be

made up with revenue somewhere.

- This policy priority saves and costs the same beneficiary while contributing to improved

health.

Decreases Emergency Care Costs

The Affordable Healthcare Act pursues different policy priorities than the Budget Control Act of

2011. Whether or not their implementation can be complementary is debatable.

- The costs that are saved by the Affordable Healthcare Act in preventative care, and the

avoidance of unnecessary and less efficient emergency care in the future, is to be

realized.

- It can be readily argued that the quality of life gains associated with the Affordable Care

Act more than compensates for the costs of the acts implementation minus the saved

revenue from avoiding emergency treatments.

Impacts National Medical Service Measures

The objective of each policy priority is to achieve the outcomes identified within that policy.

Funding is allocated to achieve the agenda specified in the policy.

- The success of the policy is dependent on the measures and metrics utilized to evaluate

policy outcomes.


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- Although the legitimacy of the metrics utilized are left for another discussion and not

included in this analysis the outcomes are easily reduced to general themes: health,

safety, and general welfare.

- These outcomes are interdependent and no sound policy can be developed without

consideration of overlapping dependencies with other policies.

Community & Support ServicesCaregivers & Family Supports

Respite Care

Many DD clients live with their family for an extended period of time prior to their introduction

to alternative housing models in the social service industry.

- Respite care services represent one of

the discretionary policy areas that

continue to be jeopardized during

budget cuts.

- This represents a problem since

accessibility to the funding to utilize

the alternative housing models in the

social service industry is scarce.

- Extensive waiting lists are common.

- The fact that respite care options are

limited, and the extension of these

programs is often unfunded, increases

the familys need for alternative

housing models.

- Since funding is limited for both the health of the family is undermined as they wait for

alternative services and support to finally become available.

Program Funding Levels Impact on Family Economic Status

Socio-economic indicators include wealth, savings, health, education, employment, and the list

goes on.

- Families with a member that is disabled frequently forego these opportunities in

exchange for having the resources and time, albeit limited, to take care of their disabled

family member.

- These same socio-economic indicators represent opportunities and resources that are

then not accessible.

- Healthcare costs, support services, and housing costs are incurred by the family as long

as funding limits and eligibility restrictions can impact the family for a generation.

Financial Impact on Ability to Retire


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The familys ability to retire is dependent on having unused income for investments and savings

wherein the payout is postponed until retirement age.

- With families with a member who is disabled and is not yet eligible for funding benefits

and services any unused income, if any, is used to take care of the family member.

- In many instances second and third mortgages must be taken on the home in order to

pay for the additional bills of taking care of a disabled family member.

- The technical services available to help families to better support and understand the

needs of their disabled member lack public funding sources until the disabled member is

eligible for the funding for these services and benefits.

- One of the more common gaps in funding exists between that of eighteen years of age

and twenty four years of age (or more).

- Despite many disabled children having the services and benefits available to them while

attending school these same benefits and services are not established for graduation

from school.

- The natural graduation from school to the community is left unfunded, un-served, and

unsupported through the public sector.

- As a result, disabled family members often utilize the extended high school

programming available to disabled students from the ages of eighteen years of age to

the age of twenty one as a form of supervision

Social Security Retirement Age & Benefit Level: Impact on Family Economic Status

Social Security benefit levels and the criterion for eligibility for benefits impacts the entire

family system. Strained systems impact every member of that system.

- Whether direct or indirect the impact of limited benefits and exclusionary criterion for

eligibility determines the scope and breadth of resources and opportunities that will be

available to each beneficiary.

- The family becomes strained as members of each family system are required to provide

services and financial support to other members of the system.

- Whereas one member may be able to accommodate their particular limitations faced

the consequence of these limitations on the system are easily magnified as a member

with a disability is left with less support and assistance.

- Diverted resources similarly divert attention. Diverted attention thus impacts the quality

of support available to disabled family members.

Services:

Slots Available within a time of Expanded Service Needs & Institutional Closures

Services are available based on eligibility criterion and the availability of funding.

- Slots, associated with funding availability, represent a scarce commodity.


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- New slots are infrequently made

available despite DD individuals needing

these services and resources as they

age out of the public education system.

- Access to services affects household

stability, income potential, and health.

Limited access to services also affects

individual stability, treatment efficacy,

and their ability to successfully

integrate into the community.

- Delays are individually associated with

increased treatment resistance, poorer

health, and increased behavioral

problems.

Funding Limitations on Expansions

Treatment and service delivery models are constructed based on then current evidenced based

practices of the era. What this means is that models become outdated as customer needs and

service technologies change.

- The transition from one service model to another, and from one technology to another,

costs money.

- Delays are associated with decreased efficiencies and efficacies when compared to

more advanced standards.

- Despite this often recognized fact public and private models are resistant to upgrading

until regulatory requirements, either legal or financial, require it.

- For example, transitioning DD clients from institutions into the community was not

initiated until there were these legal and financial considerations.

- The mental health community has experienced similar trends initiating upgrading.

Mandatory Services Threatened as a Result of Federal & State Cutbacks

Each era contains cultural characteristics that shape public policy agendas.

- These evolving agendas in many circumstances exceed the legislatively required

mandate for services and benefits.

- Service and benefit levels that are individually tailored to local communities are

supported by flexible funding mechanisms although these often required combined

local, state, and federal contributions.

- As funding cuts are increasingly necessitated by the recession the federal and state

contributions to localized efforts becomes similarly restrictive.

- Definition, identification, and evaluation of outcomes is benchmarked at lower and

lower thresholds across the spectrum of policies impacting at the local levels until


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nothing is left except the original and dated mandated that fails to account for modern

values, norms, and technologies.

- Old methods, technologies, and objectives become normalized until the next biennial

session where it is hoped that more revenue becomes available.

Discretionary Services Threatened as a Result of Federal & State Cutbacks

Whereas mandatory service levels remain the discretionary services that represent the eras

modern day perspective, commitments, and priorities lose focus.

- The resulting gap between identified need and the services/benefits that are available

pangs both the individual and society.

- Social advancements are threatened as regressive priorities, technologies, and values

are reinforced.

- Although the democratic machine is enhanced through these recessionary and

regressive mechanisms the effort produces duplication of efforts, values, and

movements that already occurred in times past.

- Instead of moving forward the entire system is instead often focused on maintaining

what it has, mitigating further loss, and limiting their focus on the here and now instead

of the future.

Reimbursement Rates

Reimbursement rates represent the set amount negotiated by the government for payment.

- These payment levels are often lower than rates adjusted by the market and represent

deterrents to providers to accept these rates.

- As costs increase these rates are not sustainable.

- As these rates decrease the providers ability to similarly continue to provide said

services is not sustainable.

- Negotiation between the government and providers is often played out in the market

instead of proactive discussions intended to reach a sustainable solution.

- Providers discontinue their contract with the government to provide services to the

beneficiaries of the government as costs become unsustainable when compared to

reimbursements.

- The governments cut in reimbursement rates, or failure to increase said rates with the

cost of inflation, decreases the type, frequency, and quality of services now available to

the beneficiary.

- The government eventually recognizes this and reconsiders its reimbursement rates.

Providers thus agree to provide services again. The cycle continues.


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- Community integration, as a policy and funding priority, impacts more than just

opportunity; vocational, housing, educational, economic, and spiritual domains are also

impacted as well.

- The professional, certification, legislative, regulatory, and economic systems in place to

support the pursuit of these policy and funding priorities influences national output,

quality of life, cultural competitiveness, and global authority as a driver of progress.

Regression to Institutionalization & Marginalization as Funding & Services Decrease

As policy and funding priorities shift away from higher order values towards an emphasis on

basic necessities the short term is emphasized over the long term of the individual, community,

and the nation.

- The reduction in funding presents as a disincentive to support community building and

instead refracts such efforts thereby mitigating nation building.

- As individuals become increasingly dependent on their immediate family the community

loses the incentive to be invested in their welfare.

- The policy analysis that existed during an era of higher order value priorities becomes

hardened and instead focused on fiscal solvency as well as measures of productivity and

sustainability instead of opportunity and enrichment.

- Proactive measures are replaced with reactive measures that fail to recognize the

interdependence between mechanisms, strategies, and outcomes.

- Concerns related to health, housing, employment, education, crime, and safety are only

responded to when they become threatened; the perception of threat is limited to a

reaction after things have deteriorated instead of prior to their deterioration.

- As the frequency of the reactive approach increases the publics willingness to utilize

restrictive and thus reactive mechanisms, increases as well. Incarceration,

institutionalization, and marginalization are a result of such practices.

Impact of Employment on Benefits Levels: The Significant Gainful Activity Threshold

Arguably one of the most critical service areas in the support of community integration is

vocational development. Without vocational opportunities the individuals ability to actively

participate in their community is lessened.

- Vocational development requires education.

- Similarly, access to an appropriate education requires professionals that are trained and

certified according to the specific strategies and topics appropriate to their field.

- Training and technology development requires the support of government, institutions

of education, and big business.

- The ability to access an education requires infrastructure, building, roads, and

transportation.

- For many individuals with a disability vocational development also requires regulatory

support in the employment sector.


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- For employers to be able to effectively utilize the unique skills of individuals with a

disability they often require professional and financial supports to maintain productivity

and financial specifications.

- The opportunity for individuals with a disability to benefit from gainful employment is

dependent on their ability to balance employment opportunities with the income

threshold after which benefits levels decline. The benefit programs income threshold,

established according to financial and eligibility criterion of corresponding policy and

funding priorities, similarly represents a barrier to progress as the individual seeks to

balance opportunity with necessity.

Education:

Socio-economic Status

Education represents one of the critical mortars required in the foundation supporting skill,

cultural, economic, vocational, and social development.

-

Without access to education other

opportunities are similarly less

available.

- Education is thus associated with

quality of life.

- Education is thus associated with crime

rates.

- Education is thus also associated with

debt rates, poverty, and utilization of

public benefit programs.

- Education impacts gross domesticproduct and the competitive advantage

of corporate strategies and processes.

Classroom Size

Classroom size represents one of the key areas emphasized as a result of dropped performance

measures and the implementation of the No Child Left Behind Act.

- Classroom size impacts the instructors ability to adapt and tailor the learning materials

and teaching approach to the needs of the individual. The larger the classroom the less

individually tailored the approach.

- The instructor to student ratio also impacts school incurred costs for salaries,infrastructure, training and development, administrative oversight and planning,

property taxes, performance scores and testing, school rankings, stakeholder

engagement, district benchmarks, local governance, as well as present and future

demographic characteristics of the present and graduating classes.


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Integration Efforts

Integration represents one of the key routes identified when pursuing normalization and

inclusion efforts that minimize if not completely eradicate barriers.

- Efforts to integrate individuals with disabilities, etc., require appropriate training,

resources, strategies, infrastructure, zoning, and support funding to insure accurate

implementation is even possible.

- Integration also requires congruence amongst legislative, political, legal, and

institutional stakeholders, processes, and agreements to support the efforts

implementation and enforcement.

Housing:

Institutions Closing

The closing of institutions represents a critical sign of progress in the modern day treatment of

persons with disabilities. Although closure is justified and initiated due to many non-ideological

factors its impact as an incentive of progress in the domain of public policy is un-debatable.- The closure of institutions provides the impetus necessary for policy and funding

development to support community based integration measures.

- The closure of institutions also

spurs the development,

analysis, and utilization of more

humane treatment and service

models.

- Despite its ideological

advantages, the closure of

institutions is often unmet withsufficient funding and

programming to support

effective transitioning into the

community.

- Poor planning and support of policy and funding priorities that proactively respond to

the collateral impacts of institutions closing lends to negative impacts on hospitals,

service agencies, caseloads, and communities as the individual is left without housing,

treatment, medications, supports, nutrition, and/or stability.

Community Based WaiverThe CBW represents a benefit program that covers treatment and medical costs for individuals

with disabilities. Eligibility for this program represents a significant asset since this program, in

particular, has continued to have strong support at the policy, funding, and legislative levels.

- The lengthy wait list for this program, and the limited funding and slots available within

this program, are in conflict with the actual needs of the community and the rates by


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which individuals with disabilities graduate from high school and thus require benefits

and services sourced from different programs (see waiting list discussed earlier).

- The differential benefits available within the individual public benefit programs

increasing the administrative difficulty to administer, supervise, and thus benefit from

these programs.

- Due to the difficulties associated with the above administration issues many providers

refuse to provide their particular medical services.

Community Protection Program

The community protection program represents a unique policy area in that it focuses on people

with developmental disability who have displayed dangerous behaviors that are currently

present and represent an ongoing risk to the community.

- This program represents an alternative to incarceration. Without this program

incarceration becomes the only alternative for offenders.

- Although incarceration lacks both the safety and treatment to adequately address the

unique needs of the DD community the community protection program continues to

face strict, and often restricting, eligibility and funding criterion.

The Department of Corrections & the Courts

The D.O.C. and the Courts represents the judicial systems approach to illegal and/or dangerous

conduct. The approach taken towards each individual infraction represents historical precedent,

legislative action, and judicial interpretation of said actions, precedents, and infractions.

- The legislative and judicial systems influence and are influenced by society. The

attitudes towards the individuals conduct are represented in the corresponding policies

and practices of these complex institutional systems.

- The funding and policy priorities of each institution differ depending on the nature of

the offense, legal precedent indicating response trends for the offense within each

jurisdiction, and the funding priorities for each jurisdiction and institution.

- The punitive model is associated with less treatment, increased recidivism, and

increased trauma for people with disabilities.

- The treatment paradigm when implemented in the D.O.C. is associated with higher

costs and decreased efficacy when compared to other community based models.

- Trauma within the I/D population requires intensified treatment and housing services in

order to support in the community when compared to the general community without

an identified disability.

- Despite decreased benefit when implemented within the D.O.C., the treatment

paradigm represents a more humane and efficacious model than the strategies inherent

in the punitive model when calculating for qualitative recidivism rates that incorporate

values that extend beyond basic quantitative metrics.


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Section 8 Housing

Housing assistance represents a means to provide significant financial assistance in a key area

for people with disabilities and meeting the low income criterion for eligibility.

- Housing assistance criterion for eligibility is met based on income and is often available

in addition to other public benefit and financial programs.

- Ineligibility for housing assistance, due to a lack of funding or other reasons, often

leaves individuals with limited source income with which to pay their bills, seek

adequate nutrition, pay for transportation, housing, education & training, as well as

medical services (when not covered by another benefit program).

- Meeting the eligibility for section 8 housing, when adequate funding exists, enables the

individual to pay for other critically necessary items thereby improving their health and

quality of life.

- When funding for section 8 is unavailable other services, such as treatment, vocational,

and community integration efforts lose their efficacy. Diminishing returns result due to

poor housing services and benefits despite the funding priorities for other areas. All

support domains are interdependent.

Transitional Benefits & Services

The transition from home to school, from school to community, and from community to

employment/higher education requires financial, social, and institutional supports.

- When transitional benefits and services are not available the family, community, and

legal system is required to pick up the slack. Costs are thus allocated to collateral

programs with different funding and policy priorities.

- The absence of transitional benefits and services is frequently associated with the

absence of specialized knowledge and expertise necessary to deal with the unique

barriers and challenges faced by individuals with a disability.

- Skills deteriorate during transitional periods as novel situations require the identification

and implementation of unique skills.

- Individuals with cognitive and other skill deficits faced increased learning challenges

during transitional periods. The absence of specialized supports and services further

exacerbates this challenge.

Portability: Medical, Benefit, & Services

Portability, in the context of this I/D policy discussion, represents the individuals ability to bring

the Community Based Waiver with them to another funding jurisdiction without a lapse in

benefits and services. Funding for the waiver is ported with the individual to their new address

that resides in the new jurisdiction.

- Portability is also an option available to the section 8 program. In order to portthe

section 8 voucher OR the Community Based Waiver (CBW) the criterion for a legitimate

reason to port the voucher must exist.


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- Although denied requests to port the waiver(s) are infrequent their occurrence can limit

the individuals ability to move closer to family, opportunities, and consolidated support

network.

- Budget cuts, such are considered necessary in the current economic recession,

jeopardize all funding jurisdictions thereby heightening their need to retain the

equivalent funding available for each CBW. The flexibility inherently needed to support

the CBWs portability is strained as a result.

- When a CBW is ported the slot in the existing jurisdiction is not necessarily replaced.

The then service provider is left with the previous infrastructure still intact but without

the same demand for services. Transitional assistance is again required to support the

sustainability of the service delivery system. Pressure to fill the open service slot

increases albeit with an existing CBW from elsewhere through the referral process.

Staffing

Wage Budget AllocationsBudgets are allocated according to priority and interdependence. Value chain analysis is just one

way of identifying structural, process, and technical interdependencies. Continuity of service

requires a sustainable infrastructure and this infrastructure requires that all of its parts are

working together.

- Failing to support one link in the network can leave the rest of the network weakened.

- The challenge is to identify the interdependencies inherent in these policies and budget

priorities and insure they are supported adequately.

- The benefits of receiving quality services are dependent on budgets and their

adjustment with inflation and other cost of living benchmarks in order to insure that

costs do not outstrip the capacity of the infrastructure.- Wages impact recruitment and

retention of employees as well as the

quality of the skills recruited and

retained.

- Wages are established based on

contract rates which are funding

through both public and private

sources.

- Reimbursement rates impact business

revenue streams. When costs exceedrevenues the business becomes

insolvent.

- Since the business is interdependent

with its capacity to provide services to


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specification any impact on its capacity

similarly impacts its services.

- Wages support the skills needed to meet service specifications. Without sufficient

budgets to recruit and retain talent the creativity needed to respond flexibly and

adaptively to infrastructure and other capacity challenges is decreased.

- Budgets for staffing are allocated into hours which in turn determine the frequency and

quality of the services that are provided.

- When hours are preset wage calculations must be adjusted accordingly. Recruitment

and retention then suffer as a result as wages decrease.

- Constrained capacity limits the company to pursuing lines of service that cannot

compete with other businesses.

Training Budget Allocations

Training supports the employees to use the specific technical skills needed to flexibly and

adaptively respond to the challenges of their work.

- Training quality, frequency, and relevance impacts the effectiveness and efficiency

of staffing efforts.

- The companys ability to differentiate itself from its competitors is determined by

the quality of its services.

- The quality of services is dependent on the quality of the staffing that provides

them.

- The retention of quality staffing is dependent on performance meeting

specifications.

- The ability to meet the specifications of performance requirements is dependent on

training.

- The retention of skills acquired in training is dependent on the retention of staffing,

without which produces a revolving door where skills are lost to competitors.

- Staffing turnover is common in the social service industry. One reason is the lack of

viable wages to support a family. Another is the challenges faced in an entry level

field where entry levels skills are frequently inadequate for a complex and changing

environment of challenges.

- Consistent staffing is required to maintain consistent service quality.

- Inconsistent staffing often leads to inconsistent service quality as new staff are hired

and trained to meet service specifications that exceed their performance at the

onset of employment. This is why it is so important to minimize staff turnover as

much as possible.

ConclusionsPolicy priorities are interdependent or exclusionary, but not both. What this means is that some policies

require the support of other policy areas. When policy priorities that require interdependence are


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instead pursued with exclusionary, and thus non systems-thinking mechanisms, the combined benefit is

lost. Interdependencies amongst policies exist whether or not they are recognized.

When these are not recognized, or when these interdependencies are not incorporated into subsequent

policy planning and drafting sessions, all stakeholders suffer the consequences. This is proven by the

need for the Budget Control Act of 2011.

The problems that can result as a result of the implementation of the Budget Control Act of 2011 are

arguably unrivaled in domestic policy. Budget cuts impact policy agendas which in turn impact benefit

programs and services; these in turn impact customer service metrics and our clients quality of life.

Quality of life is not free and neither is the absence of it. The only sound policy is one that takes

responsibility for the consequences of its policies. Quality and costs are complementary metrics. Costs

are reduced through the development and implementation of sound policies that proactively respond to

the needs of the community.

the 2013 fiscal cliff, washington state budget analysis

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