The Oklahoma Department of Human Services failed to provide more access to services like home day care and therapy for people with intellectual disabilities despite increases in state and federal funding, according to a state spending watchdog.
The Legislative Office of Fiscal Transparency found that the Department of Human Services could do more to provide disability services to people on a years-long waiting list and that increases in federal and state funding have not resulted in significantly more people getting services, according to a report it released Tuesday. The services are funded through waiver programs with a combination of state and federal Medicaid funds.
A consultant the Department of Human Services has hired for $8.5 million to help solve the waiting list problem isn’t doing work that is substantially different from five other previous assessments, the report found.
Department of Human Services Director Justin Brown and Chief of Staff Samantha Galloway pushed back hard against the report’s findings during a meeting Tuesday at the Oklahoma Capitol and said the data, methodology and conclusions of the report were “factually inaccurate” and “a gigantic distraction” for agency staff.
“We just don’t believe this is a worthwhile use of time and resources while we remain singularly focused on transforming the system,” Brown said.
The agency claims it did not have sufficient time to issue a response to the report before the meeting.
Minutes before Tuesday’s meeting gaveled in, Galloway distributed paper copies of the Department of Human Services’ response, a move that some lawmakers said was concerning since they didn’t have time to review it.
The document highlighted what the Department of Human Services claimed were factual inaccuracies and misunderstandings of the program and state and federal systems. The agency also disputed what it said were inaccuracies in waiting list data from the report.
Over the past months, the relationship between DHS and some advocacy groups for the developmentally disabled and their families has cooled. The agency has stopped providing waiting list data to advocates while a consultant conducts an assessment on disability programs.
Norman resident Wanda Felty has been an advocate for people with developmental disabilities. Her daughter was also once on the waiting list, but has since received services. For more than a decade, Felty has coordinated monthly meetings for parents with children on the waiting list, often with speakers from the Department of Human Services and other officials. The group also has monthly updates, drawn from state data on how many people are coming off the list and how many are still waiting for services.
Felty, who was at Tuesday’s meeting, told The Frontier that the Department of Human Services stopped providing her group with that data in March. The agency had previously provided her group with the information since 2010, though there had been issues with getting it in a manageable format for about a year.
“Apparently, whatever we were getting and exposing, they decided they didn’t like, just my opinion,” Felty said.
Galloway said DHS has stopped providing the data because of the time and resources it takes the agency to manually gather the information for Felty’s group.
“We have full-time work to do as it is,” she said.
“Apparently, whatever we were getting and exposing, they decided they didn’t like.”
Wanda Felty
Oklahoma City resident Ellyn Hefner, whose 17-year-old son is on the waiting list, said she attended the meeting on Tuesday in hopes to hear about how the system could be improved, but said she was disappointed that much of the meeting focused on data disputes, rather than what is being offered..
“It’s just the way it’s handled. It (the waiting list) has always been mishandled. I wish the conversation would have been toward the people who need services instead of the disputing of data. I think that was a waste of time for everybody,” Hefner said.
More funding has not substantially shortened a 13-year waiting list for services
There are only a set number of slots available each year for people to receive disability services through three different Medicaid waiver programs. Oklahoma now has a 13-year waiting list for services, though a few cases are granted services on an emergency basis. As of March, there were 5,619 people on the waiting list.
Providing services to everyone on the list would cost the state an estimated $49 million per year, according to the report.
Department of Human Services leadership set a goal this year to eliminate the waiting list entirely, and has hired the consultant Liberty Healthcare of Oklahoma to assess the availability and cost of providing services for everyone on the list.
Liberty has a five-year contract worth $8.5 million with the Department of Human Services for the assessment. But the Legislative Office of Fiscal Transparency found that Liberty’s work “is not materially different than prior assessments of the programs.”
Since 2011, the Department of Human Services has conducted five other assessments of the waiting list. Liberty’s contract with the Department of Human Services doesn’t say how the agency will use the information to provide better services or provide more people on the waiting list with services, according to the report.
Liberty is expected to have around 20 percent of the assessments done by January and will report its findings to the Legislature.
Galloway vehemently disagreed with the report’s findings on the Liberty contract, and said the new assessment will be more comprehensive than past efforts and will involve interviewing everyone on the waiting list, rather than a random sample. Under the contract, the consultant will also help people find available services in their area, she said.
“We want families that are waiting to not be afraid of this assessment and we want families to participate,” Galloway said. “We want to know what their needs are so that we can make arrangements. In all sincerity, we want to end this waiting list.”
The Legislative Office of Fiscal Transparency found that while the number of people on the waiting list has declined over the past few years, most of the decrease came from a “clean-up” the Department of Human Services did during the 2019 fiscal year by removing people who said they no longer wanted or needed services, had moved out of state, died or could not be reached. That effort eliminated about 2,400 applicants from the list.
Part of the Department of Human Services’ plan to eliminate the waiting list suffered a setback earlier this year when the Centers for Medicare and Medicaid Services said a state law limiting eligibility for services to those who have lived in the state for at least five years was unconstitutional.
The number of people who actually received services through the waiver programs has remained relatively steady between the 2013 and 2020 fiscal years, the report stated.
The waiting list grew by 50 people and just 171 additional people received services during that time, although the Legislature has provided around $2 million each year in additional funding for the last three years.
“LOFT observed no direct correlation between the additional appropriated funds dedicated for serving those waiting and the actual transition of people moving from the Waiting List to receiving a waiver,” the report found.
Additional funding hasn’t helped because the state is bound to five-year estimates it gives the federal government for the maximum number of waivers it can serve. The state also cannot set the maximum level of waivers beyond what it can show it has funds to support, according to the report.
