The document discusses challenges facing New Hampshire's developmental services system due to severe funding shortages projected to last for some time. It provides context on the state budget and outlines reductions already made to the Department of Health and Human Services (DHHS) and Bureau of Developmental Services (BDS) budgets. The document also presents BDS's budget requests for fiscal years 2010 and 2011 to address enrollment increases and service needs while historical financial data shows NH's developmental disability waiver costs compare favorably to other New England states.

1. New Hampshire Developmental Services System Present and Future Challenges

2. Intent Of The Forum The State is facing a severe funding shortage Projected to last for awhile It is likely that our service system will be affected Individuals, families, providers, area agencies, BDS, DDHS and local communities BDS and area agencies are soliciting input, ideas and suggestions regarding how we may collectively deal with the difficulties we are facing

3. Intent Of The Forum An opportunity to consider creating changes that are more effective with respect to Desired service outcomes and Cost A chance to imagine how: The service system may operate in the future It may support individuals and their families Resources can be used in more effective ways

4. Fiscal Conditions And Challenges

5. Fiscal Year 2009 [July 1, 2008 - June 30, 2009] The State budget has $5,2 billion in Total Funds $1,6 billion in General Funds (GF) DHHS was assigned the largest share of the $1.6B General Funds $713M of the $1.6B About 44% of the total General Funds [The next largest GF portion is only 11% of the state total]

7. Fiscal Year 2009 Out of the $713M GF within the DHHS budget About $103 M (14%) GF was assigned to BDS BDS has the second largest share of the GF dollars within the DHHS budget Both DHHS and BDS have “high profiles” within the state budget

8. “ Cost Drivers ” According To NH Center for Public Policy Studies Medicaid Provider Payments Retirement System Retirement Health Care Corrections BDS Wait Lists Catastrophic Aid to Schools School Building Aid

9. FY 2009 Budget Reductions The State has a $250M (15%) shortage in GF. So far DHHS has given up about $43M in GF The impact on BDS (as of January 2009) BDS has given up about $1.2M in General Funds without interrupting any direct services The planned 2% cost-of-living rate increase has been eliminated All of the FY ’09 Wait List funds have so far been preserved After two rounds of budget cuts the State is still facing a $75M deficit

10. Historical Financial Perspective On The Current System

14. NH’s DD Waiver per person cost compares favorably with the other New England States’ average costs.

15. BDS Rate Increase History

16. Future Challenges

17. FY 2010 & 2011 Budget Forecast NH Center for Public Policy Studies The State is likely to have an overall shortage of $500M for the biennium Level funding for FY ’10 and 3% growth in FY ’11 will result in a deficit of $403M A 3% cut in 2010 and restoring the 3% in 2011 will still lead to a $230M deficit

18. BDS Request For FY 2010 & 2011 [ In Comparison To The 2009 Budget ] Fiscal Year 2010 Increase of about $25M in General Funds $50M in total funds (state and federal) Fiscal Year 2011 Increase of about $40M in General Funds $80M in total funds (state and federal)

19. BDS Request For FY 2010 & 2011 Enrolment Increases for: DD Waiver (648) ABD Waiver (53) In-Home Support Waiver (80) Early Intervention (338) Cost of Living Increase (across the board) Direct service staff wage increase Health care coverage for home providers Family Support (respite, transportation, heating, etc.) Intensive training for children with Autism (age birth to 3) Core training for direct service staff Fire safety modifications

22. Reasons For Increases In The Wait List Numbers?

33. Senate Bill 138 RSA-171-A:1(a)(II) “Beginning with the fiscal year ending June 30, 2010, and thereafter, the department of health and human services shall incorporate the cost of fully funding services to eligible persons … and the legislature shall appropriate sufficient funds to meet such costs and requirements.”

34. Aging Caregivers More Students Aging Out Aging Individuals Financial Challenges