Case Study: Small provider funding cut in half by Medicaid change

53 percent of reimbursements cut under new reimbursement model

Mary Roberts kisses her son, Jacob Roberts, as he finishes his lunch at The Village Community day habilitation program i
Mary Roberts kisses her son, Jacob Roberts, as he finishes his lunch at The Village Community day habilitation program in West Branch on Thursday, March 1, 2018. Robets has two adult children with autism who attend the program, of which she was a founding member. (Rebecca F. Miller/The Gazette)

On Feb. 21, officials from the Iowa Department of Human Services hosted a two-hour public comment session at the Coralville Public Library.

A handful of health care providers, followed by a dozen or more sometimes tearful and angry family members of special-needs individuals, expressed their frustration at the recent cuts to Medicaid payments for long-term support and service providers.

Since the state implemented a change to its reimbursement model to the home- and community-based services waiver in December, Village Community officials say they are seeing a 53 percent cut in its Medicaid payments — a funding source they rely heavily on to stay afloat.

Located at a former winery near West Branch, the Village Community offers day habilitation and supported community living services in a high staff-to-member ratio environment five days a week.

It has 14 total members, the majority of whom are at stage on the autism spectrum and range in age between 18 and 32.

Under the previous fee-for-service system, the organization received $150 a day per member for day habilitation, Executive Director Ann Brownsberger said.

Now, the payments are based on one of six tiered rates that were determined on an individual basis, with tier six being the greatest amount of reimbursement.


However, the Village Community and other providers said at the public comment hearing the assessment was not reflective of the actual cost of services each individual needs.

At the most, the Village Community can receive $117.03 a day for individuals placed on tier six. However, Brownsberger said, most of their members are on tier two or three — meaning they receive $71.15 or $81.03 a day respectively.

The Village Community officials said their model should receive more investment as they believe it is cost-effective in the long term. They have seen success in their members — some of whom include their own children — after they began receiving care in the Village Community, both in their physical health and in their behaviors.

Alison Brownsberger, Ann’s 20-year-old daughter who has a chromosomal disorder, struggled when she attended special education classes at the Iowa City Community School District, her mother said. She would often have to be placed in seclusion or restraint, to the point she injured herself in one instance.

But Allison has improved since joining The Village Community. It’s been more than a year since they’ve had to restrain her, Brownsberger said.

It was a similar story for Board President Mary Roberts’s 25-year-old daughter Kelsey, who is on the autism spectrum and had not been able to acclimate successfully in any other program. But here, she’s “done beautifully.”

“With all that time and effort, seeing how well she’s doing is very validating,” Roberts said.

The Village Community was an idea hatched in 2013 by the parents of children with developmental and intellectual disabilities.


The three co-founding mothers — Brownsberger, Roberts and Brenda Kurtz of Iowa City — established the health care organization in the hopes of providing a place where their children could be cared for throughout the rest of their lives, even after their parents were gone.

So even with these new challenges from managed care, Brownsberger said they don’t want to consider the possibility they would have to close the facility.

“The reality is the Village not existing is not an option for our families,” she said. “We started this program for our kids. I’ve not let Alison down yet in her lifetime and I don’t plan on doing that now.

“If this fails, I see it as a failure on my part as a parent to her because this is something I need to do for her.”

This is something she also needs to do for her other two children, Brownsberger said.

“As much as this organization was created for (Alison), this was created for them as well so that they don’t have the struggle that we’ve had as parents,” she said. “Ultimately that’s what’s going to happen. When my husband and I aren’t here, I know they will step up and be there for her, but I want them to have a community of people who are going to support them in doing that.”

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