Shortfall Gives Hope to Disability Rights Advocates

Disability rights advocates try year after year to persuade lawmakers to close Texas’ state-supported living centers, the large, institutional-care settings that the United States Justice Department has monitored for dangerous conditions. Every time, their efforts have been rebuffed — by the adamant parents who rely on the facilities to care for their loved ones and by the lawmakers who count on the centers as economic drivers in their districts.

This session, advocates say they have a big plus in their column: the state’s giant budget crunch. They hope lawmakers, facing an estimated $15 billion to $28 billion shortfall, will have to shutter some of the centers, which cost Texas $500 million a year to operate.

“Does this economic reality make it easier for legislators to do it? I sure hope so,” said Amy Mizcles, governmental affairs director for The Arc of Texas, which wants people with disabilities to receive community-based care. “We keep hearing this fiscal-responsibility mantra. We have a real opportunity to provide better quality care in a much less expensive setting.”

So far, there is little evidence that state officials will take this course. State Senator Steve Ogden, Republican of Bryan, the key Senate budget writer who has been most open to downsizing the state schools, declined to comment.

Meanwhile, the Department of Aging and Disability Services, which operates the centers, said it was prohibited by state law from closing any of the state-supported living centers without legislative direction.

“We can’t,” said Cecilia Fedorov, a spokeswoman for the department. “But that doesn’t mean the Legislature can’t.”

Even with the budget shortfall, advocates for community-based care are not optimistic. Since state leaders ordered agencies to trim their budgets to help close the gap, the Department of Aging and Disability Services has recommended cutting new community-based care slots and slashing Medicaid reimbursement rates for workers at nursing homes, group homes and in-home facilities.

Meanwhile, money for the state-supported living centers has grown, a requirement of the state’s five-year, $112 million settlement with the Justice Department over conditions inside them.

“I’ve heard that everything will be on the table,” Ms. Mizcles said. “But every bit of action that’s been taken thus far is completely to the contrary.”

Parents who rely on the centers to care for their adult children say the influx of money is having an enormous positive impact. The settlement agreement “has been a wonderful thing,” said Nancy Ward, with the Parent Association for the Retarded of Texas. “We need to give them a chance to keep on doing the improvements with the money they got.”

According to advocates for community care, however, the state-supported living centers do not make financial sense. A third of the disability department’s budget for people with intellectual and developmental disabilities serves the 4,600 people living in 13 state-supported living centers — a comparable amount finances more than 17,000 people receiving care at home or in small-group settings. The annual cost per resident in a state-supported living center is roughly $120,000, compared with nearly $50,000 in community-based care.

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