The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Fiscal Policy
BILL: CS/CS/SB 1758
INTRODUCER: Fiscal Policy Committee; Children, Families, and Elder Affairs and Senator Brodeur
SUBJECT: Individuals with Disabilities
DATE: January 31, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rao Tuszynski CF Fav/CS
2. Rao Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
The Agency for Persons with Disabilities (APD) administers services to individuals with
developmental disabilities through federally funded Medicaid waiver programs. APD’s iBudget
program permits individuals to receive home and community-based waiver services and select
the services that are best suited for them while living in their home, rather than an institutional
setting.
CS/CS/SB 1758 amends multiple sections of law related to the APD to:
 Require the APD to offer care navigation services to clients and their caregivers, including,
but not limited to, creating care plans that address immediate, intermediate, and long term
needs and goals of the client.
 Modify the application process for APD services, requiring the creation of an online
application process and streamlines the timeframes the APD has to determine eligibility.
 Reduce the age requirement of a client’s caregiver in pre-enrollment category 4 from 70
years of age to 60 years of age or older. This will allow a higher number of individuals to be
included in category 4 of the pre-enrollment prioritization list.
 Require iBudget waiver support coordinators to inform iBudget clients of the option to apply
for the CDC+ program when creating family or individual support plans.
The bill transfers the Florida Unique Abilities Partner Program from the Department of
Commerce to the Agency for Persons with Disabilities.
BILL: CS/CS/SB 1758 Page 2
The bill requires the Agency for Health Care Administration, the APD, and other stakeholders to
develop a plan for a new home and community-based services Medicaid waiver program for
clients transitioning to adulthood and requires a report to the Governor, President of the Senate,
and Speaker of the House by December 1, 2024 on the progress of this plan.
The bill also appropriates funding to the Agency for Persons with Disabilities for the 2024-2025
fiscal year and has a significant negative fiscal impact on state government. See Section V. Fiscal
Impact Statement.
The bill has an effective date of July 1, 2024.
II. Present Situation:
Agency for Persons with Disabilities – Generally
Chapter 393, F.S., identifies the need to provide community-based services and programs for
individuals with developmental disabilities that enable individuals to achieve their greatest
potential for independent living while reducing the number of individuals in unnecessary
institutional placements.1
The Agency for Persons with Disabilities (APD) provides services to individuals with
developmental disabilities and manages Medicaid waivers that provide federally approved
services for individuals with developmental disabilities.2 Florida has procured waivers of federal
Medicaid requirements for the purpose of providing home and community-based (HCBS)
services to individuals at risk of institutionalization.3 The HCBS waiver provides services to
individuals with developmental disabilities that allow recipients to live in their home or a home-
1
Section 393.062, F.S.
2
Section 20.197, F.S.
3
Rule 59G-13.080(1), F.A.C.
BILL: CS/CS/SB 1758 Page 3
like setting and avoid an institutional setting.4 Eligible recipients must meet institutional level of
care requirements.5 In addition to central headquarters in Tallahassee, the APD operates a total of
six regional offices and 14 field offices throughout the state, as detailed below:6
iBudget Florida Program
The APD administers Florida’s individual budget-based HCBS Waiver, known as iBudget
Florida, for individuals with specified developmental disabilities who meet Medicaid eligibility
requirements.7 The iBudget program allocates available funding to eligible, Medicaid-enrolled
clients and provides the client an established budget with the flexibility to choose services within
a specified service package that best allows them to live in their community.8
The APD began implementation of iBudget Florida on May 1, 2011; the final areas of the state
transitioned from the previous tiered waiver system on July 1, 2013.9 The iBudget program uses
an algorithm, or formula, to set individuals’ funding allocations for waiver services.10 The APD
administers the iBudget pursuant to s. 393.0662, F.S.
The APD serves approximately 35,000 individuals through iBudget Florida, contracting with
service providers to offer various supports and services to assist individuals to live in their
community.11 Examples of waiver services include residential habilitation, behavioral services,
personal supports, adult day training, employment services, and occupational and physical
therapy.12
Section 393.066, F.S., requires the APD to plan, develop, organize, and implement its programs
of services and treatment for persons with developmental disabilities to allow clients to live as
independently as possible in their own homes or communities.13 All elements of community-
based services must be made available, and eligibility for these services must be consistent
across the state.14 Services for clients must be purchased rather than provided directly by the
APD when more cost-efficient. However, the APD must approve all purchased services.15
4
The Centers for Medicare and Medicaid Services, Home and Community-Based Services 1915(c), available at:
https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-
community-based-services-1915c/index.html (last visited 1/18/24).
5
Id.; Rule 59G-13.080(1), F.A.C.
6
Agency for Persons with Disabilities, Regional Offices, available at: https://apd.myflorida.com/region/ (last visited 1/18/24).
7
Section 393.0662, F.S.
8
Id.
9
The Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental
Disabilities and their Costs: First Quarter Fiscal Year 2022-23, p. 2, November 15, 2022 available at:
https://apd.myflorida.com/publications/reports/ (last visited 1/18/24).
10
Id.
11
E-mail from Kendall Kelley, APD Legislative Affairs Director, January 19, 2024 (on file with the Senate Committee on
Children, Families, and Elder Affairs)
12
Supra. note 9.
13
Section 393.066(1), F.S.
14
Id.
15
Section 393.066, F.S.
BILL: CS/CS/SB 1758 Page 4
Eligibility for iBudget Services
Current Florida law requires the APD to review applications for eligibility of iBudget program
services within 60 days after receipt of the signed application. If the applicant is deemed to be in
crisis,16 Florida law requires the APD to review eligibility determination within 45 days.17
Individuals who are determined to be eligible for the Waiver program are either given a slot in
the program or placed on a wait list if the demand exceeds available funding. As of December
2023, there were 21,587 individuals on the waiting list.18
The APD assigns each waitlisted client to a preenrollment category based on their needs and
prioritized in the following decreasing order of priority:19
 Category 1 – Clients deemed to be in crisis.
 Category 2 – Includes clients in the preenrollment categories who are:
o From the child welfare system with an open case in the Department of Children and
Families’ statewide automated child welfare information system and who are either:
 Transitioning out of the child welfare system into permanency; or
 At least 18 years but not yet 22 years of age and who need both waiver services and
extended foster care services; or
o At least 18 years but not yet 22 years of age and who withdrew consent to remain in the
extended foster care system.
 Category 3 – Includes, but is not limited to, clients:
o Whose caregiver has a documented condition that is expected to render the caregiver
unable to provide care within the next 12 months and for whom a caregiver is required
but no alternate caregiver is available;
o At substantial risk of incarceration or court commitment without supports;
o Whose documented behaviors or physical needs place them or their caregiver at risk of
serious harm and other supports are not currently available to alleviate the situation; or
o Who are identified as ready for discharge within the next year from a state mental health
hospital or skilled nursing facility and who require a caregiver but for whom no caregiver
is available or whose caregiver is unable to provide the care needed.
 Category 4 – Includes, but is not limited to, clients whose caregivers are 70 years of age or
older and for whom a caregiver is required but no alternate caregiver is available.
 Category 5 – Includes, but is not limited to, clients who are expected to graduate within the
next 12 months from secondary school and need support to obtain a meaningful day activity,
maintain competitive employment, or pursue an accredited program of postsecondary
education to which they have been accepted.
 Category 6 – Clients 21 years of age or older who do not meet the criteria for categories 1-5.
 Category 7 – Clients younger than 21 years of age who do not meet the criteria for categories
1-4.
16
Rule 65G-1.047, F.A.C. provides that the severity of crisis is determined by risk to the health, safety, and welfare of each
applicant relative to other applicants. Rule 65G-11.004 provides a procedure for determining if a client is considered to be in
crisis.
17
Section 393.065, F.S.
18
Supra note 11.
19
Section 393.065, F.S.
BILL: CS/CS/SB 1758 Page 5
Eligible individuals that meet the criteria for Categories 1 or 2 are directly enrolled onto the
iBudget waiver.20 Currently, there is a higher demand for iBudget services than the amount of
funding that is available, which means individuals that require services are put on the waitlist for
services based on the categorization of their needs. The following table displays the number of
individuals in the preenrollemnt categories as of December 2023.21
Category Description Total Clients
Category 1 Crisis -
Category 2 Children in Welfare System at the time of permanency or -
turning 18
Category 3 Intensive Needs 210
Category 4 Caregiver Over Age 70 83
Category 5 Transition from School 20
Category 6 Age 21 and Over 12,809
Category 7 Age Under 21 8,464
Grand Total 21,587
The average time a client spends in a preenrollment category is 8.6 years.22 The following chart
identifies the length of time clients have been in a preenrollment category.23
Length of Time in a Percentage of
Preenrollment Category Individuals
Under 5 years 42%
5 –10 years 20%
10+ years 37%
iBudget Waiver Support Coordinators and Family Support Plans
After an individual is deemed eligible for services, the APD is required to consult with the client,
if competent, the client’s parent or guardian, or, when appropriate, the client advocate to create a
family or individual support plan.24 A support plan must be designed to include the most
appropriate, least restrictive, and most cost-beneficial environment for the accomplishment of the
objectives for client progress, including an appropriate placement in the client’s home or
community.25
Waiver support coordinators are permitted to review the progress of and annually revise the
family or individual support plan upon consultation with the client, the client’s parent or
20
Agency for Persons with Disabilities, SB 1768 Analysis, p. 2 (on file with the Senate Committee on Children, Families, and
Elder Affairs)
21
Supra note 11.
22
Supra note 11.
23
Supra note 11.
24
Section 393.0651, F.S.
25
Id.
BILL: CS/CS/SB 1758 Page 6
guardian, or the client advocate.26 Additionally, waiver support coordinators collaborate with the
recipient of services and service providers to accommodate the needs of the recipient within the
recipient’s iBudget services allocation.27
Florida Consumer-Directed Care Plus Program
The Legislature created the Florida Consumer-Directed Care Act in 2002 aimed to increase the
choice and control over long-term care services individuals with disabilities receive.28
Authorized by the federal Medicaid State Plan Amendment, the Consumer-Directed Care Plus
(CDC+) program permits individuals to choose their providers and to direct the delivery of
services as they see fit, within the funds appropriated by the Legislature.29
Consumers are able to use the monthly budget allowance to purchase long-term care services
which include, but are not limited to, the following:30
 Personal care.
 Homemaking and chores, including housework, meals, shopping, and transportation.
 Home modifications and assistive devices which may increase the consumer’s independence
or make it possible to avoid institutional placement.
 Assistance in taking self-administered medication.
 Day care and respite care services, including those provided by nursing home facilities or
adult day care facilities.
 Personal care and support services provided in an assisted living facility.
To be eligible for the CDC+ Program, a recipient must:31
 Be enrolled in the Individual Budgeting Waiver (also known as the iBudget Waiver);
 Reside in their own family home or the home of a relative; and
 Not be disenrolled from the CDC+ Program due to their mismanagement or inappropriate use
of Medicaid funds.
Hope Florida
Hope Florida is a program dedicated to guiding Floridians on an individualized path to
prosperity, economic self-sufficiency, and hope. Hope Navigators offer services that identify
barriers that individuals face and work with the individual to discover resources and develop a
plan to achieve economic self-sufficiency. Through a community approach that utilizes resources
from the private sector, faith-based community, nonprofits, and government entities, Hope
Navigators can identify the services and resources that are the best fit for the individual.
26
Id.
27
Agency for Health Care Administration, Developmental Disabilities Individual Budgeting Waiver Services Coverage and
Limitations Handbook, available at: https://apd.myflorida.com/ibudget/rules-regs.htm (last visited 1/18/24).
28
Chapter 2002-223, Laws of Florida.
29
Section 409.221(4), F.S.; Florida Agency for Health Care Administration, Federal Waivers, available at:
https://ahca.myflorida.com/medicaid/medicaid-policy-quality-and-operations/medicaid-policy-and-quality/medicaid-
policy/federal-authorities/federal-waivers (last visited 1/19/24).
30
Section 409.221, F.S.
31
Agency for Health Care Administration, Consumer-Directed Care Plus Program Coverage, Limitations, and
Reimbursement Handbook