Friday, December 28, 2018

Housing Changes That Could Change Your Life: Part Two

Part two of this blog post will address the HCBS Housing Choices” draft policy and procedures, which, unlike the Contribution to Costs policy, are wide open for comment and revision. (Refer to for the set of proposed housing policies and procedures.)  The Housing Choices policy and procedures lay out what is supposed to happen in the future if people receiving residential supports want to live with people other than DDS-designated roommates or in a rental unit that exceeds the rent cap established by DDS.  To an extent the choices offered in this policy already exist, but entail individual negotiation with DDS. This policy would standardize the options available to people and – most importantly - shift the risks of these arrangements onto the people receiving supports.  As the procedures (2.C.3.) state, “the person…accepts the associated risks, including financial risks and facing eviction for non-payment of rent.”

This is a real departure from past practice, and it’s why a great deal of caution and deep thought are needed.  Since there is no real time urgency for implementing this policy, DDS should take the time needed to responsibly think through the implications along with stakeholders.  The next opportunity for discussion will be Monday, January 7 at 2:00  in the Joy Evans conference room at DDS headquarters and at Project Action’s January meeting.

Let’s look first at who this applies to - only those receiving residential supports (supported living or residential habilitation) services under the DDS-administered I/DD Medicaid waiver.  A lot of people in the Supporting Families meeting on the 13th were confused about this. To be clear, the policy applies only to those receiving intensive supports in a home owned or leased by a residential-services agency or the person being supported.  (Some of the proposed changes are make things more confusing, though, as discussed below.)

Now let’s look at why this is happening:  D.C. rents are rising astronomically, and people are getting priced out of the local housing market.  Some folks who have been living for a long while in a particular building have been forced to move because their rents have risen above the DDS rent limit.  So more and more people are having to move where rents are less expensive, mostly out of the city and into Prince George’s County.  (I discussed this in my post, “D.C. Housing News You Can Use,“ on August 9.)  People just starting to get supports are also being moved out of the city.   So those who can do so are looking at other options if they want to stay in familiar neighborhoods and not lose their ties to D.C. and their community (including voting in the District, which our citizens with disabilities have been encouraged to do).

Finally, let’s look at some of the details, and where – based often on direct personal experience - I see bumps along the road if DDS moves to implement the Housing Choices policy and procedures without further thought and discussion:

-          In the policy (3.D. under “Standards”), DDS assumes that a person “has the option to choose to become either a sole lessee or a lessee with one or more consenting third party co-signers.”  Unfortunately, this option does not necessarily exist.  If a person has no credit record – which is the case for many people with disabilities who have not held paid work - then some (maybe most) landlords will not allow the person to be a lessee – not even a co-lessee.  They will only allow someone else – usually parents or other family members - to be the lessee, with the person being listed on the lease as the resident in exactly the same way they are when a provider agency does the leasing.  DDS will quickly need to decide whether an apartment rented by a parent for a person getting supports then becomes a “natural home” and whether, if it does, the person can still qualify for the “housing choices” being offered.  The existing standard for who can own or rent a supported-living residence – section 1934.7 in - suggests an inconsistency here that needs to be addressed.

-          The Housing Choices policy (Standards, 3.E.) further calls for DDS to pay the residential provider an amount up to its rent limit.  Currently, when family or others pay above the rent cap, the provider combines both payments and the landlord receives a single payment. Under the proposed approach, it appears there would be two payments to the landlord, one from the provider (the DDS payment), and another from the person or their family for the balance. If this is the intent, then does DDS know that all landlords would accept such an arrangement, and how would the lessee be sure the accompanying DDS payment would occur on time (see below in the discussion of risks)?

-          The policy assumes that all risks can be shifted onto the lessee, but in at least one regard this is not the case.  Landlords often require renter’s insurance, but - based on my direct personal experience - an insurance company will not cover liability for staff who work in the apartment under such a renter’s policy – they will only cover the lessee and named resident. This means that the provider agency still will bear the risks for the actions of its own staff and will need to carry applicable liability insurance.

The above considerations apply to landlords’ and insurance companies’ requirements, but as it moves to shift the risks of housing arrangements onto the people it supports, DDS must mitigate risks over which it has control, for example:

-          DDS is not always timely in its payments to provider agencies, and some providers are also late in their own payments. If the person or their family is on the lease, and the DDS/provider portion of the rent is paid late, that will affect the credit rating of the person or family member on the lease, and if paid very late or not paid at all, could cause a person to be evicted.  There need to be ironclad assurances by DDS and provider agencies that payments will be made to landlords by the 5th of the month so that delays on their part will not negatively affect others’ credit ratings.

-          The new procedures (“The Process for Making Housing Choice,” 3.E.6.) lay out an approval process by DDS for any proposed living situation before the lease can be signed.  Landlords may be willing to hold an apartment while this process takes place if a DDS provider agency is the one who’s renting, but it isn’t clear that a landlord will hold an apartment for a person or family if the DDS approval process takes a while, so DDS should commit to getting this done within a specified period.

-          Section 3.H. (under “Standards”) of the policy addresses what happens in case a person opting for a nontraditional housing choice is evicted, and goes on to describe a process for either placing the person into an existing vacancy in provider housing or, after further discussion, allowing them to choose another nontraditional living situation.  An eviction can happen quickly, and the process described takes time.  DDS should plan to have a clearly defined respite space for people in these circumstances, to ensure they do not wind up on the street in the meantime.

I know I haven’t thought of everything.  Other unforeseen issues will arise, along with financial consequences such as those I discussed on part one of this blog post.  This calls for DDS to have a core of dedicated troubleshooting staff who can step in quickly to assist when the requirements of landlords and insurance companies don’t align with DDS expectations and are beyond the capabilities of service coordinators to resolve.  Housing decisions must often take place quickly, and lengthy delays will only ensure that desirable apartments go to someone else while details are worked out. 

The procedures also state (section 1.) that “DDS will post information on its website about DDA residential supports and rental limitation rates.”  DDS also needs to post a clear discussion of likely risks and what it intends to do to mitigate risks over which it has control, as discussed above.  Many issues can be foreseen, and I’ve called attention above to a number of them.  DDS needs to try to sort these out before moving forward so that all the learning doesn’t take place at the expense of people and their families.

Housing Changes That Could Change Your Life: Part One

This is part one of my last blog post of 2018.  Read both parts one and two quickly, because decisions are being made in the early days of 2019 by the D.C, Department on Disability Services (DDS) about new policies and procedures affecting anyone who gets residential supports from DDS. 

At the December 13 Supporting Families Community of Practice meeting, the revised policies and draft procedures to accompany them (,
were distributed and discussed in small groups.  These are complicated documents, and I’m happy to learn that, contrary to its original plans, DDS is extending the period for feedback at least to mid-January.  Both will be reviewed again at HCBS waiver meetings in early January, and at the Project Action! meeting in January.

There’s little that can be done with respect to the Contribution to Costs policy and procedures, since the D.C. council already passed its law and since the regulations have been finalized.  This set of documents will, however, be discussed on Wednesday, January 2 at 2:00 in the Joy Evans conference room at DDS headquarters.  As I’ve said before, I don’t believe there was sufficient effort to make stakeholders aware when the law was submitted and the regulations were out for comment last year.  However, at this point any fundamental changes are going to require further action by the D.C. council. In the near term, as DDS moves to implement this policy, I see two significant considerations: 

1)      Implementing the contribution to costs policy and procedures is going to involve some very large changes in practice, both at intake and in annual ISP (Individual Support Plan) meetings.  Many service coordinators are struggling to accomplish their core functions and will need solid backup to deal with these new complexities, so DDS needs to make sure it develops a team of dedicated staff who will fully understand all the financial implications and calculations.  We were told on December 13 that people will receive a detailed accounting of the locally-funded costs of their care, and this will be a complex undertaking.  In the longer term, there are surely going to be other unforeseen consequences from the contribution to costs policy for this unit to consider.  (I also would like to know what DDS has in store with respect to the language in the policy under 2.A., “or their estates,” which is not addressed in the procedures.)

2)      Some foreseeable financial implications will result from changes that would come under the accompanying “HCBS Housing Choices” policy and procedures, which I’ll discuss in part two of this blog post.  People’s SSI payments don’t only decline as a result of work income.  It’s also the case that if family or others help people with their housing costs over and above what DDS pays, their SSI payments will go down in that case as well.  People still will get their $100 allowance, but DDS will receive less.

An urgent change that I hope the council will make immediately is to ensure that cost-of-living increases will apply to the allowances received by the people DDS supports.  A fixed $100 allowance year in year out will have the effect of progressively impoverishing D.C. citizens with disabilities as the cost of living increases, while DDS gets the benefit of the annual increases in SSI or other benefits (making the name "Independence Square" in the accompanying photo of DDS headquarters especially ironic.) This is a flawed arrangement, not fair or justifiable, and I look forward to a change by the council very soon to remedy this, preferably by calculating contributions to costs on a percentage, rather than fixed-amount, basis.  

Part two of this blog will deal with the HCBS Housing Choices policy and procedures – please read on if you or those you support receive residential supports under the DC waiver.

Wednesday, December 12, 2018

DDS Housing Policies on the Agenda December 13!

As I mentioned in my last post, tomorrow will be the Supporting Families Community of Practice meeting, where the DDS policies on residential supports and contribution to costs of care from people receiving them will be discussed and input will be invited.  Here is the agenda:

Attend or call in if you possibly can - DDS needs to hear from you!