Determining the Cost of Services

Why Create a Budget First?

A representative at the county board may have advice about handling this problem.  Some provider agencies help reduce the complications by billing separately for each kind of funding. Individuals living together in a home do not need to receive funding from the same source.  However, when funding comes from different sources, the logistics can get complicated.

Any Individual Service Plan (ISP), or any proposal for funding must thoroughly describe the home’s staffing needs and clearly reflect not only what each child needs, but also why he or she needs it.

How Exact Rates Are Determined

The county board determines the rate that your child will be allowed for Supported Living or Medicaid Waiver funded services based on a Level of Care Assessment.

Once the precise level of funding is determined, a plan is developed to meet your child’s needs within that budget. If your child lives with others receiving the same services, the rate will take this into account.

For example, if four people need 24 hours of service per day, the cost will be divided.  If one of the people in the home stays in the hospital, the agency will bill the rate for only three people, even though a staff person still needs to be in the home for 24 hours.

What to Include in an ISP

It is important that your child’s Individual Service Plan (ISP) include the following information.

Resident Description — Should describe your child well enough to:

• Justify the proposed level of support
• Show how the supports for a particular group can be cost effective.
• Focus on what your child (each resident) needs for health and safety rather than what would make everyone “happy.”

Hours of Support Service:

• Must reflect that the hours of service are adequate only because your child is sharing staff time with others.
• Also specify the actual hours of service your child would need if he or she were to live alone.
• Build in a reserve to provide for services if one person is absent for a period of time.

County Board/Private Agency Costs:

• Hourly rate
• Employer share of FICA taxes
• Worker’s Compensation insurance
• Unemployment taxes
• Health insurance for staff
• Staff benefits (vacation, sick time, etc.)
• Liability insurance
• Training for staff and supervision expenses

In an agency contract, these costs will be included in the hourly or daily rates. These costs can also explain why an agency bill is substantially greater than the amount paid to direct support staff.  An agency may have some overhead expenses (i.e. office space) that you do not have if you manage staff directly.  However, when you manage staff directly, you must pay insurance, which usually offsets your other savings.

Sample Support Cost Estimate

Support Staff Schedule:

FT = full time | PT = part time | M = manager | a = AM | p = PM

Staff Pay Rates:

Staff Sample Budget: