The Facts: Community Pathways Waiver Renewal

An Interview with Patricia Sastoque

By Carrie McGraw, Maryland Department of Disabilities


The recent proposed changes to some home and community based service structures through Maryland’s Developmental Disabilities Administration (DDA) have prompted both positive and negative reactions throughout the disability community. DDA continues to work toward balancing community concerns with the changes necessitated by required federal guidelines and best practices. DDA notes it is their top priority to provide timely responses to community members by answering questions in regard to how and if these changes will affect them, their loved one, or their service provider. 

The Communications Director at the Maryland Department of Disabilities sat down with DDA Director of Programs, Patricia Sastoque, to get to the bottom of some of these concerns, ask direct questions from the community in regard to the intended changes, counter some inaccurate information, and provide opportunities to submit further feedback. 

Question:  What concerns you most about this change process?

What concerns me most is that there are community members who may or may not be affected by these changes, but some are not receiving reliable information directly from DDA. It is important for all stakeholders to ask direct questions of DDA or their providers/case managers and receive answers pertinent to their situations. Relying on indirect sources such as social media posts from outside organizations, information from second hand sources, or simply rumors is detrimental to this process. It is important that those affected become familiar with the federal requirements for their particular program to better understand the challenges of applying these requirements at the state level. Then, we hope these community members will go through the many channels we have established to communicate concerns or suggestions directly to DDA.

Question:  Is DDA trying to “push through” changes that will eliminate or cut services that those with disabilities depend on now to live safely and inclusively in their communities? 

DDA met with various stakeholders to gain input into new waiver services and changes to current services in order to achieve the following goals in a timeframe compliant with federal guidelines necessitating change.

  • ​Create a more flexible, person-centered, family-oriented system of supports;
  • Reflect stakeholder suggestions from listening sessions, consultant reports, and various stakeholder recommendations over the past two years;
  • Simplify the waiver language and description of processes so that everyone can understand;
  • Incorporate best practices;
  • Develop new services;
  • Meet federal community setting service requirements; and 
  • Improve business rules, processes, and service rates.​

Question: What has DDA done to work toward the goals of meeting federal service requirements and improving supports while considering the vast array of stakeholder input?

 Stakeholder input processes began in October, 2014 with independent consultants conducting fifteen listening sessions statewide; providing options for input via written comments and surveys; holding topic specific webinars with various date and time options; forming focus groups; and convening meetings with established workgroups. The DDA carefully considered all input from various individuals, self-advocacy groups, families, service providers, and advocacy organizations, groups, and associations. At times, suggestions, requests, and input conflicted with other groups or with federal requirements. The current service proposals reflect changes based on consideration of all of these factors.

Before finalizing the service proposals, DDA conducted a two-day service symposium sharing revised proposals, answering questions, and soliciting input on the drafts in an open dialogue with participants. In addition, the DDA provided a dedicated email address for individuals and groups to share input for those who were unable to attend. The symposium dialogue included seeking suggestions to enhance services and provider qualifications, questions we need to consider, cautions and concerns, suggested processes, proposed policy, regulatory requirements, operational consideration, and financial/billing needs and changes.

Based on the symposiums and written information received in the dedicated email account, the DDA is making revisions to the original proposals including Home Supports/Community Personal Supports. Prior to finalizing for the official thirty day public comment period, the DDA is meeting with stakeholder groups to share updates for final input. The official, 30-day public comment period will occur in September 2017 where everyone will again have the opportunity to submit comments for consideration.​

Question:  Did DDA state there will be “winners” and “losers” in this change process?

DDA would not and did not use these terms in relation to those supported by DDA funded services. During the symposium, there were several questions related to the Rate Study. DDA shared an update on the status to include expecting the report to be completed by the independent consultant in July and the consultant’s plan to conducting regional listening sessions to get input on the report. 

Currently, the DDA pays a variety of rates for the same service depending on the provider, additional services like one to one staffing, court orders, geographic area, number of people supported in the site or home, etc. The possibility of new rates for services will mean that some providers will get a higher reimbursement/rate and some may get a lower reimbursement/rate from what they are currently receiving. Therefore there will be some providers who may find themselves “winners” and some “losers” of funding in this process based on what is accepted.  DDA apologizes if our attempt to simplify our explanation created any misunderstanding of our intent.​


Question: Online characterizations of the process have said the new proposals will limit opportunities, restrict options, deny services, or waste taxpayer money.  What is your response to these concerns?

Again, I am concerned that some information being distributed on the Internet is not based in fact. I am hopeful people with concerns will reach out directly to seek the information they need and to provide feedback directly to DDA as well. In actuality, DDA’s current proposals are intended to:

  • ​Expand opportunities for employment, inclusion, and family support by providing multiple meaningful day services (such as Employment Supports and Community Development Supports) during the day compared to the current option of only one service of this type per day.
  • Broaden options for the most fragile and vulnerable individuals with the most complex needs within federal requirements to include new service such as Nursing Services, Remote Monitoring, Co-Worker Supports, and Supported Living in addition to enhancements with current services using national best practices.
  • Educate, facilitate and coordinate essential Medicaid State Plan Early Periodic Screening Diagnosis and Treatment (EPSDT) entitled services that allow children and adults to live safely in their home and community including behavioral supports and nursing services.
  • Protect taxpayer money by:    
  •              Ensuring federal compliance and prevent duplication of services provided under other federal programs which can result in audits, loss of funding, and jeopardize the overall program. 
  •              Establish effective and efficient payment systems and processes to minimize administrative impacts on providers and DDA utilizing the new LTSS system.


Question: Are these new proposals best practices for a state public service agency?

As public servants, it is our responsibility to listen to all stakeholders, seek best practices, and provide program, policies, and funding for quality services to support individuals in reaching their defined quality of life. The DDA statute, regulations, and several current service models were established in 1986 which at that time may have been a best practice. Since that time best practices for services and service models have evolved and Maryland should continue to improve and adapt to that environment. Change is difficult, but we feel Marylanders deserve services which adhere to both best practices and federal guidelines while individually and sensitively meeting the needs of as many Marylanders as possible under the current funding system within a large scale service dissemination structure.​

Question: Where can Marylanders get more information right now?

The DDA has a dedicated webpage with various information about the renewal that includes proposed services and next steps. We will be posting the revised proposal based on the symposium in the coming month.