FINANCES

Adventure Course: Exercise track and stations

The funding arrangements in Ohio are complicated and difficult to explain. Above all, Bittersweet Farms has enjoyed financial stability in the last few years. In contrast to other states, where funding patterns can determine the success or the failure of program efforts, Bittersweet is fortunate, because currently, Ohio has many channels of funding. Because Bittersweet has been aggressive about accessing funds from several different sources, they have gained more freedom to carry out projects of their choice. They feel better off than if they had to go to one office to get all of their funding needs met.

It's possible that there will be changes ahead, but because Bittersweet Farms has worked closely with the funding system, anyone planning a new funding format for the state, would have to include this program in the plan.

Recent changes in funding arrangements have helped Bittersweet Farms become financially secure. Seven years ago, when the only government funds received were for the ICFMR residential program, Bittersweet had problems supporting their vocational day care program. They tried to rely on the out of pocket payments from families of about $20.00 per day. Their burden was about $400.00 each month, while contributions only accounted for about 25% of operating costs. Bittersweet was faced with a decision of possibly closing their vocational daycare program. Parents shared concerns about what would happen if they could no longer pay. The Director worried about the survival of both programs, given the financial constraints. Other sources of funding were needed.

When the Director presented these issues to seven different school systems, and to the county boards with which they were affiliated, he got a nice response. Funds from the school systems helped start a formal vocational day program and school program, for students they had identified, and with whom Bittersweet was familiar. That school program, on Bittersweet's grounds, lasted for a few years until the students graduated, and dramatically increased Bittersweet's funding.

There was another group of day students that came to Bittersweet for adult services. Bittersweet set up contracts with Wood, Fulton, Lucas and Ottawa Counties for a per diem rate for each adult. Although that rate was less than what it cost Bittersweet, they found a way to augment it, by becoming certified in a new form of Medicaid called the Community Alternative Funding Source. CAFS, as it is called, funds schools and workshops just for those services that remove barriers interfering with education and vocational training. Examples of such Medicaid eligible services include delegated nursing services, behavioral modification supports, and any training that deals with behavior, health, hygiene or grooming.

Because Bittersweet was able to get this form of Medicaid, they were able to offer the counties and the schools an arrangement they couldn't refuse. It might cost a fraction of what it would cost the county Board of Developmental Disabilities, if it were to provide services at its own workshops. However, funds received from governmental sources of this type generated matching funds through the state's CAFS Medicaid program. Those Medicaid matching funds have earned Bittersweet enough to cover the costs of their vocational program over the last few years.

The program has been beneficial to the county boards and school districts as well, for they were responsible for some students with extremely challenging behaviors. In a few cases, schools and workshops created separate behavioral treatment rooms for individuals who couldn't handle the stress of the main workshop or school settings. In spite of limited success with such controlled settings, advocates preferred the open and socially dynamic alternative of Bittersweet Farms to the restrictiveness of an isolated workspace.

In one particular case, agencies in Columbus agreed that Bittersweet might be a good alternative to try, because of risks a young man created in a workshop. They enrolled him, and he's now making more than minimum wage on the workshop scale and doing a wonderful job at Bittersweet. He is now in Bittersweet's supportive living program, and doing very well.

Success stories like that one, and others, came to the attention of state agencies in Columbus, and helped Bittersweet get the Medicaid CAFS certification that they were seeking. That certification is primarily given to schools and workshops. Bittersweet Farms is one of just a handful of private non-profit organizations receiving that funding, and it now accounts for about 10% of their budget. So, for the very first time, Bittersweet Farms has 100% funding for its residential, 100% funding for its supportive living program, and 100% funding for its vocational day program.

Staff Costs

Staff wages come from all the benefits already mentioned, including Medicaid dollars and the school, and workshop income. As Bittersweet continues to maintain a high ratio of staff to residents, income flow is critical. The direct care ratio is one staff person to two participants during the working hours, but personnel training time must also be factored in to the equation.

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