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Governor’s Council on Developmental Disabilities
Georgia Advocacy OfficeInstitute on Human Development and
Disability
Marcus Institute
Challenges in DD ServicesOlmstead in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
Departments and ServicesAgency Adult Service Child Service
DCH Independent Care Waiver Program; SOURCE
Medicaid Buy-In
Katie Beckett, CMOs, Peachcare
DHR MRWP waiver programs
Aging Programs
Family Support,
CMS, Babies Can’t Wait
DOE Transition to adult services
K-12 education, special education
DOL Vocational Rehabilitation
DECAL Pre-K Program
DCA Housing, home modifications
History of Olmstead1999 US Supreme Court decision
Plaintiffs Lois Curtis and Elaine Wilson Attorney Sue Jamieson
PlanMulti-agency stakeholder committee (2001-2002)
identified number of people to be transitioned funding needed time frame
Governor Barnes unable to commit to effort No plan formally submitted
Governor Perdue modified the plan with document of intents No mechanism for accountability
Out-of-Home Residential Placements: Georgia 2006
• Georgia ranked 32nd in the percentage of out-of-home placements in settings for 6/fewer persons.
Source: Braddock et. al. (2007, preliminary).
32%
35%
18%
13%
Total: 9,033 Persons
Group homes, foste r homes,
apartments2,916
Supported Liv ing3,202
6 or Fewer Total Including Supported Living: 68%
Nursing facilities1,604
State Institutions 1,201
Private ICFs/M R 16+110 (1%)
Georgia Fiscal Effort for DD Services 1977-2006
Source: Braddock et al. (2007, preliminary)
77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06Fiscal Year
$0.00
$0.50
$1.00
$1.50
$2.00
$2.50
$3.00
$3.50
Spending ($) per $1,000 Personal Income
$2.17 $2.20
$2.00
$1.73
$2.26
$2.42
$0.89 $0.93 $0.97
$1.06
$1.79 $1.82
$1.28 $1.28 $1.03
$0.67
$0.47
$0.60
TotalCommunity ServicesInstitutional Settings
NW Regional 103
Central State 461
SW State 152
Georgia Regional 79 East Central
461
Persons with DD in State Hospitals
Hospital IssuesState Hospitals
Are understaffedHave under-trained employees Have high turnover rates Overuse medications and restraintsLack effective transition plans for people to move outLack capacity to transition people successfully back to
the community
Network Response to OlmsteadHR 1307
5-year plan for funding home and community-based services
Funding package includes transitioning people from institutions
Since 2005, this effort has resulted in 4000 new services, and of those services 304 were for institutional transitions. There have been 114 actual placements.
OCR Complaint
Network Response to OlmsteadReal Choices Systems Change grants
Transition program that builds on model Peer Support Program Direct Support Staff development initiativeMedication Certification Program Improvement in communication policies, procedures in agencies
providing long term care servicesDevelopment of regional access system for MH and DD servicesDevelop uniform individual budgeting mechanismsDesign key features of self-directed service delivery system
Money Follows Person RebalancingGeorgia will move 1347 individuals from nursing homes and large
state institutions with $34,000,000 in funding over 5 years
Challenges in DD ServicesOlmstead in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
EPSDT EnvironmentEligibility:
Constant challenges to eligibility Many categories of Medicaid access, with varying eligibility
criteriaAccess:
Providers discouraged from serving families resulting in service gaps Excessive paperwork Prior authorization process Low reimbursement rates
Coverage Caps and limits to services Certain services excluded from state plan
Katie Beckett/Deeming WaiverState revised level of care criteria
2000 families kicked off Medicaid
Legislature allocated $7.6 million in transitional funding (2006) $5.4M allocated as cash disbursements to
families denied Medicaid $2600 dispersed to each family via a debit card
$2.2M set aside for development of community-based funding mechanism and program
• Support monitoring & evaluation• Habilitation (day, community) • Home Health services, nursing care• Supported employment services• Personal support/supported living• Respite care• Environmental modification; accessibility adaptations; vehicle
adaptations• Specialized medical equipment/supplies• Case management• Residential training & supervision• Personal emergency response system• Consumer directed service delivery option
Services Provided by HCBS Waiver
Source: National Association of State Medicaid Directors (2006).
New Options Waiver (NOW)Focus on day supports, and a comprehensive waiver for
residential and support servicesSupports Intensity Scale: Consumer need is based on
the SIS and services will be individually tailored according to the results of the SIS
Individual Budgets: the SIS will determine within a range how much funding is available to meet person’s identified needs
Choice of Services: Families will have more options for arranging support for their member, or they can remain in the services they have
NOW WaiverFinancial Support Services: Families can choose their
providers and use the fiscal agent to pay the bills for them, including background check, taxes, SS, W-2s, etc
New Services payable under the waiverDental Natural Support Training
Transportation OT, PT, Speech, Nutrition
Behavioral support Community Guide
Network Response to Challenges in Medicaid
Convening stakeholder groups to share information on CMO implementation
Preparing memos and briefs on impact of changes to Medicaid
Communicating with parents to provide information and encourage advocacy
Collecting and analyzing data Informing legislators about impact on familiesLegal action
Challenges in DD ServicesOlmsted in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
Provider Capacity is a Priority
Limited or no choices in rural GeorgiaVariable quality of providersTendency toward congregate settingsHigh turnover in front line workers and support
coordinationBelow average reimbursement ratesNeed a new array of providers with new waivers
Direct Support Community Staff Wages: Below Poverty Level
• The average community direct support wage in Georgia was 24% below the state’s institutional average direct support wage.
All Workers State-Operated Poverty Level Nursing Aides Comm. ID/DD Comm. ID/DD$0
$4
$8
$12
$16
$20
Dollars per Hour
$17.18
$10.50$9.62 $9.18 $8.68
$8.00
GeorgiaU.S.Georgia U.S.Georgia
Direct Support Professionals DevelopmentCollaboration with
MHDDAD Real Choices Systems Change Grant Aging Mental HealthDivision of Adult and Technical EducationGCDD
Standard curriculum offered at 7 technical institutions
Formation of Direct Support Professional Alliance
Network Response to Provider Capacity
Supporting and promoting state efforts to develop provider capacity
Signaling to providers that money will be available for integrated and inclusive home and community –based services
Educating people about services available in the NOW waiver and how to access them
Supporting provider rate increases
Challenges in DD ServicesOlmsted in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
Number of Georgia Families Supported Decreased 21% (2004-06)*
*As reported by the Georgia Department of Human Resources
Source: Braddock et al. (2007, preliminary)
86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
Fiscal Year
0
2,000
4,000
6,000
8,000
10,000
Number of Participants
499
1,056
545
2,0172,669
7,9087,598
5,648
8,2428,585
6,801
Network Response to Decreased Support
Demonstration and Funding ProposalsProvided within MRWP waiver as “Natural Supports”Some state funded
Family Support 360 grant 24 established Navigator Teams With the support of Children’s Trust Fund dollars and
Parent Leadership Coalition Support 30 more Navigator Teams will be established in the next year
Challenges in DD ServicesOlmsted in GeorgiaMedicaid: EPSDT, Katie Beckett, and
WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
IDEA: Children Served• Child Counts (2004)
• Age 3 -5: 20,801• Age 6- 21: 175,127
• Highest incidence 1. SLD
2. SLI
3. MR/DD
4. ED
5. OHI
IDEA• State’s performance goal for 3 years
• Include 90% of the children with special needs in the regular classroom at least 80% of the day
• Effort has resulted in significant improvement in the state’s CRCT test scores: SWD made gains in every subject in every grade
Current Issues in Education• Senate Bill 10• Revision of diploma regulations• Special education funding formula revision
Challenges in DD ServicesOlmsted in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
Transition
• Each year about 700 students with developmental disabilities exit the school system and go on the waiting list for adult services
• Challenges include making multiple systems work together for employment and real community activities
Network Response to Transition Issues
• Statewide Transition Steering Committee • Convened by the DD Council and DOE• Meets regularly to review best practices , disseminate
information, and recommend policy to the State Advisory Panel and the State Board of Education
• Working on diploma options, special education funding formula, and successful models for employment
• Supports Partnership for Success Inclusive High School Grant
• Will advise Transition Component of Employment First Georgia Institute
Challenges in DD ServicesOlmsted in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
Employment• 19.7% of adults with developmental disabilities in
supported employment• By end of 2007 the goal is 25%
• 80% of employment was sheltered employment, facility-based work models and non-work models (2004)• Only 20% was integrated employment
Georgia has to make a switch from facility non-work day services to integrated, community-based employment
Network Response to Employment Issues
• Provide opportunities for employers and consumers to see innovative employment in action
• Sponsors Discovery Day which • Allows corporate Atlanta opportunity to explore
employment opportunities for people with disabilities• Provides opportunity for employers, providers, and
people with disabilities to meet, exchange ideas and network
• Established and partially funded Employment First Institute
Challenges in DD ServicesOlmsted in GeorgiaMedicaid: EPSDT, Katie Beckett, and WaiversProvider CapacityFamily SupportEducationTransitionEmploymentAging
Aging: People with DD are Healthier and Living Longer
• 17,000 Georgians are living with caregivers over 60 years old• Respite is greatest unmet need of older families caring
for adults with disabilities
• 35% are living with middle-aged caregivers• Long waiting lists for community services, even those
on the short term list
Network Response to Aging Challenge
• Support Aging and Disability Resource Connection (ADRC)• Located in Atlanta and Augusta• Handled 45,000 contacts for resource and
referral network• State legislature funded three additional sites
• Coastal Georgia AAA and MHDDAD Region 5• Northeast Georgia AAA and MHDDAD Region 2• Southern Crescent AAA and MHDDAD Region 1
• Support Naturally Occurring Retirement Communities
Georgia is Improving!
Georgia’s national ranking has moved from 44th to 30th with regard to community based services!
State TreasuresOlmstead state
Sue JamiesonElaine WilsonLois Curtis
Connie and John O’BrienCitizen AdvocacyCollaboration within the DD network