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Moving Forward Supporting People With Disabilities and Their Families

NASDDDS/NASMHPD Joint Legal Division Barbara Brent NASDDDS. Moving Forward Supporting People With Disabilities and Their Families. We Have Made Great Progress From T his……. t o …. This…. FRIENDS. WORK. PLAY. State Budget Shortfalls are Improving but,….

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Moving Forward Supporting People With Disabilities and Their Families

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  1. NASDDDS/NASMHPD Joint Legal Division Barbara Brent NASDDDS Moving Forward Supporting People With Disabilities and Their Families NASDDDSNational Association of State Directors of Developmental Disabilities Services

  2. We Have Made Great Progress From This…… to…. NASDDDS National Association of State Directors of Developmental Disabilities Services

  3. This… FRIENDS WORK PLAY

  4. State Budget Shortfalls are Improving but,… Growth of 8.3% per Year Would not Restore Losses from Recession Until Fiscal Year 2019 . National Association of State Directors of Developmental Disabilities Services

  5. Shifting Medicaid Environment • New State Plan Service Options • 1915(i) HCBS state plan option • 1915(k) Community first Choice Option • Balancing Incentive Program stimulate access to community supports, MFP • CMS efforts to define community settings • Broadened use of capped support waivers • Focus on Medicaid-Medicare dual eligibles • Affordable Care Act: health homes, accountable care organizations, etc. National Association of State Directors of Developmental Disabilities Services

  6. Confronting the “Brutal Truth”- Then Moving Forward Growth in public funding will slow Workforce will not be able to keep up with demand The Waiting List NASDDDS National Association of State Directors of Developmental Disabilities Services

  7. State Responses to the Challenge • In the worst times, service reductions and rate reductions • When there is time for thought: • Focus on rebalancing • Focus on sustainability • Supporting Families • Getting people a job • Looking beyond residential- or a different kind of residential • Focus on Equity • Individual Budget Allocation-with full self determination or allocations to leverage • Fair and equitable rates • Managed care • Specific for lifelong disabilities and I/DD specifics (achieved in some states), community, self direction and employment National Association of State Directors of Developmental Disabilities Services

  8. States are Rebalancing @29,000 2011 Source: UMN RTC/ICI NASDDDSNational Association of State Directors of Developmental Disabilities Services

  9. States are Rebalancing 12 States Have No Public Institutions >16 UMinn RISP Rpt. 2010 NASDDDSNational Association of State Directors of Developmental Disabilities Services

  10. States Are Moving Away from Facilities-not usually due to the law or the money as the first goals anymore 16 States have <200 people in large facilities x downsizing initiatives Source: UMN RTC/ICI UMinn. RISP Rpt. 2010 NASDDDSNational Association of State Directors of Developmental Disabilities Services

  11. Thinking for the Long Term About Cost NASDDDSNational Association of State Directors of Developmental Disabilities Services

  12. Sustainability depends on how good we are at supporting families and getting people jobs. Nancy Thaler, NASDDDS NASDDDSNational Association of State Directors of Developmental Disabilities Services

  13. Big House State Op ICF-MRs The idea is to nudge a system to be person-centered, to support families, and involve people in their community. The idea is to nudge a system down the incline to reduce per person expenditures. CommunityICF-MRs Highest Cost HCBS WaiversComprehensive & Specialty Waivers Supports Waivers Nudging the System State Funded Family Support Services Employment Lowest Cost DEMAND People with Developmental Disabilities(1% of the population) NASDDDS National Association of State Directors of Developmental Disabilities Services

  14. Sustainability Means Supporting Families 57.5% Nevada 69% Delaware 68% NJ 68% Wash 67% Louisiana 66% Hawaii 65% Mass. 62% NY 62% West Virg.60% Arizona 86% Calif. 71%Florida 70% Idaho 75% S.C. 72% Lakin et.al. RISP 2009 –UMinn.

  15. Attorneys: Supporting Your Client • Most are eager to move to more inclusive settings and innovation---and it isn’t easy- multiple customers: department, executive and legislative branches, providers, families, self advocates • May not share the same belief that the safest route is always the best route. It is a matter of balance • How can I help you achieve what your goal is today? • What are your risks? • What will help mitigate those risks? • CRIPA- - -it is about community- it is about the ADA National Association of State Directors of Developmental Disabilities Services

  16. Supporting Family Caregivers • Family support is more than respite • It is foundational • It is a life journey • It is inclusive • Family support is a rich array of services, relationships and connections

  17. States are Focusing on Employment Success in employment varies widely 2009 • Washington State (88 %) • Oklahoma (60%) • Connecticut (54%) • Louisiana (47%) • New Hampshire (46%) 2009 –UMass Boston ICI ID/DD Agency Survey NASDDDSNational Association of State Directors of Developmental Disabilities Services

  18. Resource Allocation, Fair and Equitable Rates and Self Direction NASDDDSNational Association of State Directors of Developmental Disabilities Services

  19. Searching for Equity and Fairness –And Self Direction!Individual Allocations with Consumer-Directed Options • Individual Resource Allocation • Equity and Fairness • Predictable costs • Consumer-Directed Services and/or Fiscal Intermediary Supports • Hire and fire staff, hire relatives, neighbors or other trusted people, control a budget • Thirteen states offered individual budgets and consumer control statewide for at least some individuals in Jan. 2009 • Other states use fiscal intermediary and the ability to hire and fire, but do not provide for full consumer directed budgets • Some states are using fair and equitable rates- same rates for same services NASDDDSNational Association of State Directors of Developmental Disabilities Services

  20. Managed Care Brings Opportunities Opportunities: • Reduce reliance on facility based services • Integration with medical, behavioral and long term care services and supports • Control costs • Address the waiting list • Innovation- offering more types of services and supports Concerns • Need to keep the DD expertise and oversight • Focus on outcomes related to employment, inclusion and life long services and supports • Supporting people with the most significant support needs in the community • Keeping medical important and improve access and coordination - but community in the forefront NASDDDSNational Association of State Directors of Developmental Disabilities Services

  21. Medicaid Managed Long Term Care-does not include all the states that have acute managed care • Arizona -1115 • Michigan-B/C counties • Vermont-1115 • Wisconsin-B/C counties • Texas Star Plus-B/C • North Carolina - B/C all counties rolling out this year • New York-will now be a 1915 (b) (c) • New Hampshire • Kansas, I/DD delayed one year • Kentucky ? • Illinois -1115 delayed • New Jersey -1115 approved • More with behavioral health NASDDDSNational Association of State Directors of Developmental Disabilities Services

  22. Responses to the Challenge-Eyes on the Prize • Focus on rebalancing – reducing reliance on facility based programs • Focus on sustainability • Supporting families • Getting people a job • Looking at new ways to support people at home and in communities • Focus on individual budget allocations, consumer self direction, etc. • Managed care • Keep the values, outcomes, identity and community- support more people well. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  23. Are We Ready for the New World? • Can we start early and continue on the journey with people – life planning changes more frequently for all of us? • Can we assume community in all we do? • Can we become nimble in helping people navigate the community- the public system- our own communities? • Can we support everyone in learning new skills? The law according to community, compliance according to community, the world according to community. • Compliance is important- and helping people get a life is the core of the work. National Association of State Directors of Developmental Disabilities Services

  24. Christopher Says “Yes!” and A. Says Keep Working at It.. • First job starts this summer! • Supported with integrated acute, long term care services specific to dd. Family support is more than respite. • No residential any time soon. Lives with his family- integrated acute, long term and behavioral supports. Hourly habilitation, behavior support, community inclusion. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  25. Thank you! Barbara Brent National Association of State Directors of Developmental Disabilities Services bbrent@nasddds.org Direct Line: 703-896-0043 Web Site: http://www.nasddds.org NASDDDSNational Association of State Directors of Developmental Disabilities Services

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