State of Developmental Disabilities in Georgia Governor s Council

State of Developmental Disabilities in Georgia Governor’s Council on Developmental Disabilities Georgia Advocacy Office Institute on Human Development and Disability Marcus Institute

Challenges in DD Services q Olmstead in Georgia q Medicaid: EPSDT, Katie Beckett, and Waivers q Provider Capacity q Family Support q Education q Transition q Employment q Aging

Departments and Services Agency 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 Pre-K Program DECAL DCA Housing, home modifications

History of Olmstead 1999 US Supreme Court decision Plaintiffs Lois Curtis and Elaine Wilson Attorney Sue Jamieson Plan Multi-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 32 nd in the percentage of out-of-home placements in settings for 6/fewer persons. Source: Braddock et. al. (2007, preliminary).

Georgia Fiscal Effort for DD Services 1977 -2006 Source: Braddock et al. (2007, preliminary)

Persons with DD in State Hospitals NW Regional 103 Georgia Regional 79 East Central 461 Central State 461 SW State 152

Hospital Issues State Hospitals Are understaffed Have under-trained employees Have high turnover rates Overuse medications and restraints Lack effective transition plans for people to move out Lack capacity to transition people successfully back to the community

Network Response to Olmstead HR 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 Olmstead Real Choices Systems Change grants Transition program that builds on model Peer Support Program Direct Support Staff development initiative Medication Certification Program Improvement in communication policies, procedures in agencies providing long term care services Development of regional access system for MH and DD services Develop uniform individual budgeting mechanisms Design key features of self-directed service delivery system Money Follows Person Rebalancing Georgia will move 1347 individuals from nursing homes and large state institutions with $34, 000 in funding over 5 years

Challenges in DD Services ü Olmstead in Georgia q Medicaid: EPSDT, Katie Beckett, and Waivers q Provider Capacity q Family Support q Education q Transition q Employment q Aging

EPSDT Environment Eligibility: Constant challenges to eligibility Many categories of Medicaid access, with varying eligibility criteria Access: 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 Waiver State revised level of care criteria 2000 families kicked off Medicaid Legislature allocated $7. 6 million in transitional funding (2006) $5. 4 M allocated as cash disbursements to families denied Medicaid $2600 dispersed to each family via a debit card $2. 2 M set aside for development of community- based funding mechanism and program

Services Provided by HCBS Waiver • 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 Source: National Association of State Medicaid Directors (2006).

New Options Waiver (NOW) Focus on day supports, and a comprehensive waiver for residential and support services Supports 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 Waiver Financial Support Services: Families can choose their providers and use the fiscal agent to pay the bills for them, including background check, taxes, SS, W-2 s, etc New Services payable under the waiver Dental Transportation Behavioral support Natural Support Training OT, PT, Speech, Nutrition 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 families Legal action

Challenges in DD Services ü Olmsted in Georgia ü Medicaid: EPSDT, Katie Beckett, and Waivers q Provider Capacity q Family Support q Education q Transition q Employment q Aging

Provider Capacity is a Priority Limited or no choices in rural Georgia Variable quality of providers Tendency toward congregate settings High turnover in front line workers and support coordination Below average reimbursement rates Need 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.

Direct Support Professionals Development Collaboration with MHDDAD Real Choices Systems Change Grant Aging Mental Health Division of Adult and Technical Education GCDD 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 Services ü Olmsted in Georgia ü Medicaid: EPSDT, Katie Beckett, and Waivers ü Provider Capacity q Family Support q Education q Transition q Employment q Aging

Number of Georgia Families Supported Decreased 21% (200406)* *As reported by the Georgia Department of Human Resources Source: Braddock et al. (2007, preliminary)

Network Response to Decreased Support Demonstration and Funding Proposals Provided 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 Services ü Olmsted in Georgia ü Medicaid: EPSDT, Katie Beckett, and Waivers ü Provider Capacity ü Family Support q Education q Transition q Employment q Aging

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 Services ü Olmsted in Georgia ü Medicaid: EPSDT, Katie Beckett, and Waivers ü Provider Capacity ü Family Support ü Education q Transition q Employment q Aging

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 Services ü Olmsted in Georgia ü Medicaid: EPSDT, Katie Beckett, and Waivers ü Provider Capacity ü Family Support ü Education ü Transition q Employment q Aging

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 nonwork day services to integrated, communitybased 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 Services ü Olmsted in Georgia ü Medicaid: EPSDT, Katie Beckett, and Waivers ü Provider Capacity ü Family Support ü Education ü Transition ü Employment q Aging

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 44 th to 30 th with regard to community based services!

State Treasures Olmstead state Sue Jamieson Elaine Wilson Lois Curtis Connie and John O’Brien Citizen Advocacy Collaboration within the DD network

Major Collaborative Projects Children's Freedom Initiative Unlock the Waiting List Campaign Self Advocacy Employment First Georgia