Budget Symposium
OACBDD
John L. Martin, Director
August 21, 2013
1
Agenda
The Connection between the
DODD FY 14 and 15
Biennium Budget and
Olmstead
2
National Trends
Olmstead and the Department
of Justice:
•Continued movement away
from ICF/IID to waivers and
smaller settings.
•Movement from “sheltered
work” supportive employment.
3
Supreme Court Upholds Americans with Disabilities Act
‘Integration Mandate’ in Olmstead decision on 6/22/99
In rejecting the state of Georgia’s appeal to
enforce institutionalization of individuals with
disabilities, the Supreme Court affirmed the right
of individuals with disabilities to live in their
community in its 6-3 ruling against the state of
Georgia in the case Olmstead v. L.C. and E.W.
The ‘integration mandate’ of the Americans with
Disabilities Act (ADA) requires public agencies to
provide services “in the most integrated setting
appropriate to the needs of the qualified
individuals with disabilities.”
4
“Olmstead was brought by, and thus decided in the context of,
two women with developmental disabilities who were
challenging their unnecessary segregation in a residential
institution owned and operated by the State. Id. at 593.
Nevertheless, neither the principles of the decision nor the
integration regulation is limited to the decision’s particular
facts. Thus, courts have applied the Olmstead Court’s
analysis to numerous other facts and circumstances involving
the unjustified isolation of persons with disabilities, including
claims by persons with physical or non-mental disabilities,
claims to prohibit unnecessary segregation in private
segregated facilities funded under the state’s disability
services system, and claims to prohibit cuts to community
services that would place persons at risk of unnecessary
institutionalization.”
Taken from the STATEMENT OF INTEREST OF THE UNITED STATES OF AMERICA
Lane v. Kitzhaber, 2:12-cv-00138-ST filed by Thomas E. Perez on April 20, 2012 in the Oregon DOJ action.
5
“Just as the text of Title II and the integration
regulation is not restricted to person with mental
disabilities, to state-owned facilities, or to
persons already institutionalized, so too is this
statutory and regulatory text not limited solely to
residential settings. Accordingly, the U.S.
Department of Justice has continued to make
clear that the integration regulation prohibits the
unnecessary segregation of persons with
disabilities by public entities in non-residential
settings, including segregated sheltered
workshops.”
Taken from the STATEMENT OF INTEREST OF THE UNITED STATES OF AMERICA
Lane v. Kitzhaber, 2:12-cv-00138-ST filed by Thomas E. Perez on April 20, 2012 in the Oregon DOJ action.
6
Olmstead Activity
In 2009, the Civil Rights Division
launched an aggressive effort to enforce
the Supreme Court’s decision in
Olmstead v. L.C., a ruling that requires
states to eliminate unnecessary
segregation of persons with disabilities
and to ensure that persons with
disabilities receive services in the most
integrated setting appropriate to their
needs.
7
Olmstead Activity
The Department of Justice continues to
work with state and local governments
officials, disability rights groups and
attorneys around the country, and with
representatives of the Department of
Health and Human Services, to fashion
an effective, nationwide program to
enforce the integration mandate of the
Department’s regulation implementing
title II of the ADA.
8
Olmstead Activity
An active Department of Justice
armed with Olmstead and the ADA.
•40 actions in 25 states in recent
years
–Settlement agreement
–Litigation
–Findings Letter
9
Ohio’s Olmstead
Concerns
10
States with over 1,000 people in State Institutions
age 16 and over
(2009 - 2011)
*
State
% decreased
in
2 years
1. Texas
2. New Jersey
3. Illinois
4. California
5. North Carolina
6. Mississippi
7. New York
8. Ohio
9. Pennsylvania
10. Virginia
National
12%
2%
12%
19%
4%
3%
12%
14%
6%
7%
12%
CPD
474
622
537
908
468
310
1,430
511
753
582
# of Beds Ranking *
4,331
2,649
2,034
1,774
1,572
1,333
1,313
1,228
1,174
1,105
29,574
Indicates overall ranking of all states and D.C., number of beds adjusted for population
45
49
39
22
42
51
24
33
32
37
11
• 20 states have fewer than
100 people living in state
institutions with over 16
beds.
• 13 states no longer
operate any facilities.
12
State with more than 1,000 private ICF/IID Beds
16 beds and above for FY 11
State
# of beds
1. Ohio
1 Illinois
2 California
3 New York
4 Pennsylvania
5 Florida
6 Iowa
National
3,417
3,384
2,092
2,003
1,842
1,545
1,454
23,603
13
15 states have no
one living in a private
facility larger than
16.
14
Nationally, over the past 10
years, the number of people
living in private facilities
larger than 16 beds has
decreased by 33%. In Ohio,
we have actually increased
by 6%.
15
Our Olmstead
concerns extend
beyond the ICF/IID
program.
16
Of the money spent in
Adult Services
7% - Supported Employment
93% - Sheltered Work/Enclaves
17
There are more people
receiving services in
sheltered workshops
in Ohio than any other
state.
18
The
Data
Trail
19
Sheltered Workshop (SW)
State
1. Ohio
2. New York
3. Minnesota
4. California
5. Pennsylvania
6. Wisconsin
7. Michigan
8. Indiana
9. Massachusetts
10. North Carolina
SW People Served
17,118
14,166
11,597
10,608
9,915
6,529
4,441
4,224
3,640
3,131
20
Sheltered Workshop (SW)
State
1. Minnesota
2. South Dakota
3. Ohio
4. Wisconsin
5. Iowa
6. Rhode Island
7. Pennsylvania
8. New York
9. Oregon
10. Indiana
SW Person Count Per 100K
217
196
148
114
93
87
78
73
66
65
21
Integrated Employment (IE)
State
1. Vermont
2. Connecticut
3. Washington
4. New Hampshire
5. Oregon
6. Maryland
7. Rhode Island
8. Ohio
9. Oklahoma
10. Iowa
IE Person Count Per 100K
155
133
109
97
94
84
76
67
65
62
22
Facility-Based and Community-Based NonWork Per 100,000
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
25.
Rhode Island
Vermont
New York
Nebraska
Colorado
District of Columbia
Alaska
Wisconsin
Oregon
Indiana
Ohio
373
286
228
223
214
208
197
187
186
181
102
23
Total Served in Day Services Per 100,000
1. Vermont
2. New York
3. Iowa
4. South Dakota
5. Rhode Island
6. Ohio
7. Oregon
8. District of Columbia
9. Minnesota
10.Nebraska
441
355
313
293
288
284
279
274
263
261
24
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Day Services Per 100,000
Ottawa
Van Wert
Henry
Putnam
Wyandot
Sandusky
Allen
Paulding
Richland
Clark
Seneca
Carroll
Belmont
Hocking
Perry
Pike
Lucas
Darke
Mercer
Guernsey
51
46
46
42
41
41
40
40
40
40
38
38
37
37
37
37
37
36
36
35
25
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Facility-Based
Van Wert
Ottawa
Vinton
Pike
Clark
Guernsey
Carroll
Paulding
Putnam
Monroe
Wayne
Sandusky
Wyandot
Seneca
Lawrence
Richland
Morgan
Perry
Meigs
Columbiana
Work Per 100,000
37
36
34
33
31
30
30
30
30
28
27
27
26
26
25
24
23
22
22
22
26
Integrated Employment Per 100,000
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Henry
Mercer
Clinton
Union
Allen
Wood
Fayette
Washington
Lorain
Morgan
Athens
Medina
Knox
Sandusky
Stark
Hancock
Logan
Belmont
Lucas
Summit
20
17
17
16
14
14
11
11
11
11
11
10
10
9
9
9
8
8
8
8
27
Nationally the emphasis is on
integrated employment and a deemphasis on sheltered workshops.
This has created a series of trends,
including employment first policies like
Ohio initiated a year ago. This was a
key initiative of the current chair of the
National Governor’s Conference.
28
National Trends
• Performance based rates
• A few states are totally out of the sheltered
workshop business
• A number of states have closed the front door on
sheltered workshop admissions
• Virtually every state is looking at realigning their
funding away from sheltered workshops
• Increase effort to eliminate the subminimum wage
exemption
• Working age adult policy (can only go into adult day
after 9 months in Integrated Employment)
29
DODD issued its White
Paper on ICF/IID’s and its
Employment First Policy
as a result of these
Olmstead concerns.
www.dodd.ohio.gov
30
As a result of the recently passed budget:
•Money and language changes will continue
to support employment efforts.
•ICF language and money will support
downsizing and conversions. Providers have
committed to 1200 beds being converted or
downsized over the next 5 years.
•Downsizing of developmental centers will
continue at 90 per year.
31
Language Changes in the Budget
Language Provisions for Employment
Rebalancing: Employment First
– Make changes to improve data collection
– Make permanent the Governor’s Employment
First Taskforce
– Create a presumption that all individuals with
disabilities can work
– Ask local county boards to create their own
employment first policies
– Create a new employment first line item
32
Employment First Line Item ($3 million a year)
1. Put up a data collection system
2. Fund seven pilot local teams
3. Provide statewide training in supported
employment
4. Implement with Opportunities for Ohioans with
Disabilities (RSC) a program to fund job placement
for 1,500 working age adults a year statewide.
(Hamilton County is slated for approximately 120
slots per year)
Goal: Move 5.5% of individuals served in segregated
settings to integrated employment per year.
33
Our efforts to support
downsizing, conversion of
ICF to Waiver, and
Employment are based on
more than Olmstead and
the fear of litigation.
34
The transition from ICF’s to Waivers and from
Sheltered Workshops to Integrated Employment
is based on some fundamental principles.
1.Choice: part of being human is the
right to make choices. The more
choices we take away from people the
more we dehumanize them. Think
prisons, dictatorships, communism,
slavery and segregation.
35
PRINCIPLES – CHOICE continued
In this context Olmstead and the “American’s
with Disabilities” Act are at their core civil
rights legislation. Their aim is to put choice
and control in the hands of individuals and
their guardians, not the provider.
•In the ICF program the provider controls many
choices, including day services and most important,
the funding for the bed.
•In the Waiver program this control is transferred
from provider to the individual or guardian. They
can take their money and leave.
36
PRINCIPLES - Segregation
2. Segregation: ICF’s and sheltered
workshops are often larger (Ohio has
3,400 people living in facilities larger
than 16 beds) segregated campus like
settings. Segregation sends a
dehumanizing message “they are not
like us”, and either “we need to be
protected from them” or “they need to be
protected from us” or “they are so unlike
us they can not live like us.”
37
PRINCIPLES - Money
3. Money: provides the
opportunity for real
choice, self-esteem and
freedom.
38
These principles of segregation and
choice create National pressure
and National trends which
question the long term viability of
the ICF program and sheltered
workshops and the willingness of
the Federal Government to
continue funding these program.
39