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

 Olmstead in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

Agency Adult Service Child Service
DCH Independent Care Waiver
Program; SOURCE
Medicaid Buy-In
DHR MRWP waiver programs
Aging Programs
Katie Beckett, CMOs,
Peachcare
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 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
State Institutions
1,201
13%
Group home s, foste r home s, apartme nts
2,916
32%
Nursing facilitie s
1,604
18%
6 or Fewer Total Including
Supported Living: 68%
Priv ate ICFs/M R 16+
110 (1%)
35%
Supporte d Liv ing
3,202
Total: 9,033 Persons
•
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
$3.50
$3.00
Total
Community Se rv ice s
Institutional Se ttings
$2.50
$2.42
$2.00
$2.17
$2.20
$2.26
$2.00
$1.79
$1.82
$1.73
$1.50
$1.00
$1.28
$1.28
$0.93
$1.03
$0.97
$1.06
$0.89
$0.60
$0.50
$0.67
$0.47
$0.00
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 06
Fiscal Year
Source: Braddock et al. (2007, preliminary)

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

 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

 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 $34,000,000 in funding over 5 years

 Olmstead in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

 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)
 $5.4M allocated as cash disbursements to families denied Medicaid

 $2600 dispersed to each family via a debit card
$2.2M set aside for development of communitybased 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

 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-2s, etc
 New Services payable under the waiver
Dental
Transportation
Natural Support Training
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 families
 Legal action

 Olmsted in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

 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
$20
$16
$12
$8
$4
$17.18
$10.50
$9.62
$9.18
$8.68
$8.00
$0
All Workers
Georgia
State-Operated
Georgia
Poverty Level Nursing Aides
U.S.
Comm. ID/DD
U.S.
Comm. ID/DD
Georgia
•
The average community direct support wage in Georgia was
24% below the state’s institutional average direct support wage.

 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

 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

 Olmsted in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

10,000
Number of Georgia Families
Supported Decreased 21% (2004-
06)*
8,242
8,585
7,908
7,598 8,000
6,801
6,000
5,648
4,000
2,669
2,017
2,000
1,056
*As reported by the Georgia Department of Human Resources
0
86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06
Fiscal Year
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

 Olmsted in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

• 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

• 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

• Senate Bill 10
• Revision of diploma regulations
• Special education funding formula revision

 Olmsted in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

• 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

• 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

 Olmsted in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

•
• 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

•
•
• 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

 Olmsted in Georgia
 Medicaid: EPSDT, Katie Beckett, and Waivers
 Provider Capacity
 Family Support
 Education
 Transition
 Employment
 Aging

• 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

•
•
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’s national ranking has moved from 44 th to 30 th with regard to community based services!

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

 Children's Freedom Initiative
 Unlock the Waiting List Campaign
 Self Advocacy
 Employment First Georgia