Budget Symposium OACBDD John L. Martin, Director August 21, 2013

1. Budget Symposium OACBDD John L. Martin, Director August 21, 2013

2. Agenda The Connection between the DODD FY 14 and 15 Biennium Budget and Olmstead

3. 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.

4. 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.”

5. “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.

6. “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.

7. 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.

8. 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.

9. 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

10. Ohio’s Olmstead Concerns

12. 20 states have fewer than 100 people living in state institutions with over 16 beds. • 13 states no longer operate any facilities.

13. State with more than 1,000 private ICF/IID Beds 16 beds and above for FY 11 State # of beds 1. Ohio 3,417 • Illinois 3,384 • California 2,092 • New York 2,003 • Pennsylvania 1,842 • Florida 1,545 • Iowa 1,454 National 23,603

14. 15 states have no one living in a private facility larger than 16.

15. 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%.

16. Our Olmstead concerns extend beyond the ICF/IID program.

17. Of the money spent in Adult Services 7% - Supported Employment 93% - Sheltered Work/Enclaves

18. There are more people receiving services in sheltered workshops in Ohio than any other state.

19. The Data Trail

20. Sheltered Workshop (SW) State SW People Served 1. Ohio 17,118 2. New York 14,166 3. Minnesota 11,597 4. California 10,608 5. Pennsylvania 9,915 6. Wisconsin 6,529 7. Michigan 4,441 8. Indiana 4,224 9. Massachusetts 3,640 10. North Carolina 3,131

21. Sheltered Workshop (SW) State SW Person Count Per 100K 1. Minnesota 217 2. South Dakota 196 3. Ohio 148 4. Wisconsin 114 5. Iowa 93 6. Rhode Island 87 7. Pennsylvania 78 8. New York 73 9. Oregon 66 10. Indiana 65

22. Integrated Employment (IE) State IE Person Count Per 100K 1. Vermont 155 2. Connecticut 133 3. Washington 109 4. New Hampshire 97 5. Oregon 94 6. Maryland 84 7. Rhode Island 76 8. Ohio 67 9. Oklahoma 65 10. Iowa 62

23. Facility-Based and Community-Based Non-Work Per 100,000 • Rhode Island 373 • Vermont 286 • New York 228 • Nebraska 223 • Colorado 214 • District of Columbia 208 • Alaska 197 • Wisconsin 187 • Oregon 186 • Indiana 181 • 25. Ohio 102

24. Total Served in Day Services Per 100,000 • Vermont 441 • New York 355 • Iowa 313 • South Dakota 293 • Rhode Island 288 • Ohio 284 • Oregon 279 • District of Columbia 274 • Minnesota 263 • Nebraska 261

25. Day Services Per 100,000 • Ottawa 51 • Van Wert 46 • Henry 46 • Putnam 42 • Wyandot 41 • Sandusky 41 • Allen 40 • Paulding 40 • Richland 40 • Clark 40 • Seneca 38 • Carroll 38 • Belmont 37 • Hocking 37 • Perry 37 • Pike 37 • Lucas 37 • Darke 36 • Mercer 36 • Guernsey 35

26. Facility-Based Work Per 100,000 • Van Wert 37 • Ottawa 36 • Vinton 34 • Pike 33 • Clark 31 • Guernsey 30 • Carroll 30 • Paulding 30 • Putnam 30 • Monroe 28 • Wayne 27 • Sandusky 27 • Wyandot 26 • Seneca 26 • Lawrence 25 • Richland 24 • Morgan 23 • Perry 22 • Meigs 22 • Columbiana 22

27. Integrated Employment Per 100,000 • Henry 20 • Mercer 17 • Clinton 17 • Union 16 • Allen 14 • Wood 14 • Fayette 11 • Washington 11 • Lorain 11 • Morgan 11 • Athens 11 • Medina 10 • Knox 10 • Sandusky 9 • Stark 9 • Hancock 9 • Logan 8 • Belmont 8 • Lucas 8 • Summit 8

28. Nationally the emphasis is on integrated employment and a de-emphasis 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.

29. 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)

30. 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

31. 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.

32. 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

33. Employment First Line Item ($3 million a year) • Put up a data collection system • Fund seven pilot local teams • Provide statewide training in supported employment • 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.

34. Our efforts to support downsizing, conversion of ICF to Waiver, and Employment are based on more than Olmstead and the fear of litigation.

35. The transition from ICF’s to Waivers and from Sheltered Workshops to Integrated Employment is based on some fundamental principles. • 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.

36. 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.

37. PRINCIPLES - Segregation • 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.”

38. PRINCIPLES - Money 3. Money: provides the opportunity for real choice, self-esteem and freedom.

39. 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.