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State Trends in the Current The Fiscal Environment

State Trends in the Current The Fiscal Environment. CMS Region 5 Intellectual and Developmental Disabilities HCBS Leadership Summit Columbus, Ohio Nov. 29th, 2011 Nancy Thaler, Ex. Director NASDDDS. Three Big Problems – Two Will be With U s for Decades.

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State Trends in the Current The Fiscal Environment

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  1. NASDDDSNational Association of State Directors of Developmental Disabilities Services State Trends in the Current The Fiscal Environment CMS Region 5 Intellectual and Developmental Disabilities HCBS Leadership Summit Columbus, Ohio Nov. 29th, 2011 Nancy Thaler, Ex. Director NASDDDS

  2. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  3. Three Big Problems – Two Will be With Us for Decades NASDDDSNational Association of State Directors of Developmental Disabilities Services

  4. The National Structural Budget Deficit NASDDDSNational Association of State Directors of Developmental Disabilities Services

  5. NASDDDSNational Association of State Directors of Developmental Disabilities Service Demographic Shift- Aging Baby Boomers NASDDDSNational Association of State Directors of Developmental Disabilities Services

  6. Demographic Shift - Not Enough Workers to Take Care of the Baby Boomers Larson, Edelstein, 2006 NASDDDSNational Association of State Directors of Developmental Disabilities Services

  7. NASDDDSNational Association of State Directors of Developmental Disabilities Service Confronting Reality Workforce will not keep pace with demand Growth in public funding will slow The Waiting List

  8. State Responses to the Challenge NASDDDSNational Association of State Directors of Developmental Disabilities Services

  9. Sustainability of the System • #1 • Focus on Sustainability • What can we & future generations afford? • What can we justify based on: • Relative costs of various options? • Resources spent in comparison with ? • Outcomes achieved for resources spent? Source: Lakin U. of Minn. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  10. NASDDDSNational Association of State Directors of Developmental Disabilities Services Re-evaluating current services – How many could we serve? Data Source: Lakin, K.C. MSIS and NCI data from 4 states (1,240 Individuals) NASDDDSNational Association of State Directors of Developmental Disabilities Services

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

  12. Source: Human Services Research Institute The idea is to nudge a system down the incline to reduce per person expenditures.  The idea is to nudge a system to be person-centered, to support families, and involve people in their community. Big House State Op ICF-MRs 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)

  13. Conclusion Sustainability depends on how good we are at supporting families and getting people jobs. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  14. People Living with Family 57.5% Arizona 85.6% Calif. 70%Florida 71% Idaho 75% N.J. 70% S.C. 73% Wisconsin 41% Michigan 55% Minn. 50% Indiana 39% Illinois 36% Ohio 42% Lakin et.al. RISP 2009 –UMinn.

  15. 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

  16. NASDDDSNational Association of State Directors of Developmental Disabilities Services The Challenge: Creating a New Service Paradigm Sustainability depends on how well we support families and get people Jobs.

  17. NASDDDSNational Association of State Directors of Developmental Disabilities Service A New Way to Think About Supporting People and the Families They Live With Adapted from work by Michelle “Sheli” Reynolds, PhD University of Missouri- Kansas City, Institute for Human Development NASDDDSNational Association of State Directors of Developmental Disabilities Services

  18. NASDDDSNational Association of State Directors of Developmental Disabilities Service A New Way to Think About Supporting People and the Families They Live With Sheli Reynolds NASDDDSNational Association of State Directors of Developmental Disabilities Services

  19. NASDDDSNational Association of State Directors of Developmental Disabilities Service A New Way to Think About Supporting People and the Families They Live With Sheli Reynolds NASDDDSNational Association of State Directors of Developmental Disabilities Services

  20. NASDDDSNational Association of State Directors of Developmental Disabilities Service A New Way to Think about Supporting People and the Families They Live With Sheli Reynolds NASDDDSNational Association of State Directors of Developmental Disabilities Services

  21. A New Service Paradigm • Supporting individuals and families is the core mission • Family includes grandparents, aunts, uncles, siblings, cousins and people who “are like family” • New services: e.g. “family helpers”; technical support for assistive technology; navigators; logistics management; health and medical appt. management • Employment services and alternatives when people aren’t working • Adapt Person-Centered Planning to Family-Centered Planning to include financial planning & succession planning for care giving NASDDDSNational Association of State Directors of Developmental Disabilities Services

  22. NASDDDSNational Association of State Directors of Developmental Disabilities Services A New Service Paradigm • Support Self Advocacy and Family Support Network infrastructure • Support coordination – small ratios; training in family dynamics; conflict resolution; knowledge about employment; strong supervision • Consumer direction; individual budgets • Pay family care givers and peer supports • 24 hour help line/reliable crisis intervention as part of infrastructure • Reduce service utilization • Protect people from abuse and neglect • Reduce caregiver burnout

  23. Does Everyone Have to Live with Their Family to Have a Sustainable System? No. It means we have to maximize the extent to which as many people as possible can live great lives without 24 hours of paid supports. Options include….. • Family • Extended Family • Friends • Shared Living • Independently or with a friend • Technology • Etc. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  24. Supporting Individuals and the People They Live With It doesn’t matter with whom people live, the supports should match what they need. Shared Living Aunts & Uncles Own Home/ Roommate Nuclear Family Siblings Cousins Job And a NASDDDSNational Association of State Directors of Developmental Disabilities Services

  25. Individual Resource Allocation • #2 • Resource • Allocation Resource Allocation – using data (individuals assessments and state cost data) to predetermine funding levels for each person What Resource Allocation Hopes to Achieve • Fairness • Equity • Predictability • Enables Self-Direction • Controls Costs Colorado, Georgia, Louisiana, Oregon Wyoming, Conn. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  26. Managed Care • #3 • Managed Care • Arizona • Michigan • Vermont • Wisconsin • Texas Star Plus • North Carolina – Piedmont expanding • New York • California • Kentucky • Kansas • Kentucky • Illinois • New Jersey • ? • ? NASDDDSNational Association of State Directors of Developmental Disabilities Services

  27. Integrated Care for Dual Eligible Individuals NASDDDSNational Association of State Directors of Developmental Disabilities Services

  28. Managed Care Opportunity & Questions • Opportunities • Reduce reliance on institutional services • Integration with medical and behavioral health • Address the waiting list • Innovation • Questions • Will MCO understand the difference between acute care and long term supports? • Types of services; provider qualifications; performance measures; • Will the difference between aging and disabled be recognized? • A few years at the ends of life vs. supporting the future 60 years • Will resources for the most severely disabled be preserved? • Will the role of families be understood? NASDDDSNational Association of State Directors of Developmental Disabilities Services

  29. Multiple Systems of Long Term Supports? NASDDDSNational Association of State Directors of Developmental Disabilities Services

  30. Can We Put the Pieces Together? NASDDDSNational Association of State Directors of Developmental Disabilities Services

  31. Nancy Thaler Executive Director National Association of State Directors of Developmental Disabilities Services 113 Oronoco Street Alexandria, VA 22314 703-683-4202 nthaler@nasddds.org

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