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DD Subcommittee Strategic Planning

DD Subcommittee Strategic Planning. New Horizons For Challenging Times Compiled by Courtney W. Tarver, Associate Commissioner, Division of Developmental Disabilities Alabama Department of Mental Health & Presented to the DD Subcommittee of ADMH’s Management Steering Committee on

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DD Subcommittee Strategic Planning

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  1. DD Subcommittee Strategic Planning New Horizons For Challenging Times Compiled by Courtney W. Tarver, Associate Commissioner, Division of Developmental Disabilities Alabama Department of Mental Health & Presented to the DD Subcommittee of ADMH’s Management Steering Committee on December 4, 2012

  2. Key Events Since Last Meeting • Presidential Election • Governor’s Commission Appointed on AMA • Further Legislative Jt. Committee Meeting • Natl. Assn. of Medicaid Directors Conference • SELN Conference • NASMHPD/NASDDDS Legal Conference • NASDDDS Annual Conference • 2 x Meetings each of DD Sub Workgroups (Svc.’s, Employment, Financial Strategies) • DD Division Strategic Planning

  3. The Changing Landscape for State Developmental Disability Systems Nancy Thaler, Executive Director NASDDDS

  4. The Changing Landscape from the Past to the Present

  5. From this…… to…. NASDDDSNational Association of State Directors of Developmental Disabilities Services

  6. FRIENDS WORK PLAY

  7. Institutional Census Decline Oklahoma 31,101 09 Source: UMN RTC/ICI NASDDDSNational Association of State Directors of Developmental Disabilities Services

  8. 12 States Have No Institutions NASDDDSNational Association of State Directors of Developmental Disabilities Services

  9. The Changing Landscape Ahead NASDDDSNational Association of State Directors of Developmental Disabilities Services

  10. # 1 The Aging Baby Boomers NASDDDSNational Association of State Directors of Developmental Disabilities Services

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

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

  13. Many Caregivers are over 55 NASDDDS National Core Indicators NASDDDSNational Association of State Directors of Developmental Disabilities Services

  14. # 2 National Debt NASDDDSNational Association of State Directors of Developmental Disabilities Services

  15. Current Policies Are Not Fiscally Sustainable: Change is Coming No Matter Who Wins the Next Election Source: CBPP projections based on CBO data.

  16. # 3 Waiting Lists Don’t Go Away The Waiting List NASDDDSNational Association of State Directors of Developmental Disabilities Services

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

  18. State Response to the Challenge Focus on Sustainability NASDDDSNational Association of State Directors of Developmental Disabilities Services

  19. More People Living with Family 57.5% Wisconsin 41% Michigan 55% Minn. 50% Indiana 39% Illinois 36% Oklahoma 36.6% Arizona 86% Calif. 71%Florida 70% Idaho 75% S.C. 72% Lakin et.al. RISP 2009 –UMinn.

  20. Families are the primary support

  21. How Can We Shape the Future? NASDDDSNational Association of State Directors of Developmental Disabilities Services

  22. The Questions Is….. • Not whether people who have developmental disabilities will be living with and relying on their families for support but…… whether people and their families will struggle alone or have a great life because the supports are there for them and they are part of their community. NASDDDSNational Association of State Directors of Developmental Disabilities Services

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

  24. Sheli Reynolds

  25. 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 • Tech support services to support the use of technology NASDDDSNational Association of State Directors of Developmental Disabilities Services

  26. 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 NASDDDSNational Association of State Directors of Developmental Disabilities Services

  27. 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

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

  29. 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)

  30. 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

  31. Benefits of Employment • Get out of poverty • More independence • Make Friends • Make a contribution to the community • Positive image and valued role within the family and community • Opportunities for learning and expanding relationships NASDDDSNational Association of State Directors of Developmental Disabilities Services

  32. Thinking for the Long Term Estimated figures – use your own figures and do the math NASDDDSNational Association of State Directors of Developmental Disabilities Services

  33. 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)

  34. Challenges • Continued Education of Public, Policy-makers and Families to show Dis-Ability; • Prioritize Medicaid Operating Agency Populations w/Medicaid; • Stagnant State Dollars Forcing Serving More with Less; • Paradigm Shift/Culture Change in Service Models from Congregate to Person/Family-Centered Supports; • Expansion of Broad Services to More People with DD Conditions

  35. National Takeaways • Feds are REALLY focused on helping states: • HHS/OCL w/AI/DD, DOJ & OCR listening to “helpers” • CMS-All key ofc. heads from states, • DOL engaged w/$ (See Workforce Development Agencies) • Funding for Technical Assistance to Natl. Agencies-NASDDDS & others, SELN • Managed Care Growing in Acceptance! • 1115 and 1915(b)(c) authority • New CMS Ofc on how to make MLTSS work • Creativity is Encouraged and Rewarded • Use of any & all tools encouraged like 1915(i), (J) & (k) • MFP

  36. HELP for US • NASDDDS (all fm states), NASMHPD other NA’s • SELN • HRSI (Val Bradley) • CQL • DOL/ODEP (w/$$) • HUD-B’hamOfc.+ Local PHA’s, Regional HA’s, & Fed Level • Other States Including but not only those like us (GA TN, SC, VA, DC) (but also, MD, AZ, CO, WI, WA, OK) • Sister State Agencies, especially ADRS, ADSS, Medicaid, Education, ADECA, AIDT, ASES, AHFA, DOT • DD Partners: UCEDD, DD Council, ADAP • ADMH & other Divisions • Each Other as Indivduals, Family Members, Advocates & Service Providers

  37. BUT…IF NO CHANGE, ENFORCEMENT • DOJ (AL Unit) • HHS, OCR or OIG • CMS Program Integrity • DOL • HUD

  38. Alabama Reform Generally • Affordable Care Act Implementation??? • Declined to I.D. Services for Insurance Exchange • Undecided on What Parts to Accept/Implement • Alabama Medicaid Reform • Unique Structure and Counter-productivity • Joint Legislative Committee Activities • From: Task Force on Reconfiguring AMA • Chair-SHO-Dr. Williamson • Successor Staff/Retention/Fiscal Turbulence • To: Governor’s Commission on Medicaid Reform • Chair-SHO-Dr. Williamson • Joint Legislative Committee Chairs Represented • All Health Disciplines Represented • Commissioner Reddoch is a Member • Public Meetings encouraged via video conferences

  39. Fiscal Climate • 5th year of state dollar decline • FY 13— Cuts Still Possible • FY 14—General Fund Still $100M hole • Ala./DMH “Right-Sizing” Likely & Soon • Central & Regional Ofc. & Positions/Functions May Change • Last band-aid—3 year Constitutional Amendment Only Stops Some Bleeding in GF • Federal Fiscal Climate Likely to Hurt vs. Help

  40. Some Fog is Clearing on Changes to Health & Disability Policy • Supreme Court Upheld Most of ACA • State Opting Out of Medicaid Insurance Exchange/Expansion In Present Form • State Commission on Medicaid Plan 1-31-13 • Presidential Election Kept Administration • Key Fed. Ofc. Staffing & Contracts Being Filled • Policy Answers Moving Fwd.

  41. Likely Alabama Changes • Major AL Medicaid Overhaul-(1115?) • More Managed Care in some Form, Possible MLTSS • Some State Agency Consolidation • Some Waiver Consolidation/Coordination • New Waiver w/AMA dollars (We operate ACT II) • Some DMH Reorganization • Sluggish State Revenue • Feds Shifting Costs to States

  42. Budget Proposals • Issue for 2013= $8.5M--DD Div. Response= Level Svcs (Only fill attrition slots) & Few vacancy fills (but potential re-purposing/reorganizing C.O. & Regions), cuts deficit by $2.5M; • Issue for 2014= Gen. Fund $100M loss—DD Response=Same given FMAP & Personnel Cost Increases ******** • Potential negatives: • If no more reductions by other Divisions, may still have to cut contract rates & potential staff. • Medicaid Changes?? • Potential positives: • BP Settlement ?? • Shifts of costs to or revenue from Ed. T. Fund since $400M increase. • Medicaid Changes??

  43. Strategies for Getting More w/Same or Less Reduce: Residential as Primary Home Choice Sheltered Work & Day Hab Low Quality & Conflicted Case Management *************************************** Increase: Individual Home Ownership/Rental Integrated, Competitive, Customized Employment High Quality, De-conflicted CM/Svc Coordination

  44. Resources Not Yet Fully Tapped • SELN • DOL/ODEP+ • New Money Follows the Person Grant • Some State Agencies (AMA-New Waiver $$, ED, ADECA, AHFA, AIDT, ASES, ADRS) • UCEDD • HUD/USDA • Ourselves & Pvt. Partners

  45. Committee Reports • Services • Employment • Financial

  46. DD Div. Broad Planning to Date MISSION VISION GOALS

  47. MISSION To assure that people with Developmental Disabilities are provided quality supports and services to lead meaningful lives.

  48. VISION People with Developmental Disabilities Will Live Integrated Lives through a Choice of Employment, Home and Relationships.

  49. GOALS • Become a more consumer – driven system that supports individuals, families and self-direction; • Design the system to become more pro-active rather than re-active in the provision of services and supports; • Become an Employment First State; • Improve the quality of Case Mgt. and expand it to people not yet in service (svc. coord./navigation); • Improve the Intake Process for service eligibility; • Expand Services to include people with Developmental Disabilities • Expand housing opportunities for people with Developmental Disabilities

  50. ACTION • Adopt Committee Reports as part of Strategic Plan • Adopt Support of DD Division • Mission, • Vision, • Goals …as part of Strategic Plan

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