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MACDDS July 2012

The Change Wolf is at the Door!Les WagnerExecutive DirectorOctober 9, 20121MACDDS July 2012

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EVOLUTION1969 parents in Pike County started the county board initiative.Until recently, DMH has administered case management and all Home and Community waivers.DMH historically has determined who is eligible for services, what their plan would be and what services they would receive.

County Boards in MissouriIn 1969 Missouri passed legislation allowing counties with voter approval to establish a property tax levy Funding must be used to support individuals with developmental disabilities.86 of 115 counties have passed local tax levies.Local tax levies in 2010 totaled over $82.5 million.

SB 40 Boards 1969

SB 40 Boards Today

County Boards in the beginningIn the 70s and 80s, most county boards used local resources to develop new services:Sheltered WorkshopsGroup Homes Other Related Services

Matching Fund Opportunities(What big eyes you have!)In the late 80s Division of DD started developing home and community Medicaid waivers.County Boards started leveraging local funds in the DD waivers.In 2005, County Boards matched over $5.8 million of local funding to purchase Medicaid waiver services valued in excess of $12 million.Division projects County Boards in 2012 will match over $14 million of local funding to purchase DD Medicaid waiver services.

Crisis Only EraThe Department of Mental Health allows services only to those in crisis.Consequence: County boards are unable to access Medicaid waiver services for individuals on their county wait lists.

MACDDS conducted research to determine if a county-based Medicaid waiver could be used to allow counties with local funding to preventatively address needs of individuals.

MACDDS sought a Missouri Foundation for Health grant to support waiver research, bringing expertise in from national consultants.PfH was created as a result. Today, MACDDS continues to seek new and innovative opportunities to increase services.

PARTNERSHIP FOR HOPE

Partnership for Hope(The better to see with, my dear.)Fundamental systems change- prevention emphasis. The end of the crisis only era.No longer requires individuals to wait years before receiving services.Individuals and families receive support services sooner at a dramatically lower cost.

Partnership for HopePositive outcomes:Individuals are able to stay in their own home.Parents are able to eliminate or delay need for more costly residential services.Individuals continue to live in their own community.Families stay connected.

Partnership for HopePfH is expected to delay or prevent residential services cost for over a thousand individuals.PfH waiver services average $25 per day per person.Residential services are projected to cost over $200 per day per person.Delaying more costly residential services for 100 individuals for a year saves $6.3 million a year.14

Partnership for HopeCounty boards determine who participates and the services to be planned and provided.

Want to guess what happened next?

DD System RedesignUtilization Review ScoresMedicaid Eligible Individuals12Served with New State Resources in the DD Waivers1110987654321Proposed Solution

Individuals receive services using County Based Waiver if local resources were available.

Partnership for Hope Waiver

Number of New Individuals Served Each Year

Budget Economic ImpactDivision of Developmental Disabilities Partnership for HopeMaximum Projected Expenditure for 1,270 Individualsfor Fiscal Year 2012Total Revenue$15,240,000

Partnership for Hope WaiverOriginal Counties Participating October 1, 2010

Partnership for Hope WaiverCounties Added in February 2011

Partnership for Hope WaiverCounties Added in September 2011

Partnership for Hope WaiverCounties Added in February 1, 2012

Partnership for Hope WaiverCounties Added in August, 2012

Partnership for HopeAre you all ears yet?

Partnership for HopeEmployment ServicesJob DiscoveryIncludes:VolunteerismJob explorationJob shadowingEmployment preparation (resume development, work procedures)Business plan development for self-employment Job PreparationTraining and work experience to teach the skills necessary to succeed in paid community employmentVolunteerismFollowing directionsFocusing on tasksCompleting tasksAppropriate work place attireHygieneCommunity EmploymentCompetitive work in an integrated work setting.Co-Worker Job SupportsEmployer provides job supports as a part of the natural workplace

Partnership for HopeOther Support ServicesDay ServicePersonal AssistantTemporary ResidentialDental ServicesAssistive TechnologyBehavior AnalysisPositive Behavior SupportsCommunity SpecialistEnvironmental Accessibility AdaptationsOccupational TherapyPhysical TherapySpeech TherapyTransportationProfessional Assessment and MonitoringSupport Broker (available to those who self or family direct their supports)

COUNTY-BASEDTARGETED CASEMANAGEMENT

Budget

State Case Manager sLocal Case ManagersTotal Case Management FTEsFY 2006502.17107.53609.70FY 2012285.89382.35668.24

Case ManagementIn 2006 17 Counties providing local TCM services supporting 4,301 individual, 15% of persons servedCurrently 84 counties providing local TCM services supporting over 15,294 individuals, 49% of persons served

Counties with Local Targeted Case Management ServicesAs of July 2006

Counties with Local Targeted Case Management Services

County Boards in Missouri 2011

GrowthDramatic increases in persons servedEnrollment in waiversPartnership for Hope expansionTargeted Case ManagementEmployment initiativesLegislative initiativesMembership growth

MACDDS Growth 2001 to 2011

MACDDSVISION:To be an effective catalyst shaping public policy and practice for people with developmental disabilities.MISSION:Dedicated to promotion of county initiatives in developmental disability services.

Member BenefitsIdentification of Priority Issues/ProblemsDevelopment of SolutionsMonitoring and Evaluation of TrendsReduced Waiting ListsImproved Training and Compliance Legal and Technical Assistance for SB 40 boardsConfidential Member NetworkingIdentify and Share Best PracticesAssistance Locating Additional Resources

Additional Member Benefits for Related Private OrganizationsAccess to decision makersOpportunity to participate in MACDDS committees and networking including:Targeted Case ManagementResidential ProviderHR and relatedRPO Membership dues are $1500/year38

IssuesSystems Problems organization changing too fast to manage changeNeed for Consistent Liaison with State GovernmentAccountability and SustainabilityMajor reforms Federal and State i.e., Balancing Incentives Program, Affordable Care Act

Issues(What big teeth you have)Revisions to TCM contractsMatch agreementsEligibility and referrals disputesMMAC compliance auditsWaiver amendmentsWaiver definitionsIssue du jour

2013 Legislative PrioritiesExpand County and State PartnershipsSupport the state in fully funding match for Medicaid Waivers.

Expand the Partnership for Hope to assist individuals in becoming self-sufficient productive citizens.

Explore other county initiatives directed at efficiencies.

Oppose actions undermining county boards statutory authority or that would impact revenue or appropriations affecting individuals with developmental disabilities.41

2013 Legislative PrioritiesEssential Health and SafetyStabilize community supports for Missouris most vulnerable citizens through sufficient funding of long term quality providers.

Continue to reduce the census of Habilitation Centers. Redirect Habilitation Center funds to allow individuals to explore community living and become productive citizens.

Provide statewide specialized community supports for individuals in medical or behavioral crisis.

Expand employment opportunities for people with developmental disabilities by incentivizing businesses who employ them at or above minimum wage.

Maintain Missouri Department of Transportation funds and support state and local transportation initiatives to allow people to access their communities for medical and employment purposes.42

Special thanks to the Division of Developmental Disabilities for their assistance in providing graphics and information provided in this presentation.

Les Wagner, Executive DirectorMACDDS29 S. 9th Street, Suite 208Columbia, MO 65201573-442-5599leswagner@macdds.org