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MACDDS July 2012
The Change Wolf is at the Door!
Les Wagner
Executive Director
October 9, 2012
MACDDS July 2012
EVOLUTION• 1969 – 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 Missouri• In 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 beginning…
• In the 70s and 80s, most county boards used local resources to develop new services:– Sheltered Workshops– Group 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 Hope• Positive 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 Hope• PfH 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.
Partnership for Hope• County boards determine who
participates and the services to be planned and provided.
Want to guess what happened next?
DD System RedesignUtilization
Review ScoresMedicaid Eligible Individuals
12Served with New State
Resources in the DD Waivers11
10
987654321
Proposed 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 Hope
Maximum Projected Expenditure for 1,270 Individualsfor Fiscal Year 2012
Total 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 Hope
Are you all ears yet?
Partnership for HopeEmployment Services
1. Job Discovery– Includes:
• Volunteerism• Job exploration• Job shadowing• Employment preparation
(resume development, work procedures)
• Business plan development for self-employment
2. Job Preparation– Training and work experience
to teach the skills necessary to succeed in paid community employment• Volunteerism• Following directions
• Focusing on tasks• Completing tasks• Appropriate work place
attire• Hygiene
3. Community Employment– Competitive work in an
integrated work setting.
4. Co-Worker Job Supports– Employer provides job supports
as a part of the natural workplace
Partnership for HopeOther Support Services
• Day Service
• Personal Assistant
• Temporary Residential
• Dental Services
• Assistive Technology
• Behavior Analysis
• Positive Behavior Supports
• Community Specialist
• Environmental Accessibility Adaptations
• Occupational Therapy
• Physical Therapy
• Speech Therapy
• Transportation
• Professional Assessment and Monitoring
• Support Broker (available to those who self or family direct their supports)
COUNTY-BASEDTARGETED CASE
MANAGEMENT
Budget
State Case Manager s
Local Case Managers
Total Case Management FTEs
FY 2006 502.17 107.53 609.70
FY 2012 285.89 382.35 668.24
Case Management• In 2006 – 17 Counties providing local TCM services supporting
4,301 individual, 15% of persons served• Currently – 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
Growth
• Dramatic increases in persons served• Enrollment in waivers• Partnership for Hope expansion• Targeted Case Management• Employment initiatives• Legislative initiatives• Membership 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 Benefits• Identification of Priority Issues/Problems• Development of Solutions• Monitoring and Evaluation of Trends• Reduced Waiting Lists• Improved Training and Compliance • Legal and Technical Assistance for SB 40 boards• Confidential Member Networking• Identify and Share Best Practices• Assistance Locating Additional Resources
Additional Member Benefits for Related Private Organizations
• Access to decision makers• Opportunity to participate in MACDDS
committees and networking including:– Targeted Case Management– Residential Provider– HR and related
RPO Membership dues are $1500/year
Issues• Systems Problems – organization
changing too fast to manage change• Need for Consistent Liaison with State
Government• Accountability and Sustainability• Major reforms – Federal and State i.e.,
Balancing Incentives Program, Affordable Care Act
Issues(What big teeth you have…)
– Revisions to TCM contracts– Match agreements– Eligibility and referrals disputes– MMAC compliance audits– Waiver amendments– Waiver definitions– Issue du jour
2013 Legislative Priorities• Expand County and State Partnerships
– Support 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.
2013 Legislative Priorities• Essential Health and Safety
– Stabilize community supports for Missouri’s 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.
Special thanks to the Division of Developmental Disabilities for their assistance in providing graphics
and information provided in this presentation.
Les Wagner, Executive DirectorMACDDS
29 S. 9th Street, Suite 208Columbia, MO 65201
