1. 1 State Legislatures and the Olmstead Decision : What’s the Latest? Independent Living Research Utilization Webcast July 17, 2002 Jo Donlin Senior Policy Specialist National Conference of State Legislatures

2. 2 Goals of this Presentation çSummarize survey results from The States’ Response to the Olmstead Decision çHighlight opportunities and challenges çReview the role of state legislatures in implementing the Olmstead decision çSummarize current NCSL Olmstead activities

3. 3 The States’ Response to the Olmstead Decision çNCSL Survey - An Ongoing Project ç1st Report Released March 2001 ç2nd Report Released December 2001 çNew Update in Progress - More to Come

4. 4 The States’ Response to the Olmstead Decision çBulk of activity has been in the Executive Branch ç40 states plus D.C have established task forces, commissions or state agency work groups (as of December 2001) çappointed by governors, legislators and health commissioners çfew involved legislators çbroad scope

5. 5 The States’ Response to the Olmstead Decision çStates are focusing efforts on developing state plans ç18 states have some type of written report or plan: AZ, CT, DE, GA, IL, IN, IA, KY MD, MO, MT, NC, OH, OK, SC, TX,WI, WY ç4 stand out as “comprehensive and effectively working”: MS, MO, OH, TX ç8 other states have plans in the works çStates are not required to do a state plan

6. 6 State Plan Guiding Principles Jan. 14, 2000 Guidance letter from HCFA & OCR çDevelop & implement a … plan for … services … in more integrated, community-based settings çInvolve consumers in plan development and follow-up çPrevent or correct unjustified institutionalization çEnsure availability of community-integrated services çProvide opportunity for consumer informed choices çAddress quality assurance & sound management

7. 7 The States’ Response to the Olmstead Decision çHousing çTransportation çWaiver program expansion çTransitioning individuals çData collection çStaffing çAssessment çConsumer/provider/ agency education & outreach Commissions have made recommendations that address 8 major issues:

8. 8 The States’ Response to The Olmstead Decision çIn 2001, little legislative activity directly related to Olmstead but… çMO enacted a wage pass through for MR/DD caregivers; funds for training staff and individuals; $$ for transition costs and added a personal care benefit to the Medicaid plan çMD expanded its waiver to 300% of the supplemental security income eligibility level çTX expanded all six waiver programs

9. 9 Challenges and Opportunities çChallenges çBudget Shortfalls çHousing çWorkforce Shortage çTransportation çData Collection

10. 10 Challenges and Opportunities çOpportunities  Everyone’s Involved - Working Together  Federal Government is Helping çCMS Guidance Letters ç “Real Choice Grants” çNew Freedom Initiative çAdministration’s policy on removing barriers to equality for 54 million Americans living with a disability çLatest development, new independence template waivers

11. 11 Legislature’s Roles in Implementation çIf you haven’t involved your legislature, now is the time! çWhy Should you Care? çControl the purse strings çEstablish programs çEnact requirements çProvide oversight

12. 12 Legislature’s Role in Implementation çMedicaid çlong-term care accounts for 35% of all state and federal Medicaid funds. çOlmstead will affect Medicaid budgets çOther State Programs are Involved çHousing, Transportation, Vocational Rehabilitation

13. 13 Term Limits, Elections & Redistricting - Oh My! çCombination could cause 25% turnover çAZ, AR, CA, CO, FL, ID, LA, ME, MI, MO, MT, NE, NV, OH, OK, OR, SD, UT, WY çOpposition and supporters leave çContinuing education process çSevere transitions in some states ÞMichigan Senate: 71% new ÞMissouri House: 45% new

14. 14 Dos and Don’ts DO: ÞGet involved (year round) ÞBe accurate, reliable, honest, concise, and vigilant ÞBuild relationships early ÞOffer to be a resource ÞBe inclusive of others ÞHave written materials ÞPersonalize the issue/take a field trip ÞThank your audience Don’t: ÞAssume you don’t count ÞWait Until Session ÞMislead or give false information ÞMake enemies ÞBe too narrowly focused ÞRefuse to compromise ÞGo on and on... ÞGive up

15. 15 NCSL Olmstead Activities çThe jury is still out. Early stages of implementation. çContinue to Educate Legislatures about Olmstead vs. L.C.- publications, meeting, website çTracking State Activities çstate plans çlegislative activity çProviding technical assistance

16. 16 Resources çNCSL Olmstead website çhttp://www.ncsl.org/programs/health/disabil2.htm çCenters for Medicare and Medicaid Services çhttp://www.hcfa.gov çNational Technical Assistance Exchange çSusan Reinhard, Rutgers University, Center for State Health Policy, 732-932-3105, x230 çRichard Petty, Independent Living Research Utilization, 713-520-0232

17. 17 Contact Information Jo Donlin National Conference of State Legislatures jo.donlin@ncsl.org 303-830-2200, x130 Wendy Fox-Grage National Conference of State Legislatures wendy.fox-grage@ncsl.org 202-624-3572