1. The Olmstead Decision: State Activities Wendy Fox-Grage National Conference of State Legislatures 1

2. Olmstead Task Forces At least 42 states + D.C. have them (as of July 2002) Broad definition of task forces 18 states completed reports and plans (as of Dec. 2001) At least 8 more were working on them (as of Dec. 2001) 2

3. Reports and Plans Most of the plans would not be considered comprehensive –they either do not meet the Centers for Medicare and Medicaid Services (CMS) guidelines or –They do not contain timelines or budgets 3

4. “Plans” Several states have task forces but are not going to issue Olmstead plans –District of Columbia, Florida, Kansas, Pennsylvania and Washington –Projects include resource centers (DC) and internal workgroups of state agencies (WA) 4

5. Recommendations 8 Major Recommendations 1.Housing 2.Transportation 3.Assessment 4.Waiver program expansions 5.Transitioning individuals from institutions into the community 6.Workforce 5

6. Recommendations (con’t) 7. Data Collection 8. Consumer/Provider/State Agency Education and Outreach 6

7. Impact on People with Disabilities Short-term effect: Very little Most of the strategies have not yet been implemented. 7

8. Why is implementation taking so long? Gloomy State Budgets –Almost all states are experiencing revenue shortfalls –Medicaid grew 25% compared to 5% revenue growth from FY 2000 - FY 2002 –47 of 49 states took action in FY 2002 or proposed action in FY 2003 to reduce Medicaid expenditures: mostly reducing Rx drug costs and holding flat provider rates New state appropriations will be needed for implementation –To increase the number of waiver slots or –To increase residential settings available for persons with disabilities 8

9. Implementation (con’t) September 11: New resources going to terrorism and state safety issues Federal Real Systems Change Grants: Most promising development 9

10. Some 2002 Olmstead Legislation & Beyond (Preliminary Analysis) Study Commissions –5 states: NH, NM, OK, VT, VA Consumer Direction –CO, FL, ME: Vouchers or direct payment for services –Inexpensive and addresses worker shortages 10

11. Some 2002 Olmstead Legislation (con’t) Systems Change Grant Legislation –Nursing Home Transition –For example, Florida Assessment and Consumer Information and Outreach –One-page info. sheet on HCBS for nursing home residents: Maryland –Assessment: FL (nursing home residents), MS (MR/DD, MI, SA) 11

12. Some 2002 Olmstead Legislation (con’t) Single point of entry –MS (MH, MR/DD, SA) –FL (Florida 211 Network) 12

13. Big Picture Early stages of implementing the Olmstead decision Impact –It has caused providers, consumers and state officials from various departments to come together. –Federal government has revised its policies and offered states flexibility and $$ for them to develop innovative solutions. –States are now looking at reforms not only in the health arena but also in the areas of transportation, housing, education and other social supports to fully integrate people with disabilities into the least restrictive settings. 13

14. Big Picture (con’t) Olmstead implementation will take many years and the plan recommendations will be phased in over time For more info, see http://www.ncsl.org/programs/health/disabil2.htm Get involved (see list of state contacts in Appendix to report) http://www.ncsl.org/programs/health/forum/ olmsreport.htm 14