State Centers: History and Current Action Needed James Conroy, Ph.D. Nancy Murray M.S.

A Brief History In 1965, Medicaid was created to finance health care for seniors, people with disabilities and the poor. Costs are shared between each state and the federal government based on a formula called the Federal Medical Assistance Percentages (FMAP), which takes into account the wealth of each state.

A Brief History Some Medicaid services are mandatory such as inpatient and outpatient hospital services and skilled nursing services. Other Medicaid services are optional such as dental services and home and community based waiver services. Waiver services are funded through the Medicaid program. Certain provisions of the Social Security Act are “waived” to allow services to be provided outside of institutional settings.

Rebalancing Rebalancing of long term supports and services for people with disabilities and seniors is an effort by states and the federal government to provide these services in community- based settings rather than costly institutions.

In 1967,almost 200,000 people with intellectual and developmental disabilities (I/DD) lived in institutions. By 2015, that number had decreased 89% to 21,030 people. (Coleman Institute for Cognitive Disabilities). State centers have existed in PA for more than 100 years. In the mid-1960’s there were 13,600 people living in PA’s 13 state centers. Today, 798 people live there.

State Center Ebensburg Center Hamburg Center # Polk Center Census Complement ** (Wage and Salary) Per Diem*   Per Annum* Ebensburg Center 214 748 $990 $361,350 Hamburg Center # 38 202 $1420 $518,300 Polk Center 210 792 $975 $355,875 Selinsgrove Center 219 817 $1014 $370,110 White Haven Center 117 455 $1140 $416,100 Total 798 3014 *Per most recent calculation from Office of Budget (6/5/17) # Current projections have everyone transitioned out of Hamburg Center by  7/31/18 ## 31 of these positons are dual employment and annuitants ** this includes all filled wage and salary positions which includes people not working on Leave without Pay (LWOP) and  Work Related Injuries/Act 534 *Per most recent calculation from Office of Budget (6/5/17) # Current projections have everyone transitioned out of Hamburg Center by  7/31/18 ## 31 of these positons are dual employment and annuitants ** this includes all filled wage and salary positions which includes people not working on Leave without Pay (LWOP) and  Work Related Injuries/Act 534

The Difference Between Community Homes and State Centers A home in a community that looks like other homes in the neighborhood and where a few people live. Some people may live by themselves in an apartment or with only one roommate. People make choices about the foods they eat. They go grocery shopping, plan meals, help prepare meals every day and eat with their housemates. An institutional setting where hundreds of people live. People do not go grocery shopping, plan meals or help to prepare meals. That is what the dietary staff does. They are limited to choosing foods served in a dining room where they eat three meals a day with many people.

The Difference Between Community Homes and State Centers People have jobs at community businesses and engage in volunteer and community activities according to their interests on a daily basis. They have opportunities to develop friendships with people who do not have disabilities. Few people are employed in the community or engage in volunteer or community activities on a daily basis. Their friends live at the state center and all have disabilities.

The Difference Between Community Homes and State Centers The average cost per person per year ranges from $100,000 to $217,000. * More than 55,000 Pennsylvanians with an intellectual disability receive various home and community-based services, including more than 12,000 who receive community residential services.* The average cost per person per year ranges from $355,000 to $518,000.* 798 Pennsylvanians with an intellectual disability receive services at a state center.* For most of them, the decision to live at a state center was made by someone else. * ODP, April, 2018

House Bill 1650 Referred to Committee on Health, July 8, 2017 “Providing for the closure of State facilities for individuals with intellectual disabilities, for the transfer of individuals with intellectual disabilities receiving care at State facilities to a home and community based support system and for the disposition of State facility property; establishing the Home and Community Based Services Fund; and making related repeals.”

Action Needed Contact Members of Pennsylvania General Assembly to educate them about (1) the difference in the quality of life for people with intellectual disabilities living in community homes and those living in state centers; and (2) the excessive costs of institutional care compared to costs of home and community based care. Reminder: there are still more than 4,000 people on Pennsylvania’s emergency waiting list, many of whom are living with elderly caregivers, who desperately need services before there is a crisis.

Thank You! For more information please contact Nancy Murray President, The Arc of Greater Pittsburgh nmurray@achieva.info Jim Conroy JConroyCOA@aol.com