U.S. Department of Health and Human Services Office for Civil Rights The National Olmstead Scene: Federal and State Actions to Achieve Community Integration Richmond, July 31, 2002

Delivering on the Promise Executive Order on Community-Based Alternatives for People with Disabilities New Freedom Initiative Olmstead v. L.C. ADA Integration Regulation

New Freedom Initiative President’s disability agenda. Features proposals in five arenas: –Assistive technology –Education –Homeownership –Employment –Community living

“The Federal Government must assist States and localities to implement swiftly the Olmstead decision, so as to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life.” Executive Order on Community-Based Alternatives

“The United States is committed to community-based alternatives for individuals with disabilities and recognizes that such services advance the best interests of Americans.” “The United States seeks to ensure that America’s community-based programs effectively foster independence and participation in the community for Americans with disabilities.” Executive Order on Community-Based Alternatives

Directs DOJ, HHS, Labor, Housing and Urban Development and SSA to “evaluate the policies and programs, statutes and regulations of their respective agencies to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities.” DOT, VA, OPM joined voluntarily

Executive Order on Community-Based Alternatives Obligates the agencies to involve consumers, advocacy organizations, providers, and relevant agency representatives in the self- evaluation process. –Written comments (8/27/01) –Studies & Policy Research –National Listening Session (9/5/01) –National Teleconference (8/15/01)

HHS Self-Assessment Methodology and Barrier Identification Review by each HHS component of all policies, programs, statutes and regulations Analysis by each component of barriers to community integration and potential solutions Review of existing studies identifying barriers to community integration Public Input

Delivering on the Promise Federal Agency Actions to Eliminate Barriers and Promote Community Integration

Delivering on the Promise HHS Secretary Thompson: Delivering on the Promise “is a comprehensive blueprint toward achieving community living for people with disabilities. “ Contains over 400 specific solutions and action steps federal agencies will take to promote community living.

Delivering on the Promise: 12 Community Living Focus Areas Health care structure and financing Housing Personal assistance, direct care services and community workers Caregiver and family support Transportation Employment

Delivering on the Promise: 12 Community Living Focus Areas (cont.) Education Access to technology Accountability and legal compliance Public awareness, outreach and partnerships Quality of community services Cross-agency collaboration and coordination

Delivering on the Promise: Key Commitments Policy development vehicles Demonstrations Regulatory improvements Technical assistance and quality of care initiatives

Policy Development Vehicle: Medicaid Community Services Reform Task Force Advises HHS on actions to remove barriers and promote community living for people with disabilities Includes representatives of all age, target groups within disability community, as well as national, state, local organizations and government associations.

Policy Development Vehicle: Office on Disability and Community Integration Focal point at HHS for disability issues beginning fall Coordinates disability science, policy, programs and special initiatives within HHS and other federal agencies. Leads interagency coordination efforts, including Interagency Council on Community Living.

Policy Development Vehicle: Interagency Council on Community Living (ICCL) HHS proposes the President formalize permanently this interagency group. ICCL would continue exploring interagency collaborations to promote community-based services policies and programs for people with disabilities.

Delivering on The Promise: Demonstration Projects Workforce shortages demonstration Adult and child respite demonstrations Alternatives to residential treatment demonstrations

Delivering on the Promise: Source Documents Nine agency reports issued 3/25/02 available at HHS Report Progress on the Promise Fact Sheet - quick highlights Preliminary Report issued 12/21/01 –Legal and factual backdrop (Part II) –Highlights key agency action steps

States’ Response to the Olmstead Decision 42 states and DC have task forces, commissions or state agency work groups. 18 states have written reports or plans (17 online). 31 states developing/developed compliance documents of some kind. 12 states working on plans to plan. 15 Olmstead-related bills were considered in 8 states in 2001 (4 enacted).

States’ Response to Olmstead Most plans are not comprehensive: do not contain timelines or budgets, or meet HHS guidelines. 6 states not developing plans. 4 state plans stand out. These feature: –Clear vision for systems change –Specific strategies and goals –Identify agencies responsible for each strategy –Budgets and timelines

States’ Response to Olmstead: Mississippi Recommendations span next ten years. Includes proposed budgets for FY (total: $447 million). Plan’s goal – per legislation - is community services for all people with disabilities by 2011.

States’ Response to Olmstead: Missouri 200-page plan includes inventory of available services. Lists agency responsible for each recommendation along with budget action needed and timeline. Contains recommendations related to: caregiver compensation, housing, transportation.

States’ Response to Olmstead: Ohio Includes comprehensive review of Ohio’s services and supports for people with disabilities. Contains proposed executive budget for FY02-03 of $145 million. Short-term recommendations center on expanding waiver programs.

States’ Response to Olmstead: Texas Includes inventory of available services. Sets forth state budget requests, statute changes, and agency responsible for implementation. Plan includes recommendations to expand all waiver programs and increase outreach to inform people with disabilities about community options.

States’ Response to Olmstead: Challenges Shortage of community workers Transportation, housing 2-tier system: 75% of Medicaid funding spent on institutions Competing waiting lists and needs of unserved versus underserved Fiscal reality: state deficits, recession, new national security costs

Federal Support for Community Integration Systems Change Grants $55 million now being awarded –36m to help states design and implement enduring improvements in their community- based support systems –6m to support states’ efforts to improve personal assistance services. –4m to provide technical assistance, training and information to consumers, families, states and other agencies and organizations

Federal Support: Systems Change Grants and AoA Funding Fall 2001: $70 million in Systems Change Grants distributed to 38 states and territories to design and implement enduring systemic changes. HHS’ Administration on Aging: $113 million awarded to states to develop comprehensive systems of service to support family caregivers, helping people with disabilities remain in the community.

Federal Support for Community Integration July 26, 2002 ADA anniversary: President Bush called on Congress to fund New Freedom Initiative budget requests. Includes $145 million for innovative transportation pilot programs to serve people with disabilities in their communities and workplaces.