Ohio’s system of supporting individuals with developmental disabilities is entering a new period in its evolution. The Ohio Department of Developmental Disabilities (DODD) and the County Board system as we know it, are preparing for change to comply with new federal Medicaid Rules and changes funded in the Governor’s historic budget. The expectation is that there be an even greater focus towards inclusion and community involvement for all persons served. Summit County Developmental Disabilities Board (Summit DD) is building on a rich history of support and involvement from the community to increase access to integrated, community-based services that connect individuals to full, equitable lives that achieve their personal vision of health, happiness and success.
“Since its origination, Ohio’s system was designed to create opportunities for individuals based on choices the individuals and their families made about what is important to them,” commented Summit DD Superintendent John Trunk. “As we navigate the changes ahead and build a more inclusive support system our two main priorities are to respect the choices of all those we support and to expand our engagement with our community.”
History of Developmental Disability System in Ohio and Summit County
Senate Bill 169 created County Boards of Developmental Disabilities in 1967 to develop, deliver and fund quality local programs to keep individuals with disabilities in their homes and communities, rather than state institutions. Boards had the ability to propose levies and bond issues to provide services based on the needs of each county. In Summit County, the Board started with a 0.5 mill operating levy and a $3.3 million dollar bond to build the Weaver School and Weaver Workshop, and provide school and work programs for children and adults where none had existed before. Operating funds were also used to pay for care in the family home.
The Ohio Department of Developmental Disabilities provides oversight to the state’s developmental disability support system through the Ohio Administrative Code. County Boards across the state, including Summit DD, are responsible for designing, coordinating and funding the majority of these services based on local need.
Over the past 15 years, Summit County took historic steps to invest in more community based integrated services for children and residential and day services for adults. Redesigned funding allowed Summit DD to leverage local funding to access Medicaid waivers that pay 60 percent of the cost of services while the County Board provides a 40 percent match. This shift in how supports could be paid for also created opportunities for the County Board to collaborate more with community partners and expand the network of service options available to individuals.
“Approximately 85% of adults supported by Summit DD receive waiver funding,” commented Trunk. “Accessing more federal funds over the past 15 years has allowed the Board to stretch our local dollars to support a growing number of individuals with developmental disabilities, from birth to senior citizen, in quality environments throughout our community.
Currently, the Medicaid waiver programs include non-medical transportation, employment and day services, and personal care assistance to help individuals live in the family home or in homes around the community. The Center for Medicare & Medicaid Services (CMS) administers the federal Medicaid program and funding and develops standards for these home and community based services.
Key Issues Driving Change
CMS Rule Change
CMS implemented a new rule last year that states Medicaid funds can no longer be used to provide waiver services in settings that isolate individuals and don’t provide full access to the greater community, such as sheltered workshops and large group living arrangements.
Additionally, the CMS rule also calls for what they refer to as “conflict free case management”. County Boards, including Summit DD, employ Service and Support Administrators (SSA) who determine eligibility, develop service plans and connect people to providers to fill the needs in their service plans. These are case management functions as defined by CMS. In addition to providing these SSA’s services, many County Boards, including Summit DD, also provide transportation and adult services directly to individuals that are funded locally or subsidized through Waiver funding. According to CMS, there is an inherent conflict of interest with this structure and CMS and DODD have reached an agreement to phase-out this conflict by 2024.
Many states, including Ohio, will need to develop a transition plan to come into compliance with the new rule. In a transition plan submitted by DODD to CMS in mid-March, Ohio requested 10-years, rather than 5 years, to come into full compliance. We expect that CMS to provide feedback on that plan later this summer.
“Today Summit DD provides 46% of day services, 52% of employment services, and 37% of transportation services,” stated Trunk. “Those percentages have decreased drastically over the past ten years as more quality providers are available. I feel we have already started down the path of creating some separation while continuing to make sure everyone gets the support they need without waiting. We’ve accomplished this by connecting individuals to many quality providers with whom we partner here in Summit County. ”
DODD’s transition plan also continues the national trend in downsizing Developmental Centers and Intermediate Care Facilities in favor of more community-minded residential options. There are no Developmental Centers in Summit County and only 92 individuals reside in an Intermediate Care Facility, which is less than 1 percent than all people receiving residential support through Summit DD.
Disability Rights Ohio
Disability Rights Ohio (DRO) believes Ohio is violating the Americans with Disabilities Act (ADA) and related court decisions because the system favors segregation and institutional placement. While the state has made progress, DRO believes there has been no meaningful steps toward ensuring people with developmental disabilities have access to greater community integration. DRO requested the state make specific changes in its system to avoid litigation.
The Governor’s Budget
Governor John Kasich’s 2016-2017 biennial budget was signed on June 30, 2015. This budget makes a historic investment in Ohioans with developmental disabilities, investing $286 million over the next two years to increase opportunities for individuals to live and work the community.
Many of the initiatives that have been covered over the last several months are a part of the final budget. Approximately 3,000 new waivers will help reduce the waiting list, and help individuals who currently live in Intermediate Care Facilities (ICF) and want to move into a home in the community with a waiver to do so. The budget will provide for a much-deserved wage increase for Direct Care Staff. Individuals who live in ICFs will have more space and privacy, and work will begin on a new reimbursement model.
Summit County’s Future
Summit DD supports each individual through their life journey. Additionally, we strive to transform public perception so that together we will build an even more welcoming community. Through long-range planning the Agency has built a more robust person-centered planning process that respects the wishes and choices of each individual, developed employment opportunities and ensured that each person has an opportunity to discover where their future path may take them, worked to ease transition points for families, and developed a quality provider community that can support individuals’ wishes and needs. For children and families, we have implemented an evidence-based early intervention program, expanded early intervention support, and increased integrated community options for children.
“Each set of services begins with a person or family-centered plan,” commented Trunk. “Person-centered planning provides choices to individuals based on what they do and do not want, it is our goal to make sure more integrated experiences are available to those who want them.”
Summit DD’s work continues in the 2016-2018 long range plan to support youth in transition with innovative and integrated options, to offer creative residential support, to develop a provider community that supports integrated services, and continue to transform community perceptions which will lead to more options than ever. Our hope is that youth will have lived a fully inclusive childhood and when they enter adulthood, inclusive day and life options will be the only choice desired by most.
Summit DD will continue to work with families and partners to implement any system changes over a period of time through the person-centered planning process. In the meantime, we will continue to work to ensure people with developmental disabilities live in the same communities and are able to do the same things as people who do not have disabilities.
“We are talking about both employment and integrated day options,” stated Trunk. “While many people are capable of community employment, if an individual doesn’t want to or can’t work in the community they won’t be forced into an employment option.”
Summit DD will also strengthen its provider development and quality assurance activities to ensure families have choices among quality providers. All providers of service must ensure that their programs meet home and community based CMS requirements.
“Our Board is committed to quality services that ensure the health and welfare of those we support,” stated Trunk. “Summit DD has a long history of viewing every person as unique, with unique needs, skills and interests. We always have been, and will remain, completely dedicated to seeing that every person gets the individualized supports they need to live a quality life. No one will be overlooked.”
With external factors urging system redesign, local and state plans in place to execute that redesign, and a budget that funds meaningful change – Ohio and Summit County are on a wave of change that can be both exciting and somewhat overwhelming to everyone involved. Summit DD’s goal is to be proactive and transparent with communication and changes as we continue our practice of honoring the choices of individuals. We will help those who wish to participate in more integrated experiences to do so, and allow those who wish to remain in their current settings to do so – as long as that setting does not have the effect of isolating them from the broader community.
In Case You Missed It
May 21, 2015, Cuyahoga Falls Community Meeting
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