Press Release

Comments from the Arkansas Waiver Association

Dear Becky:

Please accept the following as the Arkansas Waiver Association's (AWA) public input into the first draft of the Olmstead Effectively Working Plan. AWA is an association of persons with a developmental disability, their families, and the professionals who serve them. Our mission is to promote quality, integrated community supports. We thank the Department of Human Services for giving the public the opportunity to provide input.

WAITING LIST

The stated intention to fund the ACS waiver waiting list is greatly appreciated. We should point out, however, the 1999 and 2001 legislative sessions resulted in proposed appropriations sufficient to expand the waiver by an additional 2,400 persons. Of those 2,400 proposed additions, only 1,000 actually made it onto the waiver. If the other 1,400 individuals had been served, there would not be a huge waiting list facing us now. We believe it is important to understand this is not a never-ending process of continuously adding persons to the program, rather it is one in which we have not yet met the initial demand. We are, of course, aware of some of the circumstances that contributed to this.

The first draft, page 10, indicates the intention to add 1,200 people to the waiver over the next 2 years and states this will bring the total number on the waiver to the "…maximum allowed under the current waiver, which is 3,067 persons." Since there are currently 2,578 individuals on the ACS waiver (as of Oct 28, 2002), this cap will be reached after only 489 individuals have been added. We hope the intention is to raise that cap to at least 3,778. (Also, please note that of the 2,578 persons on the ACS waiver, only 1,615 are actually on the waiver with the remainder being in group homes or follow-on supports which only use the waiver as a method of tapping Medicaid funding---these options existed long before the waiver but were previously funded with general revenue dollars.)

Some places in the draft allude to releasing 50 names a month from the 102 Service Request List. Releasing names is not the same thing as adding people to the waiver. Nor is it the same thing as expanding the waiver to serve an additional 1,200 persons as indicated on page 10, first paragraph. DHS intent in this regard is unclear. Funding seems to indicate that back-fills will be in addition to the 50 a month new recipients. Is this correct?

The proposed appropriation to serve the waiting list is $6.4 million in general revenue. This should generate approximately $23.7 million Medicaid dollars. By dividing this number by the proposed 1,200 new recipients, it yields an average cost of new waivers of $19,750 each. This low a figure would have to include group homes and follow-on supports (level 3 and 4 waivers) or represents unduplicated recipients. The level 3 and 4 waivers were locked in place because of the group home conversion and all new waivers off the waiting list will have to be level 1 waivers. Our experience is the level 1 waivers will cost closer to $25,000 each. There is insufficient funding proposed to support expanding the waiver by an additional 1,200 persons as proposed on page 10, first paragraph.

LEVEL PLAYING FIELD

The Human Development Centers are funded for approximately $75,000 for every client they serve in a captitated system. ACS Waiver services are capped at $160 a day for direct services, or $58,400 for the highest need clients. (These rates are not directly comparable -- the average cost to Medicaid for serving a client on the ACS waiver is $29,000 and this figure includes all costs to Medicaid, not just waiver services). This is not a level playing field in terms of total program funding. It is especially not a level playing field for the individual as there are no caps on any individual plan of care in an HDC.

The $160 a day cap has been in place for 9 years and has never been adjusted for inflation. Today, it purchases one third less than the same amount would have purchased when implemented. The average client cost in an HDC has continued to climb while the waiver cap has remained stagnant.

The failure to adjust or eliminate the $160 cap has eroded waiver effectiveness to the point it is no longer an alternative to an HDC, and that was the original purpose for which the waiver was implemented. This results in a service delivery system where there is a price cut-off on choice for those wishing community services. That is, waiver clients have a choice up to $160 a day and after that they have no choice. Conversely, HDCs have been told they would not be closed or downsized and that no client would be moved against their wishes (Jonesboro and Monticello town meetings). It is presumed, therefore, that clients currently in an HDC will not be moved even if a particular client could be served substantially cheaper in the community. HDC clients have a choice of where they wish to be served regardless of cost while community clients' choices are restricted based on cost. This, too, is not a level playing field. This is institutional bias.

This will not be a level playing field until such time as the average cost to Medicaid of serving a client on the waiver (currently $29,000) begins to approach the average cost of serving a client in an HDC (currently $75,000) -- OR -- arbitrary caps no longer restrict choice.

GIST recommendation #15 has it right and we would encourage DHS to revisit that recommendation and implement it. Failing to do so will, by definition, create a system where HDCs are a mandatory service for some and where choice is restricted for no sound reason.

Nothing in this section should be interpreted as anti-HDC and that is not our intent. We simply want an equal choice among the options. We would support sufficient funding for the HDCs to provide quality care for those who have made that choice, though this number is noticeably absent from the draft plan.

OTHER CONCERNS

HDC without walls is not a concept we can support, nor is the fervent searching for ever new roles for the HDCs. They have a role, an important role, and they should concentrate on that. Concepts such as regional centers and transition waivers are ill advised and appear to be a thinly disguised plan to support the HDCs for a service nobody wants. If HDCs wish to become waiver providers, AWA would welcome them and their outstanding staff with open arms. If they wish to become "special" waiver providers with their own waivers and services for nobody but their clients, then we would oppose that.

Persons transitioning from the HDC to the community should not be entitled to better services than those who are currently in the community and struggling to avoid an institutional placement. To do otherwise would create a revolving door where the only route to good services is first to get an HDC placement. This is not logical, nor does it parallel the thinking of the Olmstead decision.

If a transition waiver is needed to move a client from an HDC to the community, then we have failed sorely with the current waiver. The solution is not a new waiver, but fixing the one we have.

SUMMARY

AWA appreciates the proposed appropriation to serve the waiting list. However, the failure of the plan to address even the most basic leveling of the playing field for the individual falls far short of the Olmstead promise and far short of a fair choice to live in the community. The failure to permit an individual to live in the community even when such a choice can be accommodated at an equal cost, coupled with new initiatives for the HDCs, would seem to indicate the state is endeavoring to keep its institutions fully populated at the expense of individual choice.

Sincerely,

Glenn Thomas

President

Cc: Kurt Knickerum
John Selig
Ray Hanley
David Fray
Bob Trevino