Developmental Disabilities: Service System Overview

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Developmental DisabilitiesService System
Overview

• Presented by the Wisconsin Council on
  Developmental Disabilities
• Mari Frederick, Chair
• Jennifer Ondrejka, Executive Director
• Sponsored by the Wisconsin Legislative Council

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Wisconsin Council on DD

• Federally-funded state agency charged with
  advising the Governor and Legislature and
  supporting consumers in advocacy.
• Funds pilot projects on self-determination,
  employment, education, and inclusion for people
  with DD.

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Wisconsin DD Definition

• Attributed to brain injury, cerebral palsy,
  epilepsy, autism, Prader-Willi syndrome, mental
  retardation, or another condition closely related
  to mental retardation.
• About 100,000 Wisconsin children and adults have
  developmental disabilities.

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Historical Trends

• State Institutions
• Parents Movement
• Disability Rights

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Education

• About 26,000 children with developmental
  disabilities in WI public schools.
• Comprehensive evaluation of childs need for
  services.
• Individualized Education Plan
• Schools reimbursed for about 28 of costs by
  state and federal Special Education Categorical
  Aids (330 million per year).

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Transition to Adulthood

• Transition is a process, not a program.
• Services involved
• Department of Public Instruction
• Collects resources and disseminates on website.
• School Districts
• Collects local resources and works with
  Individualized Education Plan team to prepare
  student for adult life.
• Division of Vocational Rehabilitation
• Participates on team when child turns 14 (ideal).
• County Services
• Operates workshops or supported employment
  programs depending on county.

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Transition For Most Graduates

• Entitlement to school
• services until age 21.
• Age 21 entitlement ends,
• graduate to waiting list
• for services

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Wisconsin System Chapter 51

• State Responsibility
• State institutions, DD services, civil rights,
  program development and quality assurance.
• County Responsibility
• Provide services directly or through contracts.
• 40,000 children and adults get some service.
• Limited funds result in long waiting lists.
• CMO Responsibility
• New for long-term support.

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Medicaid Program Entitlement

• Major funding source for most services.
• Eligibility limited to low-income children and
  adults with severe disabilities.
• Katie Beckett waives family income if costs of
  out-of-home placement exceed cost of care in
  familys home.

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Medicaid Card Services

• REQUIRED SERVICES
• Hospital and Skilled Nursing Facilities
• Home health care (inc. medical supplies and
  equipment) for adults who qualify for SNF
• Physician and nurse practitioner visits
• Screening, diagnosis, treatment and vaccines for
  children
• OPTIONAL SERVICES
• Hospital emergency services
• Inpatient mental hospital care
• Personal care
• Respiratory therapy
• Dental care and dentures
• Eye care and glasses
• Prescriptions
• Therapies such as physical, occupational or
  speech
• Durable medical equipment
• Laboratories and X-Rays
• Home and community based services for people with
  disabilities

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Medicaid Waivers

• Medicaid began with institutional bias new
  programs are allowing more flexibility.
• Waivers simply waive rules to use federal
  funding for community-based services.
• Waiver programs are not entitlements.

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Medicaid Waivers

• Living in community means with family, in an
  apartment, Adult Family Home, or Community-Based
  Residential Facility (CBRF) with 4 or fewer beds.
• CBRFs Group homes.

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Medicaid Waivers

• Common Features
• Individuals needs assessed for service plan.
• Services include residential staff, respite,
  jobs, case management, transportation, or day
  programs.
• State staff assigned for quality assurance.

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Medicaid Waivers CIP 1A

• Community Integration Program 1A
• Individuals leaving State Centers.
• Daily rates depend upon year person left Center,
  average of 200 per day.
• Daily rate does not include Medicaid card costs
  such as physician services, etc.
• State DD Centers
• Central Center has 300 residents.
• Southern Center has 213 residents.
• Daily rates average over 500 per day for all
  services.

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Medicaid Waivers CIP 1B

• Community Integration Program 1B
• Diversion or relocation from institutional care.
• Daily rate of state/federal funds of 49.67.
• Actual costs per day between 34 and 143.
• Waiting lists for CIP/COP over 3,861 people.

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Medicaid Waivers CIP 1B

• Over 3000 people in state matched placements.
• Over 7000 people in locally matched (county funds
  or Community Aids) placements.

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Medicaid Waivers

• Community Relocation Program
• Individuals living in private or county ICFs-MR.
• Daily rate depends on care plan.
• About 490 people have relocated.
• Community Options Program (Regular)
• Used mainly as match for federal funds under the
  Community Integration Program.

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Medicaid Waivers Brain Injury

• Defined as any injury to the brain resulting in
  disability regardless of age of onset.
• Disability must be significant and have required
  rehabilitation services in a nursing home or
  hospital.
• Waiver is another mechanism to fund
  community-based care.

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Services to Kids and Families

• Birth to Three
• Motor, vision, audio and other therapies.
• Federal and state funds entitlement.
• About 10,000 children served in 2004.
• Early intervention may prevent need for long-term
  services.

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Services to Kids and Families

• Family Support Program
• Flexible funding for services, equipment, respite
  care, and other needs.
• In 2005, about 2,423 children served 843
  underserved or served one time 2,586 kids on
  waiting list.
• Under 5 million spent in 2005 can be used as
  match for CIP 1B.

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Services to Kids and Families

• Childrens Long-Term Support Program
• Medicaid waiver.
• Children with autism receive intensive in-home
  treatment at 75 daily rate.
• Children with other disabilities receive services
  at 27 per day rate.

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The Future Direction of LTC

• From fragmented system to Family Care
• Creates an entitlement.
• Allows flexibility in funding.
• Allows for creativity and innovation in services.
• Allows for Self-Determination.
• Provides one stop shopping for information.
• Simplifies administration and reporting.

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Family Care

• All MA waivers combined into flexible pool.
• Managed care model.
• Pilots started in five counties five years ago
  will cover half of state in next biennium.
• Regional planning through county consortia.
• Serves only (at this time) adults with DD,
  physical disabilities, and frail elderly.

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Family Care

• Aging and Disability Resource Centers
• Provide information on available services in
  region.
• Provide benefits counseling.
• Assess individuals for eligibility for services
  (Functional Screen.)

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Family Care

• Care Management Organization (CMO)
• Consortium of counties contract for operation of
  system.
• Resource Allocation Decision (RAD) questionnaire
  determines the type and amount of service an
  individual will receive.
• CMO provides or contracts case management, makes
  arrangement for services, and makes payments.

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Family Care

• Self-Directed Supports Option
• Individuals, families, care managers, with the
  option for help from service brokers develop
  service plans and control implementation.
• Provides opportunities for creativity can use
  trusted friend or family members as provider
  instead of agency.

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What Do People Want?

• Considered full citizen with all the rights and
  responsibilities.
• Valued for his/her contributions.
• Seen as an individual, not a diagnosis.
• Treated with respect.

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