Texas

1
National Home and Community Based Services
Conference Atlanta, GA
Texas Money Follows the Person Addressing
Barriers to Successful Community Placement
Marc S. Gold Texas Department of Aging
Disability Services Dena Stoner Texas Department
of State Health Services September 27, 2010
2
Texas Demographics

• Population 25,373,947 (2010)
• Counties 254
• Regional Divisions 11
• Nursing Facilities _at_1,196
• ICFs/MR 868
• Local Mental Health Authorities 39
• Local Mental Retardation Authorities39
• Area Agencies on Aging 28
• Centers for Independent Living 26 (164
• counties)

3
2010 Population Statistics

• Nursing Facility 55,000
• ICFs/MR _at_10,300
• Interest Lists
• CBA _at_34,050 -- Wait time 1-2 years
• STAR _at_5630 -- Wait time 1-2 years
• MDCP 18,113 -- Wait time 3-4 years
• CLASS 32,121 -- Wait time 3-4 years
• HCS 45,884 -- Wait time 4-5 years

4
Fundamental Issues

• Texas has stringent criteria for admission
• Interests Lists 139,929 (probable
• eligibility (93,419)
• Fixed Waiver Services Arrays
• Large institutional ICF/MR structure

5
Waivers Background Information

• 1915 (c) waivers
• Nursing Facility
• Community-based Alternatives
• (CBA)
• STARPLUS
• Medically Dependent Childrens
• Program (MDCP)

6
Waivers Background Information

• 1915 (c) waivers
• ICF/MR
• Home and Community-based
• Services (HCS)
• Texas Home Living
• Community Living Assistance
• and Support Services (CLASS)
• Deaf-Blind Multiple Disabilities

7
Promoting Independence History

• June 1999 Olmstead Decision
• September 1999 Governor George W. Bushs
• Executive Order GWB 99-2 (1999)
• June 2001 Texas Senate Bill 367, Rider 37
• Texas Money Follows the Person

8
Promoting Independence History

• Governor Rick Perrys Executive Order RP-13
• TX Health and Human Services Consolidation
• June 2005 House Bill 1867
• 2007 CMS MFP National Demonstration

9
Interagency Collaboration

• Promoting Independence Advisory
• Committee (1999)
• 2004 Health and Human Services
• Consolidation
• Community Transition Teams
• Housing and Health Services Coordinating
• Council (2009)
• Several interagency councils on children
• Interagency council on behavioral health
• transformation (2007)

10
Waiver Services

• NF services most used
• Adaptive Aids/DMS
• Medical Supplies
• Nursing Services
• Attendant Services
• HCS services most used
• Dental
• Day habilitation
• Nursing
• Residential Support

11
MFP and Priority Populations

• MFP and nursing facility populations
• Priority Populations and Intermediate Care
• Facilities for Persons with MR

12
MFP Statistics (August 31, 2010)

• More than 21,000 individuals have transitioned
• from Texas Medicaid-certified nursing
  facilities
• More than 8,000 individuals remain active in
• the community
• 0-21 years of age 2,046 children
• 22-44 years of age 9 percent
• 45-64 years of age 34 percent
• 65-74 years of age 20 percent
• 75-84 years of age 22 percent
• 85 years of age 15 percent

13
MFP Statistics

• 56 percent female
• 44 percent male
• 39 percent living with a family member
• 24 percent living in assisted living
• 32 percent living alone
• 1 percent living in adult foster care
• 3 percent with other waiver individual
• 1 other
• Retention Rates _at_95 percent

14
Priority Populations

• Over 3,000 from nine or more bed
• private ICFs /MR and State Supported
• Living Centers
• Individuals with complex
• medical/behavioral needs
• Placement of choice HCS-Residential

15
Barriers to Relocation

• Long-term institutionalization
• Information/knowledge of options
• Co-occurring behavioral health issues
• Lack of a statewide provider base to serve
• individuals with complex needs
• Stabilized direct services workforce
• Lack of rural service providers /
  transportation

16
Barriers to Relocation

• Health and welfare concerns
• Family/guardian concerns
• Personal fears
• Provider liability
• Loss of community supports
• Service array flexibility
• Lack of housing

17
Barriers to Relocation

• Coordination of services/SSI address change
• Criminal History Checks
• Home Modifications
• Durable Medical Equipment

18
Communication NF population

• Relocation Specialists
• NF Ombudsman and Social Workers
• Minimum Data Set, Section Q
• Developing new PASRR process
• Community Transitions Teams
• Aging Disability Resource Centers
• Family Councils

19
Communication IDD population

• Community Living Options
• Information Process
• Community Living Options

20
Family/Guardian Concerns

• Family concerns/resistance
• Guardian issues
• Physician resistance

21
Relocations Contractors

• Nine catchment areas
• Centers for Independent Living
• Area Agency on Aging
• Case Management activities
• Pre-relocation services
• Outreach/Education
• Facilitation/Coordination
• Housing Navigation and Supports
• Coordination with local organizations
• Post-relocation services
• Coordination with managed care

22
MFP Demonstration

• NF and ICF/MR populations
• Behavioral Health project
• Housing Initiatives
• Overnight supports
• Post-relocation Services
• Voluntary Closure of private ICFs/MR
• 1,599 individuals from NFs
• 1,400 individuals from ICFs/MR
• Met all benchmarks in July 2010 and
• now exceed 3,113

23
MFP Behavioral Health Pilot

• Bexar County (2010 expansion in progress)
• Goals
• Transition adults with mental health and/or
• substance use disorders from NFs to the
• community and help them be successful
• Improve services and supports in the long-
• term care system for people with mental
• health and substance use disorders

24
A True Collaboration

• DADS (long term care) operates the overall MFP
  Project and provides relocation assistance.
• DSHS (state mental health and substance abuse)
  operates the MFP BH Pilot.
• The Local Mental Health Authority provides the BH
  Pilot services.
• HHSC (State Medicaid) provides community-based
  long term services and supports through HMOs.
• UT Health Science Center in San Antonio provides
  technical assistance, training and evaluation.

25
Collaboration in Action
26
Behavioral Health Pilot Services

• Substance abuse / dependence
• treatment services (individual and group)
• Cognitive Adaptation Training (CAT)
• Pilot services are closely coordinated with
• acute and long term services
• Pilot services are available six months
• prior to discharge from the NF and up
• to 365 days after discharge

27
Substance Abuse / Dependence

• Individual and group counseling, including
• specialized groups
• Peer Support
• Linkage to community resources

28
Cognitive Adaptation Training

• Evidence-based service, recovery-oriented
• Provides assistance and simple
• environmental modifications to help people
• establish daily routines, organize their
• environment and function independently
• Uses motivational interviewing to facilitate
• the persons initiative and independence
• Coordinated with HCBS services

29
CAT Intervention Organization

Apathy Disinhibition
Mixed
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CAT Intervention Medication
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Behavioral Health IDD

• Positive Behavior Management
• New project to explore including more
• intensive behavioral health services

32
Housing

• State Housing Agency (TDHCA)
• Public Housing Authorities
• Disability Advisory Workgroup
• Housing and Health Services
• Coordinating Council
• Transition Assistance Services/
• Transition to Life in the Community

33

• Texas Dept. of Housing and Community Affairs

• Grants to local agencies
• Tennant Based Rental Assistance 24
• months (30 of income for rent).
• Amy Young Barrier Removal Program
• 15,000 w/Additional 5,000
• Project Access Vouchers
• Only available for NF and ICF/MR
• relocations
• From 65 to 100 on January 1, 2011
• 80 for non-elderly disabled (lt62)
• 20 for 65
• Resident only pays 30 of adjusted gross
• income for rent and utilities

34
Local Housing Programs

• Housing Voucher Programs
• Relocation contractors work with state and
• local Public Housing Agencies (PHAs) to assist
  individuals find affordable, assessable, and
  integrated housing.
• Local Public Housing Authorities - Housing
  units and Section 8 Vouchers
• Resident only pays 30 of adjusted gross
• income

35
Health and Welfare

• Individual Responsibility Agreement
• Overnight Companion Services
• Working with provider base to serve
• individuals with complex needs

36
Workforce

• High turnover of community-based
• direct service workers
• Consumer Directed Services
• Workforce Advisory Council e.g.,
• Realistic Job Preview
• Major issue reimbursement

37
MFP Demonstration - New Projects

• Behavioral Health Expansion
• Dedicated staff to focus on workforce
• Housing navigators
• Staff to focus on individuals leaving
• large ICFs/MR
• Creating specific databases
• Ongoing training

38
The Future

• New Money Follows the Person Demonstration
  funding opportunities
• Waiver service array
• HUD Notice of Funding Availability
  additional Section 8 type vouchers

39
The Future

• Working with provider base
• Managed Care
• Institutional diversion programs risk slots
• and community living program
• Specialized waivers
• Childrens efforts

40
Contact Inf ormation
Marc S. Gold Director, Promoting Independence
Initiative 512.438.2260 marc.gold_at_dads.state.tx.us
www.dads.state.tx.us/business/pi/index.html Dena
Stoner, Senior Policy Advisor 512.206.4851 dena.s
toner_at_dshs.state.tx.us