Budget Symposium

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• Budget Symposium
• OACBDD
• John L. Martin, Director
• August 21, 2013

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Agenda The Connection between the DODD FY 14 and
15 Biennium Budget and Olmstead
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National Trends

• Olmstead and the Department of Justice
• Continued movement away from ICF/IID to waivers
  and smaller settings.
• Movement from sheltered work supportive
  employment.

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Supreme Court Upholds Americans with Disabilities
Act Integration Mandate in Olmstead decision on
6/22/99
In rejecting the state of Georgias appeal to
enforce institutionalization of individuals with
disabilities, the Supreme Court affirmed the
right of individuals with disabilities to live in
their community in its 6-3 ruling against the
state of Georgia in the case Olmstead v. L.C. and
E.W. The integration mandate of the Americans
with Disabilities Act (ADA) requires public
agencies to provide services in the most
integrated setting appropriate to the needs of
the qualified individuals with disabilities.
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Olmstead was brought by, and thus decided in the
context of, two women with developmental
disabilities who were challenging their
unnecessary segregation in a residential
institution owned and operated by the State. Id.
at 593. Nevertheless, neither the principles of
the decision nor the integration regulation is
limited to the decisions particular facts.
Thus, courts have applied the Olmstead Courts
analysis to numerous other facts and
circumstances involving the unjustified isolation
of persons with disabilities, including claims by
persons with physical or non-mental disabilities,
claims to prohibit unnecessary segregation in
private segregated facilities funded under the
states disability services system, and claims to
prohibit cuts to community services that would
place persons at risk of unnecessary
institutionalization. Taken from the STATEMENT
OF INTEREST OF THE UNITED STATES OF AMERICA Lane
v. Kitzhaber, 212-cv-00138-ST filed by Thomas E.
Perez on April 20, 2012 in the Oregon DOJ action.
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Just as the text of Title II and the integration
regulation is not restricted to person with
mental disabilities, to state-owned facilities,
or to persons already institutionalized, so too
is this statutory and regulatory text not limited
solely to residential settings. Accordingly, the
U.S. Department of Justice has continued to make
clear that the integration regulation prohibits
the unnecessary segregation of persons with
disabilities by public entities in
non-residential settings, including segregated
sheltered workshops. Taken from the STATEMENT
OF INTEREST OF THE UNITED STATES OF AMERICA Lane
v. Kitzhaber, 212-cv-00138-ST filed by Thomas E.
Perez on April 20, 2012 in the Oregon DOJ action.
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Olmstead Activity
In 2009, the Civil Rights Division launched an
aggressive effort to enforce the Supreme Courts
decision in Olmstead v. L.C., a ruling that
requires states to eliminate unnecessary
segregation of persons with disabilities and to
ensure that persons with disabilities receive
services in the most integrated setting
appropriate to their needs.
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Olmstead Activity
The Department of Justice continues to work with
state and local governments officials, disability
rights groups and attorneys around the country,
and with representatives of the Department of
Health and Human Services, to fashion an
effective, nationwide program to enforce the
integration mandate of the Departments
regulation implementing title II of the ADA.
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Olmstead Activity

• An active Department of Justice armed with
  Olmstead and the ADA.
• 40 actions in 25 states in recent years
• Settlement agreement
• Litigation
• Findings Letter

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Ohios Olmstead Concerns
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States with over 1,000 people in State Institutions age 16 and over States with over 1,000 people in State Institutions age 16 and over States with over 1,000 people in State Institutions age 16 and over States with over 1,000 people in State Institutions age 16 and over States with over 1,000 people in State Institutions age 16 and over States with over 1,000 people in State Institutions age 16 and over
(2009 - 2011) (2009 - 2011) (2009 - 2011) (2009 - 2011) (2009 - 2011) (2009 - 2011)
State decreased in 2 years CPD of Beds Ranking
1. Texas 12 474 4,331 45
2. New Jersey 2 622 2,649 49
Illinois 12 537 2,034 39
4. California 19 908 1,774 22
5. North Carolina 4 468 1,572 42
6. Mississippi 3 310 1,333 51
7. New York 12 1,430 1,313 24
8. Ohio 14 511 1,228 33
9. Pennsylvania 6 753 1,174 32
10. Virginia 7 582 1,105 37
National 12   29,574  
        Indicates overall ranking of all states and D.C., number of beds adjusted for population         Indicates overall ranking of all states and D.C., number of beds adjusted for population         Indicates overall ranking of all states and D.C., number of beds adjusted for population         Indicates overall ranking of all states and D.C., number of beds adjusted for population         Indicates overall ranking of all states and D.C., number of beds adjusted for population         Indicates overall ranking of all states and D.C., number of beds adjusted for population
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• 20 states have fewer than 100 people living in
  state institutions with over 16 beds.
• 13 states no longer operate any facilities.

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• State with more than 1,000 private ICF/IID Beds
• 16 beds and above for FY 11
• State of beds
• 1. Ohio 3,417
• Illinois 3,384
• California 2,092
• New York 2,003
• Pennsylvania 1,842
• Florida 1,545
• Iowa 1,454
• National 23,603

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• 15 states have no one living in a private
  facility larger than 16.

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• Nationally, over the past 10 years, the number of
  people living in private facilities larger than
  16 beds has decreased by 33. In Ohio, we have
  actually increased by 6.

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• Our Olmstead concerns extend beyond the ICF/IID
  program.

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• Of the money spent in Adult Services
• 7 - Supported Employment
• 93 - Sheltered Work/Enclaves

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• There are more people receiving services in
  sheltered workshops in Ohio than any other state.

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• The
• Data
• Trail

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Sheltered Workshop (SW)

• State SW People Served
• 1. Ohio 17,118
• 2. New York 14,166
• 3. Minnesota 11,597
• 4. California 10,608
• 5. Pennsylvania 9,915
• 6. Wisconsin 6,529
• 7. Michigan 4,441
• 8. Indiana 4,224
• 9. Massachusetts 3,640
• 10. North Carolina 3,131

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Sheltered Workshop (SW)

• State SW Person Count Per 100K
• 1. Minnesota 217
• 2. South Dakota 196
• 3. Ohio 148
• 4. Wisconsin 114
• 5. Iowa 93
• 6. Rhode Island 87
• 7. Pennsylvania 78
• 8. New York 73
• 9. Oregon 66
• 10. Indiana 65

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Integrated Employment (IE)

• State IE Person Count Per 100K
• 1. Vermont 155
• 2. Connecticut 133
• 3. Washington 109
• 4. New Hampshire 97
• 5. Oregon 94
• 6. Maryland 84
• 7. Rhode Island 76
• 8. Ohio 67
• 9. Oklahoma 65
• 10. Iowa 62

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Facility-Based and Community-Based Non-Work Per
100,000

• Rhode Island 373
• Vermont 286
• New York 228
• Nebraska 223
• Colorado 214
• District of Columbia 208
• Alaska 197
• Wisconsin 187
• Oregon 186
• Indiana 181
• 25. Ohio 102

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Total Served in Day Services Per 100,000

1. Vermont 441
2. New York 355
3. Iowa 313
4. South Dakota 293
5. Rhode Island 288
6. Ohio 284
7. Oregon 279
8. District of Columbia 274
9. Minnesota 263
10. Nebraska 261

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Day Services Per 100,000

1. Ottawa 51
2. Van Wert 46
3. Henry 46
4. Putnam 42
5. Wyandot 41
6. Sandusky 41
7. Allen 40
8. Paulding 40
9. Richland 40
10. Clark 40
11. Seneca 38
12. Carroll 38
13. Belmont 37
14. Hocking 37
15. Perry 37
16. Pike 37
17. Lucas 37
18. Darke 36
19. Mercer 36

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Facility-Based Work Per 100,000

1. Van Wert 37
2. Ottawa 36
3. Vinton 34
4. Pike 33
5. Clark 31
6. Guernsey 30
7. Carroll 30
8. Paulding 30
9. Putnam 30
10. Monroe 28
11. Wayne 27
12. Sandusky 27
13. Wyandot 26
14. Seneca 26
15. Lawrence 25
16. Richland 24
17. Morgan 23
18. Perry 22
19. Meigs 22

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Integrated Employment Per 100,000

1. Henry 20
2. Mercer 17
3. Clinton 17
4. Union 16
5. Allen 14
6. Wood 14
7. Fayette 11
8. Washington 11
9. Lorain 11
10. Morgan 11
11. Athens 11
12. Medina 10
13. Knox 10
14. Sandusky 9
15. Stark 9
16. Hancock 9
17. Logan 8
18. Belmont 8
19. Lucas 8

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• Nationally the emphasis is on integrated
  employment and a de-emphasis on sheltered
  workshops. This has created a series of trends,
  including employment first policies like Ohio
  initiated a year ago. This was a key initiative
  of the current chair of the National Governors
  Conference.

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National Trends

• Performance based rates
• A few states are totally out of the sheltered
  workshop business
• A number of states have closed the front door on
  sheltered workshop admissions
• Virtually every state is looking at realigning
  their funding away from sheltered workshops
• Increase effort to eliminate the subminimum wage
  exemption
• Working age adult policy (can only go into adult
  day after 9 months in Integrated Employment)

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DODD issued its White Paper on ICF/IIDs and its
Employment First Policy as a result of these
Olmstead concerns. www.dodd.ohio.gov
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• As a result of the recently passed budget
• Money and language changes will continue to
  support employment efforts.
• ICF language and money will support downsizing
  and conversions. Providers have committed to
  1200 beds being converted or downsized over the
  next 5 years.
• Downsizing of developmental centers will continue
  at 90 per year.

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Language Changes in the Budget

• Language Provisions for Employment Rebalancing
  Employment First
• Make changes to improve data collection
• Make permanent the Governors Employment First
  Taskforce
• Create a presumption that all individuals with
  disabilities can work
• Ask local county boards to create their own
  employment first policies
• Create a new employment first line item

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Employment First Line Item (3 million a year)

• Put up a data collection system
• Fund seven pilot local teams
• Provide statewide training in supported
  employment
• Implement with Opportunities for Ohioans with
  Disabilities (RSC) a program to fund job
  placement for 1,500 working age adults a year
  statewide. (Hamilton County is slated for
  approximately 120 slots per year)
• Goal Move 5.5 of individuals served in
  segregated settings to integrated employment per
  year.

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Our efforts to support downsizing, conversion of
ICF to Waiver, and Employment are based on more
than Olmstead and the fear of litigation.
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• The transition from ICFs to Waivers and from
  Sheltered Workshops to Integrated Employment is
  based on some fundamental principles.
• Choice part of being human is the right to make
  choices. The more choices we take away from
  people the more we dehumanize them. Think
  prisons, dictatorships, communism, slavery and
  segregation.

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PRINCIPLES CHOICE continued

• In this context Olmstead and the Americans with
  Disabilities Act are at their core civil rights
  legislation. Their aim is to put choice and
  control in the hands of individuals and their
  guardians, not the provider.
• In the ICF program the provider controls many
  choices, including day services and most
  important, the funding for the bed.
• In the Waiver program this control is transferred
  from provider to the individual or guardian.
  They can take their money and leave.

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PRINCIPLES - Segregation

• Segregation ICFs and sheltered workshops are
  often larger (Ohio has 3,400 people living in
  facilities larger than 16 beds) segregated campus
  like settings. Segregation sends a dehumanizing
  message they are not like us, and either we
  need to be protected from them or they need to
  be protected from us or they are so unlike us
  they can not live like us.

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3. Money provides the opportunity for real
choice, self-esteem and freedom.
PRINCIPLES - Money
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These principles of segregation and choice create
National pressure and National trends which
question the long term viability of the ICF
program and sheltered workshops and the
willingness of the Federal Government to continue
funding these program.