The "Rights Advocate" newsletter—March 2006
Volume: 6 Number: 1 March 2006
Contents
- » Federal Lawsuit Settled
- » Meet the P&A Staff
- » Advocacy Rally at the Capitol
- » Calendar
- » PDF version for printing
Federal Lawsuit Settled
By Bill Dolan, P&A Attorney
Protection and Advocacy and the Kentucky Cabinet for Health and Family Services have reached an agreement to settle the federal lawsuit known as Michelle P. v. Birdwhistell.
This agreement will increase Medicaid funding for developmental disabilities services. It will also move the state away from Medicaid’s bias toward serving people in institutions and toward a preference for community-based services.
What was this case about?
The Plaintiffs (the people who file a lawsuit) are several individuals who represent a class of people with mental retardation and developmental disabilities (MR/DD). They were not getting Medicaid community-based services designed to keep them from going into nursing homes or intermediate care facilities (ICFs/MR).
The Plaintiffs reached a settlement agreement that the Court has found to be fair and reasonable.
What does the Agreement provide?
Kentucky Medicaid is going through some drastic changes. For example, there will soon be no SCL waiver with “slots”, nor will there be a Home and Community Based Waiver (HCBW) designed to keep people out of nursing homes.
As soon as Kentucky receives federal approval, it will begin operating under a §1115 (Section 1115) waiver called “KyHealth Choices”. Then all Medicaid eligible people with MR/DD will get their services in a part of this waiver called the “Optimum Choices Plan”. Unlike in the SCL waiver, these services will be provided only at the time they are needed and only if they are medically necessary.
In the settlement, the Plaintiffs focused almost all of their efforts on getting more money for MR/DD services and getting those services to people with MR/DD as soon as possible. This was because big changes are coming and many of the details of those changes are still unknown. The settlement calls for the following:
- $247,900,000.00 increase in the funding for MR/DD services between today and calendar year 2010 (this will more than double the funding from current levels).
- $27,500,000.00 for Supports for Community Living in 2007 and 2008 (or to Optimum Choices when the §1115 waver is approved).
- $15,200,000.00 for crisis stabilization services for persons with MR/DD.
- $3,000,000.00 new general fund dollars for the Supported Living Program.
- A new level of service comparable to Home and Community Based Waiver available to Medicaid eligible people with MR/DD which may be self-directed for non-medical services.
- Grandfathering of all current SCL recipients into the §1115 waiver with all the services intact as of the date of the transition (currently April 1, 2006).
- Increased reimbursement to family care homes and adult foster homes by a minimum of 75% to encourage provider development.
- Adoption of “money follows the person” for people leaving publicly funded ICFs/MR, with a pledge to leave those beds empty. This policy is expected to encourage the downsizing of institutions for people with MR/DD.
- A movement toward providing community-based Medicaid services for people with MR/DD in Kentucky.
- Savings realized from the “Optimum Choices Plan” and any downsizing of public institutions are to be retained in the “Optimum Choices Plan”.
What is a §1115 waiver anyway?
Most Medicaid services in Kentucky, like doctor visits and medications are currently delivered on a “fee for service” basis. Kentucky uses §1915(c) waivers like SCL and HCBW to provide community-based services. The numbers refer to sections in the federal Medicaid law. Without these waivers the state would not have the flexibility to pay for these services in the community. These waivers are only focused on limited populations, however.
The §1115 waiver changes the entire Medicaid program into one big super-waiver. The §1115 Waiver has four benefits packages—“Global Choices”, “Comprehensive Choices”, “Family Choices”, and “Optimum Choices”. MR/DD services (ICF/MR level of care) will be delivered through the “Optimum Choices Plan”.
Will my SCL services change after SCL is switched to §1115?
When §1115 takes effect, anyone who is receiving SCL services will continue to receive all the services they have been getting. People who get SCL services now, but don’t use the residential services will not be guaranteed residential services.
What services will be offered?
All services currently offered in SCL will be offered in the “Optimum Choices Plan.” There are also some additional services such as attendant/companion care, homemaking, shopping and personal care services.
When will the change-over (scl to §1115) occur?
The federal Center for Medicare and Medicaid Services has to approve all operating procedures and any new and amended regulations. The current target date is April 2006.
Do I have to do anything to get these services?
If you have not already applied for SCL services, you can call an SCL provider in your area, or call the division for MR at (502) 564-7702. The “Optimum Choices Plan” is for individuals who meet ICF/MR level of care. If and when the §1115 waiver is approved, people receiving SCL services will automatically move to the “Optimum Choices Plan.”
Even if I can get Medicaid to pay, I can’t find a provider. Will this settlement help me?
Yes. The MR/DD budget is going to more than double. This should cause the number of providers to increase, and services to be more available. Plus, the Cabinet will increase reimbursement to family care homes and adult foster homes a minimum of 75%.
Is there a guarantee that the new money will be available?
The funds for 2007 and 2008 are in the Governor’s budget. The legislature must approve this like any other budget item. If the legislature or the executive fails to meet the terms of this Agreement, before the end of the 2008 legislative session, there is an option to return to court and resume arguing the case.
Does this have an impact on ICFs/MR?
Both sides have agreed that any savings that result from people moving from publicly funded ICFs/MR to the community will go to community services. Also, except in limited circumstances, publicly funded ICF/MR beds will not be re-filled when someone leaves the institution. Lastly, both sides have agreed that the Cabinet will work for changes in current law to give them more flexibility in making institutional changes.
What is the crisis stabilization program?
It doesn’t exist yet, but the Cabinet for Health and Family Services will work to create it. When someone is in crisis, the services in this program should focus on stabilizing them in their home, before going to any alternate setting.
Is there anything else?
The Cabinet has agreed to seek our comments on any draft administrative regulations relating to any issue that may affect the MR/DD population, and to do that before the administrative regulation is submitted for final execution.
If I have more questions or concerns, who do I call?
- Department for Medicaid Services (502) 564-4321
- Division of Mental Retardation (502) 564-7700
- Protection & Advocacy (502) 564-2967
P&A News
Meet the P&A Staff
By Paul Phillips
One of the best things about Protection and Advocacy is the quality of our staff. We have a diversity of training and backgrounds that result in a wide range of knowledge and skills. There are few disability issues that someone on staff doesn’t know something about. If we need to know more, someone usually knows who the experts are, and may even have worked with them in the past.
If you have ever had occasion to work with us on something, you may have met one or two of these folks. As an ongoing feature, I will eventually introduce all of them to you.
In this issue, we start with Beth Metzger. Then it’s my turn.
Beth Metzger
Where are you from?
I was born in Columbia South Carolina, and grew up near Knoxville Tennessee. I came to Kentucky to go to college.
Where did you go to school?
I went to Berea College and graduated with a Bachelor of Arts in Sociology. After experiencing the “real world” for several years, I went to Eastern Kentucky University for a Master of Science degree in Criminal Justice.
What other kinds of work have you done, before coming to P&A?
While in graduate school at EKU, I was a graduate assistant at the Regional Community Policing Institute there and created police training programs. I have been a Family Services Worker in what used to be the Department for Social Services. I worked in child and adult protective services, and with juveniles. I have also worked as an Initial Service Coordinator for Bluegrass First Steps. I was responsible for connecting children with disabilities between the ages of birth and three years old and their families with services.
How long have you been with P&A?
It will be 5 years in July.
What kind of work do you do at P&A?
I do Information and Referral, which involves listening to the concerns of the individuals who contact us, answering the disability-related questions, referring them to any available resources they may not be aware of, or referring them for case representation. I share in the writing of our informational publications. I coordinate our activities under HAVA (Help America Vote Act). I also serve on the TASC/NDRN Resource Advocacy Committee for our national association.
What made you decide to come to P&A (and continue to stay)—what do you find satisfying about the work?
I didn’t know that P&A existed until just before I interviewed for my job here. There are two main things I really like about working here. One is that my coworkers are fantastic. The second is that I feel like I’m really helping people get empowered.
What else would you like people to know about you—family, hobbies, other outside activities?
I’ve been married to Tim for almost 14 years. We have a daughter named Hannah who is eight years old, and a rather goofy Black Labrador named Coda. I enjoy reading, baking, crafts, and camping.
Paul Phillips
Where are you from?
I’m an Army Brat, my father was a professional soldier while I was growing up. So, I’m not really from anywhere specific. I was born in Norfolk Virginia and have lived in that area at various points in my life. It’s as close as I come to a hometown. I spent 2/3 of my childhood in different military towns in the south-east US. I also had the opportunity to spend almost five years of my childhood overseas during two stays on Okinawa, which is an island that is now part of Japan.
Where did you go to school?
I went to 14 schools during my first 12 years of school. Then I went to Roanoke College in Virginia and graduated with a Bachelor of Liberal Arts degree. I was two credits short of having a major in psychology and after I took those classes I went to Eastern Kentucky University and graduated with a Master of Science degree in Clinical Psychology.
What other kinds of work have you done, before coming to P&A?
My first professional job was in a residential treatment program for emotionally disturbed children. I’ve worked in community mental health centers in North Carolina and Kentucky. Just before coming to P&A, I was working as a psychologist in a private psychiatric hospital.
How long have you been with P&A?
It will be 20 years in the summer of 2006.
What kind of work do you do at P&A?
For the past several years, I’ve been doing mostly technical support and information management things. I manage our web sites. I’m responsible for our publication design and production. I do some writing, and edit and produce our newsletter. Everyone also comes to tell me “My computer isn’t working right.” I also handle some of our information and referral calls related to special education issues.
Prior to that I worked as an advocate in all of the settings and with all the types of clients we work with. In my last few years as an advocate, I worked with special education problems.
What made you decide to come to P&A (and continue to stay)—what do you find satisfying about the work?
The reason I was looking for another job when I interviewed with P&A was mostly a practical one. I was about to be “downsized” out of the job I had in a psychiatric hospital. But, I also didn’t feel that I was allowed to contribute very much to helping people there. it was all about doctors and drugs.
What made me feel like Brer Rabbit in the briar patch after I interviewed here was the P&A mission. To me it sounded like “truth, justice, and the American way.” We would be fighting against the senseless bureaucratic systems that kept our clients from getting what they wanted and needed, and what they deserved. It just seemed like the right thing to do, and it still does. That’s why I stay.
What else would you like people to know about you—family, hobbies, other outside activities?
I’ve been married to a wonderful woman for almost 20 years and we have a son who will finish high school next year. My interests are wide and varied. I am a perpetual student—I believe any day you don’t learn something is a day wasted.
Systemic Issues
Advocacy Rally at the Capitol
By Paul Phillips
On February 16th, hundreds of Kentuckians attended a rally at the state Capitol to advocate for increased funding for programs that serve people with disabilities, as well as other changes that will make it easier for people with disabilities to be full, participating members of our communities.
The rally was organized by The United 874K Coalition. The name comes from the results of the 2000 federal census, which showed that there are just over 874 thousand Kentuckians over the age of five who have a disability. That is 24% of Kentuckians in that age group, and does not include people with disabilities living in institutions.
A number of people spoke about their experiences as people with disabilities in Kentucky, and how they are able to successfully live in the community when the service delivery system meets their needs. Their stories covered the areas of transportation, supported housing, education, voting, personal care attendant services, supported living programs, employment, and independent living and assistive technology.
The Coalition has over 60 sponsoring agencies and organizations. One of those sponsors is P&A, through our two advisory bodies. Some members participated in the rally and P&A staff provided information on voting rights and polling place accessibility to participants at the rally. This fit perfectly with the slogan of the Coalition, which is “I count! I matter! I vote!”
After attending the rally, members of P&A’s PADD Advisory Board and other supporters had a working lunch at the Capitol Annex Cafeteria. From left to right: Tommy Malone, Joe Dodge, Michael Austin, Michael Gillespie, and Susan Scott (facing away from the camera)
Calendar
April 21-22—Friday-Saturday
The Arc of Kentucky’s 2006 Annual Conference and Pre-Conference Session for Family to Family Spring Training
Sheraton Suites, Lexington
For more information contact: The Arc of Kentucky (502) 875-5225 or (800)-281-1272
May 9—Tuesday
Kentucky Commission on Autism Spectrum Disorders
1:00 pm— 4:00 pm
Conference Room A & B, Fourth Floor, 100 Fair Oaks Lane, Frankfort
For more information, go to: http://mhmr.ky.gov/mhsas/KHMS%20PC%20Hmpg.asp
May 11—Thursday
Kentucky Mental Health Services Planning Council Meeting
10:00 am— 2:00 pm
Conference Room A & B, Fourth Floor, 100 Fair Oaks Lane, Frankfort
For more information, go to: http://mhmr.ky.gov/mhsas/KHMS%20PC%20Hmpg.asp
May 24-25—Wednesday-Thursday
Kentucky Council on Developmental Disabilities Meeting
9:00 AM— 5:00 pm
Embassy Suites Hotel, Lexington
May 26—Friday
P&A PAIMI Advisory Council Meeting and PADD Advisory Board Joint Meeting
9:00 AM— 3:00 PM
Embassy Suites Hotel, Lexington
For more information, call Protection and Advocacy at 800-372-2988.
June 12-14—Monday-Wednesday
20th Annual Kentucky Early Childhood Summer Institute—”The Race to Classrooms of Excellence”
Sponsored by: Family Resource and Youth Services Centers
Lexington Convention Center and Hyatt Regency
For more information, go to: http://chfs.ky.gov/dhss/frysc/training.htm
June 14-16—Wednesday-Friday
Autism Institute
Presented by The Kentucky Autism Training Center
Galt House Hotel— Louisville
For more information: e-mail Kristen.frarey@louisville.edu or call (800)-334-8635
July 1—Saturday
DeaFestival-Kentucky 2006
The Kentucky Center / Belvedere, Louisville
For more information, go to: http://kcdhh.ky.gov/deafestival/index.html or call V/T 800-372-2907
