California

This second report in a series focuses on how state variation in level of experience and infrastructure to undertake large-scale transition programs can affect implementation. The authors describe differences in strategies to 1) expand transition coordination capacity 2) locate appropriate housing 3) enhance long-term supports & services 4) change Medicaid HCBS programs/policies to ensure that those who transition can remain in the community after the MFP eligibility period ends.

The Network consists of 10 regional centers funded by the National Institute on Disability and Rehabilitation Research (NIDRR), a division of the U.S. Department of Education. The mission is to provide information and Technical Assistance on the Americans with Disabilities Act (ADA) to individuals, organizations and employers. They provide training materials, referrals, and a searchable database of legal documents, fact sheets and checklists.

Nearly every state provides at least some funds for services for low-income older adults or people with disabilities who have too many assets to qualify for Medicaid. AARP reports on how much each state spends on both multiservice and single-service programs. It also compares funding sources, eligibility criteria, services, cost management strategies, consumer direction, and other characteristics.

Medicaid currently fills in the gaps in Medicare’s benefit package for 8.8 million enrollees with limited income and resources (dual eligibles). Shifting aspects of this financing to the Federal government could save states money and create opportunities for better care management and coordination. Data tables show how much each state could save if certain financing roles were shifted.

Villages are a grassroots effort to address the current and unfolding challenges of an older America. Originally started in MA in 2000, the concept arose out of older community members’ desire to reside in their own homes while being able to access services that address their needs related to aging. In Village arrangements, members pay an annual fee and pool their funds to collectively purchase services. The Village-to-Village website offers resources for communities starting programs.

This spreadsheet provides a list of ADRC program sites and information about which organizations are operating the ADRC and the services and functions they provide. The list is organzied by state and then country.

CA’s In-Home Supportive Services (IHSS) aims to keep people in their homes by paying for personal care services approved by social workers. SB 1104 was introduced in 2004 to ensure and measure delivery of services and program integrity. The report examines whether the elements of the bill were enacted. It also describes alternative models for in-home service delivery, including the Cash & Counseling model and one wherein private companies provide IHSS. Sample timecards and handbooks are given.

The study compares monthly income for people receiving Supplemental Security Income (SSI) to local median incomes and Fair Market Rent rates for modest units across the U.S. In 2008, there were 219 housing markets in 41 states where recipients of SSI, people with long-term disabilities and virtually no assets, would have to pay 100% of their income for a modest one-bedroom unit. Ten years ago there were 44 such markets in 13 states. Policy recommendations are given to reverse this trend.

The presenters lead a discussion on the importance of local strategies for building affordable, accessible housing. They touch on how to identify key partners and opportunities, create a transition support network, and advocate for prioritizing housing in local programs. Examples of Money Follows the Person grantee activities are given, with a focus on Maryland’s experiences. Resources for conducting a local housing market assessment are also given.

Via IHSS Plus, participants are able to receive certain expanded in-home services as part of Medi-Cal. Before, payments for these services were not matched by a federal contribution and were administered through a separate program. The analysis looks at implementation and service use in 2005, compares recipients’ outcomes and institutionalization rates to those in the original IHSS program, and complements the State’s evaluation and other research on paying family caregivers.