Washington 2003 | advancingstates.org

<H3>Washington </H3>   <H4>Task Force</H4> At the direction of the governor in March 2000, the Department of Social and Health Services (DSHS) established an Olmstead Workgroup to coordinate planning and accelerate ongoing processes and programs. This workgroup includes representatives from the following 14 DSHS programs: the Aging and Adult Services Administration, the Children's Administration, the Division of Alcohol and Substance Abuse, the Division of Developmental Disabilities, the Division of Vocational Rehabilitation, the Medical Assistance Administration, the Mental Health Division, the Budget Office, the Office of Research and Data Analysis, the Attorney General's Office, the Department of Transportation, the Agency Council on Coordinated Transportation, the Office of Community Development and the Department of Veterans Affairs. The purpose of the Olmstead Workgroup is to further Washington's response to the Olmstead decision by seeking input from stakeholders, coordinating existing processes and programs, proposing program modifications and better evaluation measurements, and coordinating among agencies to improve access to services and supports.   <H4>The Plan</H4> Washington completed a draft Olmstead plan in December 2002. The focus of the plan is the identification of activities to divert individuals from institutional admissions, help individuals make the transition to community settings, and create performance measures. The main components of the Olmstead plan are housing, transportation, employment, and integration and stakeholder interaction. The plan includes an overview of current activities that further the intent of Olmstead-such as housing, transportation, integration, employment and systems change initiatives-and discusses DSHS plans for implementing the activities funded in the budget. Housing <UL> <LI>Stakeholder Comments: </LI> <UL> <LI>The workgroup has received more comments about housing than any other topic. For example:</LI> <LI>The supply of safe, affordable housing is insufficient to meet the demand. </LI> <LI>Wheelchair-accessible housing is difficult to find. </LI> <LI>The process of finding and securing housing is confusing and burdensome. </LI> <LI>People need a diversity of housing, including single-family, co-living arrangements, adult family homes, etc.</LI></UL> <LI>Department Activities: </LI> <UL> <LI>As people are increasingly served in the community, DSHS recognizes the need to collaborate with agencies, individuals and advocacy groups to link services with housing organizations. In order to address the need for linkages between housing and services, DSHS has:</LI> <LI>Dedicated a portion of the Olmstead coordinator's time to promote partnerships and act as a resource between housing and social services. </LI> <LI>Participated in ongoing housing policy discussions that affect affordability, availability and access for individuals served by DSHS. </LI> <LI>Identified areas that DSHS staff currently work directly or indirectly with housing providers and organizations to build on existing efforts. </LI> <LI>Implemented an executive-level initiative called Integration, including No Wrong Door, to improve cross-system collaboration to achieve community living goals. </LI> <LI>Collaborated with other state and local partners to write the Washington State Homeless Families Plan and participated in a federally Sponsored Policy Academy to address issues for homeless families in Washington. </LI> <LI>Participated in multiple cross-system efforts to link services with housing organizations, including grant-writing opportunities. </LI></UL> </UL> Transportation <UL> <LI>Stakeholder Comments: </LI> <UL> <LI>Transportation services are not adequate and are crucial for people with disabilities to live successfully in the community. </LI> <LI>DSHS needs to support ACCT's recommendations on transportation.</LI> <LI>The Olmstead Workgroup will continue to coordinate with the Agency Council on Coordinated Transportation (ACCT) to improve transportation services that support community living. </LI> <LI>DSHS administrations worked with partners to develop the Coordinated Special Needs Transportation Services, Administrative Policy No. 8.09. As required by RCW 47.06B.030 (5), the policy supports special needs coordinated transportation for people with disabilities. Administrators will work to see that DSHS clients have access to covered services through a coordinated transportation system. This is an ACCT recommendation.</LI></UL> </UL> Employment <UL> <LI>A DSHS cross-agency workgroup has been working with multiple partners, including the Social Security Administration and employment providers, to plan for the implementation of the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in Washington. The Division of Vocational Rehabilitation is leading the effort. </LI> <LI>The Medical Assistance Administration chose to implement the Medicaid Buy-In Program to support the competitive employment of individuals with disabilities. Under Healthcare for Workers with Disabilities (HWD), working people with disabilities are able to continue Medicaid coverage by paying premiums based on a sliding income scale.</LI></UL> Integration <UL> <LI>DSHS has many projects that provide collaborative client services to bring together partners from throughout the department, from other levels of government, and from non-government organizations. DSHS is building on these efforts with the No Wrong Door Initiative. This includes projects that coordinate services and share information for three specific groups that use multiple services: long term TANF families; individuals with multiple disabilities; and troubled children, youth and their families.</LI> <LI>In order to build upon No Wrong Door, the broader Integration Initiative has been established. The goals of the Integration Initiative are to:</LI></UL> <UL> <UL> <LI>Improve client outcomes and satisfaction; </LI> <LI>Increase cost effectiveness of services, especially for high-risk, high-cost clients; </LI> <LI>Improve community partnerships, including development of innovative pilot projects and models; and </LI> <LI>Increase employee satisfaction.</LI></UL> </UL> <UL> <LI>A variety of strategies and projects are being implemented throughout the department to facilitate integration, including multi-disciplinary teams for case staffing, development of shared data bases, streamling policies, and other such activities to promote the delivery of services from a client-centered perspective.</LI></UL> Stakeholder Interaction <UL> <LI>Stakeholder Comments: </LI> <UL> <LI>No system will work if it lacks meaningful input by the people who use it. </LI> <LI>Provide a method whereby the public can post questions and comments on a Web page for DSHS response.</LI> <LI>DSHS designed Internet pages, posted the Olmstead Plan and related documents and updates, and provided a means of Web-based communication between DSHS and stakeholders. This is in addition to participating in multiple consumer and stakeholder meetings where input is given; seeking advise from numerous consumer task forces and advisory groups, and hiring an Olmstead coordinator who works specifically with individuals with disabilities, families and advocates, and activities that promote community living.</LI></UL> </UL> Coordination <UL> <LI>Stakeholder Comments: </LI> <UL> <LI>Divisions and programs within DSHS need to coordinate better to serve clients who need to access services across division lines. </LI> <LI>The plan should incorporate more cross-system collaboration to address the needs of those individuals who fall through the cracks.</LI> <LI>Activities emphasize coordination between DSHS administrations and divisions and between DSHS and the Department of Transportation</LI></UL> </UL>   <H4>Implementation</H4> Legislation There was no 2002 legislation related to the Olmstead decision. Funding Appropriations for FY 02 included: <UL> <LI>$8.4 million to provide community placement for up to 80 individuals with developmental disabilities who currently reside in state and community institutions. </LI> <LI>$5.7 million to serve clients with mental illness (who currently are in state psychiatric hospitals) in other settings. </LI> <LI>$3.2 million to establish a 35-bed chemical dependency involuntary treatment program in eastern Washington. </LI> <LI>An additional $201.4 million for existing community living programs. </LI></UL> Successes State officials have been able to more solidly incorporate the community living direction into overall strategic planning. Washington has long been committed to community living through several and community waivers, but the Olmstead planning process is focusing on an integrated approach. DSHS is continuing to coordinate initiatives with other state agencies and community partners, including transportation, health care and housing. Challenges Additional funding, a key to successful change, is a major impediment due to the current budget crisis. The number of staff at the DSHS has been reduced, and funding for basic services for many low-income people is declining. Availability of affordable, accessible and barrier-free housing, as well as general and specific-needs transportation, also are major issues. Lawsuits For an update on lawsuits in Washington, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at <A HREF=\"http://www.hsri.org/index.asp?id=news\">http://www.hsri.org/index.asp?id=news</A> Next Steps The planning process, originally centered on budget years, is ongoing. Amid the budget crisis, new budget proposals are not likely. The Disability Initiative Advisory Committee (DIAC) is the conduit for consumer input, and it has recommended integration with other systems and more local partnering to administer services. Washington received a $2 million Systems Change Grant. The money will be used to assist the Washington State Department of Social and Human Services to strengthen its long-term care system with three goals: 1) enhance skills needed for self-directed care and community living for individuals with disabilities, caregivers and case management staff; 2) develop and implement statewide effective cross-system case management coordination models for consumers with multiple disabilities; and 3) develop consumer assessment tools and the automation necessary to implement consumer-directed service payment options such as vouchers or case and counseling. The state also is improving community services by changing the systems that help people move from institutions to community-based settings.