Living Independently

HHS Announces a Reorganization

Tim Wheat and Henry Claypool

Today the US Department of Health and Human Services announced the reorganization of the Administration on Aging, Office on Disability and Administration on Developmental Disabilities into the Administration for Community Living.

Henry Claypool, a former staff member of the Center for People with Disabilities, gave a brief history of how HHS came to create the ACL. He said the US Supreme Court 1999 Olmstead ruling, the Real Choice Systems Grants, Money Follows the Person legislation in 2005 and the Obama Administration’s Year of Community Living were all forerunners of this consolidated federal agency.

Putting people in institutions is the way that federal programs served people with disabilities when Medicaid began. Today the remains of this institutional bias are still a significant part of our system and are the most costly part of Medicaid. Claypool tells a history of federal initiatives beginning with Olmstead that are working to reverse the institutional bias and provide Americans with choice in how we get Medicaid Long-Term Care Services.

Claypool said he will still advise on disability issues but he will focus on ACL and move the current policy office into the new agency. Kathy Greenlee, the Assistant Secretary for Aging will head the ACL while keeping some of her current duties with Claypool as chief deputy.

Following the announcement Claypool, Greenlee and Sharon Lewis of the Developmental Disabilities Administration took questions. Unfortunately, the first question was from an agent of the Voices of the Retarded who mischaracterized institutional incarceration as an Olmstead “choice.” The HHS staff did not cut the caller off, but all suggested they would continue to advocate for people who were institionalized.
Olmstead simply does not make the choice of an institution a Constitutional Right. The Supreme Court upheld the ADA concept that “inappropriate institutionalization is discrimination.” Although all states have Medicaid institutional programs that people may choose, it is our right as American citizens to live in our own homes and in our communities. We do not have a right to be institutionalized.

It was frustrating to hear the VOR misinformation on the national announcement call; but the creation of the ACL seems like a good move to end the segregation of people with disabilities and to end the institutional bias.

Tim Wheat
Community Organizer
CPWD

Around Colorado, Around the country Henry Claypool, HHS, money follows the person

By Tim Wheat

Governor John Hickenlooper of Colorado

(DENVER, July 22, 2011) Gov. John Hickenlooper rejected ADAPT’s demand that he commit to Colorado pursuing the federal Community First Choice (CFC) Option within the Health Care Reform Legislation. CFC Option provides the state money to assist moving people from expensive institutions and nursing homes. Hickenlooper did believe it was a good idea and he did want to avoid delay in Colorado’s progress like we did in 2005 when we missed out on the first federal offering of the Money Follows the Person grant.

Dawn Russell gave the governor the opportunity to support the additional money by asking if he had heard the request.

“I got it,” said Hickenlooper.

Activists outlined the need for the CFC Option and changes to the Medicaid eligibility determination by the state. One ADAPT activist said that the group was still bitter that Colorado had failed to apply for Money Follows the person back in 2005. Colorado did apply for the federal funds last year and were awarded $22 million this April, but the delay has not only been expensive in millions of dollars, but also in the lives of people still trapped in institutions.

“If we don’t apply for CFC now we will just see that same kind of delay and our state missing out of federal funds to end the Medicaid bias,” said the ADAPT activist.

Hickenlooper got the message, but he would not go any further.

“I cannot make a commitment because I don’t know all the details,” said the governor.

Colorado ADAPT meets with the Governor

Following the twenty-five minute meeting with the governor the ADAPT group met and discussed the next steps. The indirect message from the Department of Human Services is that they are too busy to commit to pursuing the federal funds; although everyone in the state Department seems to be in favor of the proposed option.

ADAPT confronted the governor with this because his commitment would prevent Colorado from missing out on a beneficial, needed program like we did in 2005. The federal offering takes state resources to apply for the program; however, the funds that come into the state will help to improve the existing Medicaid program.

“It is not only the federal money for Colorado,” said Dawn Russell, “but it also means saving a lot of money by moving people out of expensive institutions.”

Meeting Bicha and Birch

The evening before ADAPT met with the governor, Sue Birch, the Executive Director of the Colorado Health Care Policy and Finance Division (HCPF) and Reggie Bicha, the Director of the Colorado Department of Human Services were at Atlantis to directly confront the problems with Medicaid eligibility. People in Colorado Eligible for Medicaid services are often forced an in-human amount of time simply to be determined eligible by the state system.

“I was Medicaid eligible when I left Colorado, I was eligible when I moved to Washington,” said Alice Bozeman, “but when I moved back to Colorado it took 83-days for the system to find me eligible again. Atlantis provided me services during that time even though the Medicaid system told them not to; Atlantis saved my life.”

Director Birch said that the Administration was setting eligibility determination as a high priority and that by the end of October HCPF would have some clear improvements for customers and providers to look at.

“We will be back to say we need you to come to the table to tell us how we can make the system work,” said Reggie Bicha to Dawn Russell who pressed the bureaucrats for a realistic timeline. “We are building the team now.”

Getting people out of nursing homes is a passion of ADAPT and activists pointed out how the system would provide Medicaid Long Term Care services to people in the nursing home but on the day they move out, their status had to be re-coded by the state system that could take many months. Providers of home services don’t get paid until that re-coding is complete. Not only are many providers unwilling to take nursing home transfers, but the system is obviously bias to pay expensive facility care over home and community services.

Alice Bozeman

Director Birch brought with her two employees of the statewide effort to interconnect the electronic information of Medicaid customers. Although there is much promise and millions of dollars being put toward the upgraded computer systems, those same systems have also often been the most oppressive of barriers that Medicaid recipients have faced.

Previously Dawn Russell had told of a person who she helped transition into the community out of a nursing home. Although he carried a letter with him from John Berry, the head of Long-Term Care in Colorado, no service provider would provide necessary services to him because the computer system did not list his Medicaid eligibility.

Even though someone in a nursing home is served by the same Medicaid program, it requires a human technician to “re-code” a person when they move out of the expensive facility. Regardless of the proposed computer system, this simple “human” glitch has slowed citizens move back to the community and is costly to the state.

More Photos: http://www.facebook.com/media/set/?set=a.196366823750996.62592.145326032188409&l=b3840738c1&type=1

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Colorado announces $22 million federal grant to improve options to expensive nursing facilities.

By Tim Wheat

Colorado State Capitol

The “Money Follows the Person” grant will help Colorado improve the state’s ability to provide home and community based care as an alternative to undesirable institutional placement and help move people out of expensive nursing homes into their own home. Colorado CO-ACTS program was awarded the grant by the federal Centers for Medicare & Medicaid Services and their goal is to transition approximately 500 people or more back to the community over the next five years.

CPWD has worked with the state to develop a strong grant and we applaud the state’s efforts. Our perspective has always been to end the institutional bias in the federal Medicaid program so that people with disabilities can be a part of the community and live in our own homes. We support the goal of CO-ACTS to transform long-term care services and support from institutionally-based and provider-driven care, to person-centered and community-based care.

“CO-ACTS is the solution for giving clients needing long-term care services independence, choice and dignity,” states Sue Birch, executive director. “In order to support our clients in receiving the care they need in the setting they deserve, we will build upon our existing community-based services and, at the same time, save the state money.”

The federal and state funded program is a demonstration project to prove the financial viability and structure will work in Colorado. The ultimate goal that CPWD hopes for the program is that no person with a disability would have to leave their home and community to get services and that those services become the default over expensive institutional facilities.  Currently, federal Medicaid must fund institutional options, like nursing homes, while preferable alternatives are only optional Medicaid services that may be limited or not even offered.

“CO-ACTS is a multi-agency effort. We have been working with the Department of Human Services, the Department of Public Health and Environment, the Department of Transportation and the Department of Local Affairs,” said Tim Cortez, the project director; “to ensure that we have the appropriate community-based long term care services and supports in place along with housing and transportation. All of these state agencies are working together to make certain that we have a strong safety-net for those individuals returning to the community.”

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