Transcript Slide 1

CIL-NET Presents…
Implementing and Enforcing Olmstead
A National Onsite Training
Olmstead Implementation in Wisconsin
May 12, 2011
Atlanta, Georgia
Presenters:
Mike Bachhuber, Executive Director
Independent Living Council of Wisconsin
Karen Avery, Associate Director
IndependenceFirst (Milwaukee, Wisconsin)
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners
• Networking starts close to home and reaches out
from there
• Relations with partners closer to home will be
different from relations
with more distant
partners
• Each partnership
relationship is unique
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners
• Networking starts close to home…
– What does Your CIL want to accomplish?
– What resources do you have to contribute?
– Who do you know that can help?
• …and reaches out from there
– Do you have a state-wide coalition of CILs?
– Do other CILs in your state want to do the same
thing?
– What resources do you all have to contribute?
– Who do you know that can help?
• And so on…
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners in Wisconsin
• Eight IL Centers
– Each develops strategic plan
• Input from community
• Consistent with State Plan for Independent Living
– strategic plan and work plans include advocacy
– Some of the ILCs also develop annual advocacy plans
• Wisconsin Coalition of IL Centers
– Develops statewide systems advocacy plan
– All 8 IL Centers contribute to plan, which historically has
included Access to Community-Based Services
– Grassroots organizing initiative
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners in Wisconsin
• State Plan for Independent Living
– Developed by SILC and DSU with IL Centers and
WCILC
– Need for community supports and services has been
recognized historically
– One or more objectives address need
– Mobilizes resources to address the objectives
– SILC can help evaluate progress and mobilize partners
at State level
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners in Wisconsin
• Broaden partnerships (not all will be disabilityspecific)
• Work with People First, GEP (statewide, mental
health consumer network), ADAPT and other
consumer groups
• Work with Protection and Advocacy System, DD
Council and other disability/aging advocacy
partners
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners in Wisconsin
• Examples:
• Survival Coalition
– Cross-disability coalition in state capital
• Make It Work Milwaukee Coalition
– Local, cross-disability coalition in state’s largest urban
area
• St. Croix Valley Disability Coalition
– Local, cross-disability coalition in mixed rural and
suburban area
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners in Wisconsin
• Participation in official committees/councils can
provide access to people and information.
– Local Long-term Care and Mental Health Councils
– Quality Assurance Committees
– Oversight committees, e.g. Aging and Disability
Resource Center or Managed Care Organization
Boards
• WCILC and other coalitions regularly meet with
top policymakers
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Olmstead Implementation in
Wisconsin
• State has never developed a formal, state plan
– “a comprehensive, effectively working plan for placing
qualified persons with mental disabilities in less
restrictive settings, and a waiting list that moved at a
reasonable pace not controlled by the State’s
endeavors to keep its institutions fully populated….”
Olmstead v. L.C., 527 U.S. 581 (1999)
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Olmstead Implementation in Wis.
• State was expanding community services and
supports to rebalance care from institutions
• “Family Care” managed care program
(DD/PD/Aging)
• IRIS self-directed services (DD/PD/Aging)
• ICF-MR Rebalancing Initiative (DD)
• Community Relocation Initiative (PD/Aging)
• Money Follows the Person (PD/Aging)
• SSI Managed Care (all disabilities)
• Comprehensive Community Services (MH/SA)
• Certified Crisis Service Programs (MH)
• Community Recovery Services/1915(i) (MH)
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Olmstead Implementation in Wis., cont’d. 2
Publicly-Funded Long-Term Care Consumers
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Institutional
Pop.
30,171 30,827 30,270 29,491 28,468 28,395 27,728 26,709 25,730 25,202 24,152 23,137 22,243 20,774 20,297
61.5% 59.2% 56.3% 53.6% 51.3% 50.5% 47.9% 46.9% 44.3% 42.8% 41.4% 39.5% 37.1% 34.5% 33.8%
Community
Pop.
18,907 21,225 23,500 25,574 27,005 27,829 30,184 30,238 32,320 33,615 34,229 35,442 37,680 39,445 39,760
From Propsom,
Gail, LTC
Rebalancing
Nursing
Facility
Transitions,
Dept. of57.2%
Health 58.6%
Services 60.5%
(2010) (PowerPoint)
38.5%
40.8%
43.7% and
46.4%
48.7%
49.5%
52.1%Wisconsin
53.1% 55.7%
62.9% 65.5% 66.2%
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Olmstead Implementation in Wis., cont’d. 3
State still uses facilities heavily
– 2009 Data
From Eiken, S. et Al., Medicaid HCBS Waiver Expenditures: FY 2004 Through FY 2009 (Thompson
Reuters) 2010
www.hcbs.org/browse.php/sby/Date/source/150/ThomsonReuters
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Olmstead Implementation in Wis., cont’d. 4
• CILs committed to Nursing Facility Transition as
a “5th core service”
– Received federal grant.
• CILs and other advocates did not opt to pursue
aggressive legal enforcement.
– Some CILs, others filed Office of Civil Rights
complaints with the U.S. Dept. of Health and Human
Services
– Future is uncertain
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Olmstead Today in Wisconsin
• Most LTC consumers also have mental illness
– LTC system often fails to respond to this need
• People with functional impairment due to mental
illness rather than DD/PD/Aging not included in
reform
– State has decreased preference for institution by
shifting institutional cost to counties
– This reduced state funds supporting the public mental
health system
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Working with Partners - Epilogue
• Challenges of “playing nice in the sandbox”
– When do you bite your tongue?
– When do you use the hammer?
– How does enforcement change the nature of
partnerships?
CIL-NET, a project of ILRU – Independent Living Research Utilization
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Thank You
• Karen Avery, Independence First
– www.independencefirst.org
– [email protected]
– (414) 291-7520
• Mike Bachhuber, Independent Living Council of
Wisconsin
– www.IL-Wisconsin.net/Council
– [email protected]
– (608) 256-9257
CIL-NET, a project of ILRU – Independent Living Research Utilization
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CIL-NET Attribution
Support for development of this training was provided by
the U.S. Department of Education, Rehabilitation Services
Administration under grant number H132B070002-10. No
official endorsement of the Department of Education should
be inferred. Permission is granted for duplication of any
portion of this PowerPoint presentation, providing that the
following credit is given to the project: Developed as part
of the CIL-NET, a project of the IL NET, an
ILRU/NCIL/APRIL National Training and Technical
Assistance Program.
CIL-NET, a project of ILRU – Independent Living Research Utilization
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