TEXAS
Considerable work went on in Texas in 2002 to provide community options for people in nursing homes, to allow more people with disabilities to manage their own care through consumer-directed programs, and to test new models for long-term care systems change. Yet, large waiting lists for home and community-based services continued to challenge the state to expand its efforts on behalf of people with disabilities.
Consumer Direction
In October 2002, the federal government approved Texas' plan to allow disabled people to use vouchers to obtain services in the Community-Based Alternatives and STAR+PLUS programs. The new program allows participants to employ their own attendants and have some flexibility in setting wage rates. Similar approvals had been obtained in 2001 for the Community Living Assistance and Supports Services program, the Medicaid Home and Community-Based Waiver Program for deaf/blind people, and the Consumer-Managed Personal Assistant Services Program.
The Budget
The Texas Department of Health received funding increases in the FY 2002-03 budget to reduce waiting lists for home and community-based services (HCBS) and for nursing homes. Officials expected the budget increases will allow the number of clients in HCBS waiver programs to increase by about 5,600 persons per year. However, even with those increases, officials said that about 26,000 people would remain on waiting lists for services.
Planning and Reports
The first version of a long-term care reform plan, called Promoting Independence, was delivered to the Legislature in January 2001. The Promoting Independence Advisory Board later was renamed the Interagency Task Force on Appropriate Care Settings for Persons with Disabilities. With coordination from the Health and Human Services Commission, the task force met several times during FY 2002. During this time, the task force monitored implementation of the plan, formed work groups to assist with the overall continued development of the plan, and made further advisory recommendations. The task force released a revised version of the plan on December 2, 2002.
Key to the plan is assisting individuals who seek to move from nursing homes to community settings. Phase one of the plan involved informing nursing home residents about community-based alternative programs, collecting baseline data on nursing home residents, training agency staff, and promoting community awareness of community options. Phase two is being implemented over a two-year period from September 2001 to September 2003. The Department of Human Services is hiring and training relocation specialists, developing an identification process and assessment instrument, tracking data from the relocation specialists, and conducting community awareness activities. Phase three will divert people from institutions by placing additional staff in hospitals and rehabilitation centers for pre-admission screening.
On September 4, 2002, 11 individuals and the Arc of Texas filed a class action suit against the Health and Human Services Commission, the Department of Mental Health and Mental Retardation, and the Department of Human Services. The complaint charges that Texas has failed to provide community-based living options and services for people with mental retardation and developmental disabilities. The Medicaid home and community-based waiver program for people with mental retardation was serving about 4,600 people, with another 17,500 on waiting lists. The Community Living Assistance and Support Services Medicaid waiver program for people with developmental disabilities was serving about 1,800 people; another 7,300 had requested but had not received those services.
State Administrative Agencies
The operations and programs of the Department on Aging came under review as part of the state's sunset process of ongoing reviews of state agencies. As a result of the review, a bill was enacted in 2001 establishing a new long-term care agency to take effect on September 1, 2003, by abolishing the Department on Aging, transferring its programs to the new agency, and renaming the Texas Department of Human Services (TDHS) as the Department of Aging and Disability Services. The bill also consolidated a number of long-term care programs in TDHS and transferred to TDHS several programs from the Texas Rehabilitation Commission and Texas Department of Health.
Many aging advocates opposed the move, so the 77th Legislature passed a bill that requires the Health and Human Services Commission to review the functions of the Department on Aging to determine which functions related to the direct provision of long-term care and to recommend whether any functions should be transferred to the TDHS, provided such a transfer did not conflict with the Older Americans Act. The bill extended the date to September 1, 2005, when the Department on Aging would be abolished.
In the 2003 Legislature, other restructuring bills were introduced to reorganize the state's giant health and human services system. One bill proposes combining 11 agencies into three: a Department of Health Services; a Department of Aging, Community, Disability and Long-Term Care Services; and a Department of Protective and Regulatory Services. The Department of Aging, Community, Disability and Long-Term Care Services would combine mental retardation, nursing homes and other aging services, community-based care, the Texas Rehabilititation Commission, and the Commission for the Blind.
Grant Initiative
In December 2002, the Health and Human Services Commission announced that the agency would use the almost $1.4 million it had received in federal grants to test models and practices for long-term care systems change in two areas of the state: Heart of Central Texas (13 counties in and around Belton, Killeen and Waco), and Texoma (three counties in and around Sherman/Denison). The project is called Creating a More Accessible System for Real Choice for Long-Term Care Services, or Texas Access Project. The goal is to use "system navigators" to help individuals and families cut through government red tape across agencies and organizations to obtain needed benefits, services and supports.
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