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Arkansas

Task Force

The governor of Arkansas issued an executive order in May 2000 that directed the Department of Human Services (DHS) to develop a working group. An Olmstead Working Group ("OWG") was appointed to write an Olmstead Plan for Arkansas. However, due to the enormity of the task, no plan was produced at that time. Following the initial work of the Olmstead Work Group in 2000, the Department of Human Services (DHS) submitted a 30-page report to the governor in February 2001 that noted seven initial recommendations for Arkansas:

1. Review current systems to identify opportunities for change;
2. Adequately fund the Division of Developmental Disabilities Services ("DDS") Home and Community-Based Services under the Medicaid waiver and monitor all waiver service quality;
3. Pilot and develop as assessment process to evaluate consumers' choice of care setting;
4. Develop teams to assist individuals who desire to make a transition to other service settings;
5. Appoint and convene an ongoing advisory group for Olmstead implementation;
6. Reconvene a Supported Housing Task force; and
7. Apply for a federal Real Choice Systems Change Grant.

The governor then authorized the Director of the Department of Human Services to appoint a 23-member Governor's Integrated Services Task force ("GIST") to assist DHS in writing a comprehensive, effectively working plan. The task force was created to replace the working group and guide the development of the "comprehensive, effectively working state plan." The diverse group, established in June 2001, included 16 consumers, advocates or providers; one representative each from the Department of Rehabilitation Services and Social Security Disability Determination; and five DHS division directors (Medical Services, Mental Health, Developmental Disabilities, Aging and Adult Services, and the Office of Chief Council). The GIST formed subcommittees for Public Awareness; Staffing; Finance; Supports and Services; Assessment, Access and Transition; and Quality Assurance. Since July 2, 2001, the GIST has held more than a dozen full meetings and many more subcommittee meetings.

Even with the progress on the Olmstead Report recommendations, much work remained. The GIST subcommittees formulated 115 new recommendations, which were approved by the full task force on May 28, 2002. DHS staff were assigned to work with GIST members on a writing committee to evaluate how the recommendations could be incorporated into a comprehensive and effective working plan. GIT selected its top 10 recommendations and voted to assign the work of writing the final plan to DHS. The plan now has been submitted to the governor, the Legislature, consumers, advocates, providers and the general public.

The Plan

"The Olmstead Plan in Arkansas: Catalyst for Collaboration and Change," was issued on Oct. 14, 2002, by the Governor's Integrated Services Task Force and the Arkansas Department of Human Services. It is located on the web at http://www.state.ar.us/dhs/aging/olmarplandraft021014.pdf

The top 10 recommendations from the GIST are listed below:

1. Address issues related to the Nurse Practice Act.
2. Restructure mental health service delivery.
3. Develop a Web site listing consumer services.
4. Use existing housing funds to finance integrated housing community facilities.
5. Provide information to applicants about alternatives to institutionalization.
6. Facilitate transitions from institutional settings to the community.
7. Reduce waiting lists for home and community waivers.
8. Reduce response times for obtaining home and community waiver.
9. Increase consumer direction for waiver and state plan services.
10. Advocate for mental health parity for health insurance.

Even though these 10 recommendations are ranked as priorities by the GIST, DHS considered all the recommendations and incorporated them by reference in the report. In addition, because of the cooperation that developed among GIST members, the state felt that emphasizing the ten GIST priorities would contribute to the evolving collaboration. To capitalize on this collaboration, DHS will request authorization for the governor to continue the GIST for one additional year and retain a majority of its current members.

These recommendations led to a series of strategies, including proposals for:

1. Major changes to the state's mental health care system, including a request for $11.6 million in new state funding to implement the changes during the next biennium.
2. Quicker access to home and community-based care services, including a request for $6.4 million in new state funds for the DDS waiver. These funds will be used to match Medicaid, which means more than $20 million in total spending over the biennium.
3. Assessment of all individuals (private pay and Medicaid) who are seeking to enter an institution to determine eligibility and fully inform them of their community options. The face-to-face assessment, which will occur before an individual enters an institution, will be conducted by professionals independent of any service organization.
4. Allowing money to follow the client. With the support of a State Innovation Grant from HHS, Arkansas will allow Medicaid beneficiaries who live in nursing homes an option to receive a cash allowance to live in their own homes. If just 5 percent of institutional dollars follow the client into the community through this program, more than $20 million will move from institutional to home and community-based care.

The collaboration component lays out the most current information about all the actual work done by the state, the GIST, the public, the courts, and the federal government. Much energy has gathered surrounding the work of redefining and redesigning the array of services. Although much already has occurred, many challenges lie ahead.

Funding is becoming an increasing concern. In many ways, it represents the most serious challenge to the transformation of services for people with disabilities. In addition to state budget constraints, the rigidity of the use of many of the funds, both federal and state, creates a barrier to immediate, dynamic changes. Even the services currently in place grow ever more expensive to maintain at the present level.

Because of the myriad of agencies, departments, providers, regulations, and federal and state laws, the organization of the long-term care system is far from optimal.

Institutional bias permeates long-term care, whether it regards eligibility, services or funding.

Arkansas is a rural state, which creates innumerable barriers to the delivery of services. With no statewide public transportation, the services that are available remain inaccessible for some people in remote areas. It also makes more difficult the dissemination of information regarding the menu of services. Public housing is not available in remote areas. Workforce issues also are exacerbated.

Most people are uninformed about Olmstead and its underlying principles. The prejudice toward people with disabilities, the fear of disabilities, and the paternalistic attitude common among the general population are barriers to helping disabled people achieve equal opportunity in the community. It will take time and effort to help people understand and grow accustomed to the new way of viewing the lives and hopes of individuals with disabilities-to move from a charity-based perspective to a rights-based perspective.

Implementation

There was no legislation in 2002 on Olmstead.

The development of recommendations by the GIST.

The complexity of consumer needs, policy issues, and funding sources.

No lawsuits have been filed as a result of the Olmstead decision.

The state of Arkansas received a $1.025 million Real Choice Systems Change Grant. The money is being used to increase system quality, flexibility and availability of services; develop a model of a Medicaid/Medicare integrated system that efficiently manages the costs of services; provide technical assistance regarding consumer self-determination practices to consumers and advocacy organizations; and design and implement a single point-of-entry and information system that will provide consumers with information for decision-making and choice.

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