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District of Columbia

Task Force

Starting in June 2001, the Real Choice Systems Change Advisory Committee, within the Medicaid agency of the Department of Health, has overseen the redesign of the District's long-term care system, and has addressed Olmstead-related concerns. The Medicaid agency chose to focus on the expansion of home and community-based services (HCBS) waivers and the development of a resource center, rather than to establish a comprehensive Olmstead plan. The consumer-chaired Systems Change Advisory Committee is central to the implementation of the major initiatives the District is launching. The advisory committee includes consumers, providers and the various District government agencies that provide services to individuals with disabilities. Many subcommittees are addressing individual initiatives such as consumer-directed attendant care and the resource center.

Implementation

There was no 2002 legislation directly related to the Olmstead decision.

The successes of the advisory committee include the submission and expansion of the elderly and mental retardation/developmental disabilities waivers, and the development of a disability and resource center. The department will select a contractor to operate the resource center and help the city create a service delivery model similar to Wisconsin's Family Care Program. The resource center initially will serve frail elderly and those with physical disabilities, and then, if successful, will be extended to people with developmental disabilities and those with mental illness. The model focuses both on people now in institutions and those who are applying to enter them.

The District requested 200 additional waiver slots per year for each of the next five years, for a total of 1,000 new slots, for each of the two waiver renewals. The renewals for both waivers have been approved. Services under the elderly/physically disabled (EPD) waiver also are being expanded to include assisted living and consumer directed attendant care. The expansion is projected to be budget neutral because of the offsetting costs from a reduction in nursing facility use.

The major challenge is the shortage of direct care staff.

For an update on lawsuits throughout the country, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at For an update on lawsuits throughout the country, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at http://www.hsri.org/index.asp?id=news.

The District of Columbia received both a $1.38 million Real Choice Systems Change Grant and a $725,000 Consumer-Directed Personal Assistance Services Grant. The two grants are being used to provide additional staff that will assist with resource center coordination and support.

The department's 2003 budget includes funding for initiatives aimed at improving long-term care service delivery. The new funding initiatives are the Resource Center, a long-term care/chronic care system, and a major expansion of quality monitoring activities.

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