Hawaii
Task Force
In response to the Olmstead decision, the Department of Health and the Hawaii Department of Health and Human Services initiated a planning process with its co-worker agencies and the Hawaii Centers for Independent Living to develop a strategy to improve community-based living opportunities and services for people with disabilities. Individuals with disabilities, their family members and representatives from advocacy groups, nonprofit groups, businesses, and government agencies who assist people with disabilities met over the course of 18 months to identify principles, design strategies and outcomes, and work together on successive drafts to complete the current document.
The Plan
The Olmstead Plan: State of Hawaii was issued on Sept. 13, 2002. The report identified existing councils or agencies responsible for the plan's oversight, including the Developmental Disabilities Council, the Rehabilitation Advisory Council, the Independent Living Council of Hawaii, the Executive Office on Aging, the State Department of Human Services, the State Department of Health, the Statewide Independent Living Council, and the Disability and Communication Access Board. The plan is not available on the Web.
Hawaii's Olmstead strategy is based upon five goals that address five key areas.
- Informing and educating people with disabilities, their caregivers and the general public about community-based living opportunities and issues.
- Goal 1
: Each individual will be informed and educated to make choices and decisions.
- Objective 1a
: Increase people's knowledge about choices and rights. The plan instructs the state to improve its system for informing individuals about their community-living choices and rights.
To this end, the state will develop a way to aggregate relevant information on community-living opportunities and resources, make the information more accessible, and provide a feedback mechanism so that individuals can evaluate the accuracy, accessibility and content of the information. The state will also spearhead a public education campaign to reduce ignorance and prejudice toward people with disabilities.
- Objective 1b
: Help people to use the information to make effective and informed decisions. The plan instructs the state to better help individuals to use and understand the information.
To this end, the state will encourage networking among people with disabilities, train service professionals to use information effectively to assist individuals with disabilities, and ensure that all individuals, who provide services, as state employees or contracted entities, have demonstrated their commitment to relevant Olmstead principles.
- Improving the process by which individuals with disabilities-both those in institutions and those who plan to enter institutions-undergo assessment and planning for achieving the home of their choice.
- Goal 2
: Each individual will be supported in finding an appropriate, affordable and accessible home of their choice in a timely and efficient manner.
- Objective 2a
: Undertake periodic assessments of all individuals in institutions, in a timely and efficient manner, to determine whether they choose to remain in the care facility or move to a more independent community-based living alternative. In addition, prior to their institutional placement, undertake assessments of all individuals planning to enter a care facility.
To this end, the state will develop written assurances and requirements for timely and appropriate assessments; develop a standardized assessment for interviewing individuals in care facilities and identifying their goals, strengths, needs, barriers, and, if the individuals wish to move, a transition plan; use qualified service professionals to do the assessment based upon criteria established below; and provide training opportunities to train individuals to do assessments in accordance with principles of informed-choice, person-centered planning, and neutrality.
- Objective 2b
: Create effective ways for people with disabilities, their family members and caregivers, to evaluate and report on the assessment process for quality improvement.
To this end, the state will develop a system to collect feedback from individuals with disabilities and caregivers and will ensure that an effective connection exists between this feedback system and the monitoring of state contracts.
- Objective 2c
: People in institutions who have undergone assessments that identify them as appropriate candidates for community living will make the transition from institutions into the homes of their choice.
To this end, the state will contract with service providers to act as "gate-openers" who will assist candidates for community-based living with making the transition into the homes of their choice.
- Strengthening financial resources and mechanisms necessary for individuals with disabilities to live in the community by maximizing existing public resources, creating more flexibility in how these resources can be used, and increasing these resources overall.
- Goal 3
: Each individual will have access to and will direct financial resources to meet their identified goals in a timely manner.
- Objective 3a
: Maximize the use of existing financial benefits and resources.
To this end, the state will identify all available funding streams, both public and private, for individuals with disabilities, identify the eligibility criteria governing the use of these funds, and establish a mechanism for disseminating and updating this information on an ongoing basis.
- Objective 3b
: Change policies for existing resources to increase flexibility in how funds are used and authorize people with disabilities to control how they use their own funds.
To this end, the state will work to change policies so that funding can follow the individual rather than providers, services or settings; identify and change policies that create disincentives to independent community-living (using feedback from individuals with disabilities); address funding biases that privilege placement in an institution over community-based living, by advocating for changes in federal policy and by committing to increase funds for community-living services.
- Objective 3c
: Increase the availability of new financial resources to pay for community-based living services.
To this end, the state will establish new revenue sources; revise the state supplemental payment policy to allow recipients to live in the homes they choose; advocate for a redefinition of the federal medical assistance percentage of Hawaii and an increase of federal funds; develop a unified community-based living funding plan; and establish a feedback mechanism to allow individuals to provide regular feedback on new fund development strategies.
- Building the infrastructure necessary for individuals with disabilities to live in the community, in such key areas as housing, employment, transportation and human services.
- Goal 4
: Each individual will be able to locate housing, acquire personal support personnel, use transportation, and engage in employment to sustain community-based living.
- Objective 4a
: Ensure the availability of appropriate housing and enable people with disabilities to acquire the homes of their choice.
To this end, the state will increase the number of appropriate homes; develop financing mechanisms that make owning or renting such homes feasible; fund housing location and placement services for people with disabilities; and ensure that at least one full-time staff person will work with all key players, public and private, in the complex housing environment to demonstrate, with real homes for real people, that developing appropriate housing is feasible and advantageous for all involved parties.
- Objective 4b
: Develop and maintain a suitable workforce for community-based living support personnel.
To this end, the state will identify workforce requirements for community-living personnel; identify existing funding streams for workforce training and education; determine whether additional appropriations are needed; develop a unified community-living workforce development plan; establish a public-private partnership to provide professional liability insurance for community-living support personnel; and encourage policy changes that create incentives for people to become community-living support personnel.
- Objective 4c
: Enable people with disabilities to qualify for jobs and gain employment to help sustain their community-based living.
To this end, the state will establish a unified strategy to train and place individuals with disabilities in the employment of their choice; develop a way to evaluate the progress of individuals enrolled in public and vendor training and education programs, to ensure they are progressing toward their state goals; support innovative employment strategies, such as micro-enterprise; ensure full employment opportunities for people with disabilities for all government positions and contracts; and ensure that vocational service personnel are appropriately trained to work effectively with individuals with disabilities.
- Objective 4d
: Optimize accessibility and mobility by developing and implementing long-range, systematic plans to enable people with disabilities to move throughout their communities, using all means of travel.
To this end, the state will establish a unified mechanism to identify transportation requirements for people with disabilities in different communities (in cooperation with county transportation agencies); develop a unified community-based living transportation plan with key players; integrate ADA requirements into contracts with transportation vendors; appropriate and utilize necessary funds to establish accessible transportation (in coordination with county agencies); and work with county agencies to ensure that transportation personnel are appropriately trained to interact with individuals with disabilities effectively.
- Objective 4e
: Establish and maintain support service programs to assist people with disabilities to live in the homes of their choice.
To this end, the state will increase funds to community-living support services; utilize existing funds within a reasonable time frame; develop and implement care guidelines that balance quality, affordability, appropriateness, and consumer responsibility; and incorporate principles of self-determination and consumer control into all state-funded support programs targeting individuals with disabilities.
- Effectively evaluating the state's progress in meeting the goals of its Olmstead plan.
- Goal 5
: The state of Hawaii will coordinate an on going, effective quality assurance program to monitor and assess the state's progress in meeting the goals and objectives of this plan.
- Objective 5a
: Integrate people with disabilities, their families and caregivers in the process of evaluating plan outcomes and the quality of community-based living services.
To this end, the state will identify a quality assurance entity to assume responsibility for evaluating the implementation of the plan; establish a unified mechanism for evaluating the goals, objectives and strategies of the plan; and take corrective action whenever evaluation and advice from the quality assurance entity recommends corrective action.
Implementation
Legislation
There was no 2002 legislation related to the Olmstead decision.
Successes
Hawaii was awarded a $1.3 million Real Choice Systems Change Grant to develop and implement the "Hawaii Real Choices Partnership Project."
Challenges
One of the major obstacles is being able to provide updated information to consumers due to the inability to link the various databases across the agencies.
Lawsuits
The state's Protection and Advocacy Agency filed Makin vs. State of Hawaii, in December 1998. The complaint alleged that the state's practice of wait-listing individuals for HCB waiver services violated federal Medicaid law and the ADA. In April 2000, the state and plaintiffs reached a settlement agreement. For an update on lawsuits in Hawaii and other states, 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.
Next Steps
Hawaii's $1.3 million Real Choice Systems Change grant will be used to develop and implement the "Hawaii Real Choices Partnership Project-Accountability for Consumer Choice Entry Support System (ACCESS). The grant will be used to develop the nation's first cross-agency, cross-disability Web-based single entry point (SEP). This Web-based SEP will provide consumers with in-depth, up-to-date information about all the available options offered by private and public agencies.
The Hawaii ACCESS system will include 1) an interactive assessment process that will help consumers identify services for which they are eligible; 2) a unified database showing all long-term care services offered by the state, the counties, and private organizations with openings listed geographically; and 3) a quality assurance component that will identify service gaps by tracking service requests and allowing consumers to periodically rate the services they receive. By being supported as they conduct a guided self-assessment and having direct access to information about available services, consumers will have greater self-determination of their long-term support plans.
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