Olmstead Status: Iowa

Iowa

Task Force

The Iowa Department of Human Services (DHS), as directed by the governor, issued its Iowa Plan for Community Development on June 20, 2001. The plan contains recommendations for systems change and proposes a framework for continued efforts. The steering committee that developed the plan included advocacy groups, providers, families, consumers, DHS employees and county administrators. The steering committee created the proposed plan as a process, not a finished product.

The Plan

The plan includes specific provisions and timelines for assessment of individuals and an inventory of available services. The recommendations are very broad. Although timelines are suggested for each area, the plan itself states that these timelines are "aggressive" and may change. The plan is available at http://www.dhs.state.ia.us/mhdd/MHDDReports.htm.

The plan addresses five key issue areas: health care and medical services, housing, transportation, employment and choice and community support.

Plan Principles

To develop and implement a comprehensive, effectively working plan for providing services to eligible individuals with disabilities in more integrated community-based settings.
To provide an opportunity for interested people, including individuals with disabilities and their representatives, to be integral participants in plan development and follow-up.
To take steps to prevent or correct current and future unjustified institutionalization of individuals with disabilities.
To ensure that services are sufficient to meet the minimum needs of people with disabilities to live in their communities.
To afford individuals with disabilities and their families the opportunity to make informed choices regarding how their needs can best be met in community or institutional settings.
To take steps to ensure that quality assurance, quality improvement and sound management support implementation of the plan.
To ensure that a continuum of community integrated services are made available statewide.

Steps toward Systems Change

Identify all stakeholders and their roles in the process.
Identify people currently living in institutional settings (gather aggregate data).
Provide information and education.
Individually assess needs and preferences of individuals living in institutional settings.
Develop a comprehensive list of individuals who are seeking more integrated community-based services.
Develop and maintain a comprehensive and accurate waiting list for community services.
Identify and train independent living specialists.
Develop and provide coordinated transition services.

Priorities

Iowa's plan gives more specific recommendations in each topic priorities section. Topics include:

Health care and medical services,
Housing,
Transportation,
Employment, and
Choice and community support.

The plan recommends that Iowa pursue "legislative, regulatory, and policy changes" to allow support funds to follow the person into the community equivalent to those available to support that person's need in an institution. The plan discusses expanding Medicaid eligibility levels including the Medicaid buy-in program, and increasing state Medicaid reimbursement levels to health care providers. More information, including a copy of the Iowa plan, is available at www.dhs.state.ia.us/mhdd/MHDDOlmstead.htm

Implementation

Legislation

There was no 2002 legislation related to the Olmstead decision.

Successes

The greatest success to date has been the development of the Cross-Disability Coalition in Olmstead. The Olmstead Real Choices Consumer Task Force has members from a wide variety of disability groups, has a minimum of 50 percent consumers, and has been intimately involved in every major decision affecting the project, including the development of a work plan, that was to be completed by the end of 2002.

Another major step has been a request to the governor to issue an executive order similar to the one issued by the president under the New Freedom Initiative. If issued, it would direct all appropriate state agencies to collaborate with the Olmstead Real Choices Consumer Task Force toward the identification of barriers to community living, policy changes that might be appropriate or needed, and training and information issues for staff and the general public. The request for an executive order was delivered to the governor on Oct. 15, 2002.

Challenges

The division of MHDD in Iowa was eliminated in November 2001, due to restructuring within the Department of Human Services. The functions of that division were transferred to a newly reconfigured, larger Division of Behavioral, Developmental, and Protective Services for Families, Adults and Children. Many staff positions were eliminated and combined.

Iowa suffered from a severe budget crisis, making it difficult to accomplish the work in the time frames established. The state's Olmstead efforts have been placed in one individual's job description, making it difficult to move ahead when other job responsibilities arise. The state is moving forward, but at a much slower pace than initially hoped for.

Lawsuits

Two or three appeals have been filed to date that have some mention of Olmstead, but none have yet entered the court system. For an update on lawsuits across the country, see Status Report: Litigation Concerning Medicaid Services for People with Developmental and Other Disabilities by Gary A. Smith at http://www.hsri.org/index.asp?id=news

Next Steps

The state of Iowa received a $1.025 million Real Choice Systems Change Grant. The money will be used to support the state's response to Olmstead. The state will identify systems for identification of all people with disabilities who currently are living in institutional settings and those at risk of entering institutions and develop an evaluation process to monitor systems change efforts.

BACK TO APPENDIX B

BACK TO OLMSTEAD STATUS REPORT

AL	AK	AZ	AR	CA	CO	CT	DE	DC	FL
GA	HI	ID	IL	IN	KS	KY	LA	ME	MD
MA	MI	MN	MS	MO	MT	NE	NV	NH	NJ
NM	NY	NC	ND	OH	OK	OR	PA	RI	SC
SD	TN	TX	UT	VT	VA	WA	WV	WI	WY