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Missouri

Task Force

On Feb. 4, 2000, a group of individuals and organizations held the first meeting of the Olmstead Stakeholders Group. This group continues to hold monthly meetings. The governor signed an executive order on April 18, 2000, to establish the Home and Community-Based Services and Consumer-Directed Care Commission. The objective of the commission was to develop Missouri's "comprehensive, effectively, working plan," as recommended by the U.S. Supreme Court. The commission issued its final report on Dec. 31, 2000.

On April 10, 2001, the governor issued an executive order establishing the Personal Independence Commission to implement the recommendations of the original commission and to advance Missouri's compliance with the Supreme Court decision. The commission includes the lieutenant governor, four department directors or their designee (departments of Elementary and Secondary Education, Social Services, Mental Health, and Health and Senior Services), four members of the Missouri General Assembly, and 10 public members (people with disabilities, parents and other advocates). The purpose of the Personal Independence Commission was to select the top priorities from those identified by the previous commission and draft an action plan. Olmstead reports and documents are located online at http://www.dolir.state.mo.us/gcd/olmstead/olmsteadwebpage121401.htm

The Plans

Major recommendations of the Personal Independence Commission reflect priorities for better serving people with disabilities. They include:

• Caregiver compensation,
• Housing,
• Informed choice,
• Consumer and family directed with supportive and flexible funding,
• Defining "deinstitutionalization,"
• Expanding opportunities for support and employment by expanding Medicaid eligibility,
• Identifying and assessing waiting lists and developing guidelines for the movement in each program area,
• Ongoing monitoring and reporting mechanism.

Major priorities include:

• Leadership and Planning: Develop a process evaluation and measure plan implementation yearly; one department or entity should develop a single document outlining available services; where multiple agencies serve a consumer, a lead agency should be named.
• Employee Development: Identify the number of staff trained on informed choice and how they use the training; develop statewide Olmstead training for state agency and provider staff; statewide training should encourage networking and other continuing education credits; background screening must be performed on all direct caregivers to protect consumers; with consumer input, state agencies should develop and promote train-the-trainer programs:
• Customer Satisfaction: A clearly defined appeal procedure shall be part of the choice processes; train consumers on how to coordinate, negotiate, purchase, direct, hire and fire attendants; develop a universal application form for home and community services across agencies;
• Funding: Monitor waiting lists and document why one is longer than 90 days; implement the Ticket to Work Incentives Improvement Act, including the buy-in provisions.
  

The former commission studied all disability groups, regardless of age or residential setting, before it issued its recommendations. The original plan issued in 2000 focused on the following eight activities and corresponding recommendations. Specific timelines and budgets for each item are contained within the plan.

Implementation

In the 2000 and 2001 sessions, the legislature enacted appropriations language that allows money to follow the individual. An individual who is eligible for or is receiving nursing home care must be given the opportunity to have those Medicaid funds follow him or her to the community and further be allowed to choose the personal care option that best meets his or her needs. During the 2001 session, the legislature passed SB 236, which included several recommendations from the original commission. The bill established Missouri's Medicaid Buy-In Program. It created a grant fund to assist individuals who are making the transition from nursing homes with costs associated with setting up a home of their own. It mandates training for representatives of the disability community to provide information on community-based options for individuals in institutions.

Senate Bill 923 was signed by the governor on July 2, 2002, with a provision relating to parents relinquishing custody because they cannot acquire the mental health services needed for their children. The bill states that in these cases, courts can order that the child receive mental health services in the least restrictive setting based on an individualized treatment plan.

Community Counselors: A $1 million general revenue grant, appropriated by the General Assembly with a federal Medicaid match, will be used to hire 75 community counselors who will work 1) with people in nursing homes who want to make the transition to the community and 2) with hospitals and other community agencies to divert people from entering the nursing home.

The Medical Assistance for Workers with Disabilities (Medicaid buy-in): was funded. Working age people with disabilities who make below 250 percent of the federal poverty level will be able to keep their health care, attendant services and prescription drug coverage when they return to work.

The state has faced a variety of Medicaid rate, service and eligibility reductions that may affect the state's capacity to implement its plans.

There are no current or pending lawsuits related to the Olmstead decision.

The Missouri Department of Social Services received a $2 million Systems Change Grant. Some of the activities that this money supports include the following:

• Informed Choice: A work group is developing a curriculum to train advocates and state staff on how to offer informed choice to residents of institutions. The goal is to ensure that consistent, accurate and unbiased information is provided so that individuals have access to the resources, peer support and independent living services they may need to make informed choice and transition to the community. People trained on informed choice then will make contact with residents of institutions.
• Best Practices Demonstration Projects: Part of the Real Choice Systems Change grant money will be used to support a few demonstration projects to find effective and innovative ways to improve the delivery of existing services and supports, or to find new methods to keep people in their own homes and communities. The findings from demonstration projects will be used to make recommendations for systems change.
• Interagency Coordination and Information Sharing: Individuals and families report that lack of information and poor interagency coordination are two major barriers. Grant money will be used to collect and make available information about all the community services and supports available, develop Web sites and kiosks, implement an automated referral system, and support an interagency task force.
• Transition to Independence Grants: Because Missouri's Nursing Home Transition Grant proposal was not funded, a portion of the Real Choice Systems Change Grant will be used to fund Transition to Independence Grants to help people who are moving out of institutions set up their new homes. (No grants have yet been used.)

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