ARIZONA

Arizona has had an Olmstead plan since September 2001 that state agencies periodically review and update. The plan addresses the long-term care needs of the elderly, people with mental illness, people with physical disabilities, and the developmentally disabled.

State officials believe that the planning process has helped them to identify areas where the state could improve its programs. The process has also resulted, they say, in greater involvement of consumers and advocates and greater awareness of programs, services and issues.

Since Arizona operates its home and community-based programs under a special 1115 (c) waiver from the federal government, any changes to those programs would involve renegotiation of the waiver agreements with the Centers for Medicare and Medicaid Services. State officials point out that areas they would like to change in the waiver programs- such as the use of spouses and parents as paid caregivers- in the state's work plan. Another example is transitional assistance from nursing facilities to community settings. These changes would also be cost-neutral, the officials say. Although they say that the lack of flexibility under the waiver programs hampers further improvements in access to services, they add that current budgetary constraints make it difficult for the state to provide the staff that a waiver renegotiation process would entail.

Despite these difficulties, state officials point to the continued growth of enrollment in the Arizona Long-Term Care System (ALTCS) under current programs as an indication that they are meeting needs, even without changes to the waivers. (ALTCS participation increased from 34,334 people in June 2002 to 37,000 people in April 2003.)

Although funding or other administrative problems may slow any significant restructuring of home and community-based programs, state officials believe that they are incorporating important concepts in these programs. One such concept is self-direction, choice and control for program participants, a concept that the state believes it has successfully communicated to the providers with whom it contracts for services. For example, if a participant wants to use a family member or neighbor as her personal care attendant, she can ask the provider to hire that person for her care.

Another change officials have been able to effect is statewide implementation of Options for Case Management Services. Previously, state employees carried out case management work. The contracted case management model provides an opportunity for private entities, including family members or consumers themselves to become case managers. Family members and consumers cannot be reimbursed for functioning in this role, but they can receive training from the Developmental Disabilities Division.

The 2003 Legislature enacted two pieces of legislation directly related to federal reimbursement for home and community-based services:

• House Bill 2001A, which stated that it is the intent of the Legislature that a state general fund amount of $250,000 in adult services be matched with $250,000 from the federal Social Services Block Grant for non-medical home and community-based services.
• House Bill 2535, which allows the state to provide home and community-based services, including assisted living and respite care, only if the service qualifies for federal reimbursement.