ARKANSAS

A final Olmstead plan for Arkansas was released on March 31, 2003, by the Governor's Integrated Services Task Force (GIST) and the Arkansas Department of Human Services (DHS). Since July 2001, when Governor Mike Huckabee (R) authorized the appointment of the 23-member task force, the group has held more than a dozen full meetings and numerous subcommittee meetings. The result is an 86-page report that includes 115 recommendations and contains a series of Action Steps from 2003 through October 2005. The plan can be found at http://www.state.ar.us/dhs/aging/olmarplan0303.html . In the summer of 2003, the governor was in the process of renegotiating a continuation of the task force to implement the plan.

The GIST recommendations generally cover four needs: additional resources, community capacity, new approaches to service provision, and better information for consumers. "Community capacity" refers in particular to a shortage of providers to serve clients with complex needs. "Finding better ways to attract and retain caregivers, revising policies and programs to speed up access to care, and encouraging existing and new providers to meet the specific needs and desires of more challenging clients are all essential" the report says. One way to accomplish this goal, the report notes, is by giving consumers more control over the services they receive and the people who provide those services (consumer direction). The report concludes that the Olmstead plan " ... calls for aggressive, but realistic progress, with the understanding that additional initiatives will be undertaken as resources and capacity are available."

The planning process was "really grassroots," according to state officials. The process can sometimes be painful when participants have competing goals, they note, but the interaction among task force members was useful. People get to sit down together, one official said, and learn to respect each other's agenda, although disagreements can emerge from time to time that are not always resolved. Enough consensus developed, the official said, that the effort could be considered "very positive."

Some of the GIST recommendations call for significant new resources. For example, the task force recommended $11.6 million for the FY 2003-'2005 biennium to strengthen the mental health system and $6.4 million in the same period to reduce the waiting list for Medicaid waiver services for people with developmental disabilities, amounts requested in the governor's budget plan for FY 2004 and approved by the legislature.

State officials say that the legislature was able to generate about $100 million in new funds for the Department of Human Services because of increased tobacco taxes, but most of the funds will be needed to support the growth in caseload that the department has been experiencing. Nonetheless, department officials believe they are continuing progress on the goals in the Olmstead plan. They note that, with the exception of the Developmental Disabilities waiver program, the other Medicaid home and community-based waiver programs have no waiting lists.

The GIST and DHS will continue to evaluate their priorities, officials said, particularly in view of a somewhat improving budget picture. The fiscal "slide has slowed," one official said. However, even without substantial new funding, the report notes that Arkansas has received a number of grants in recent years " ... to support systems-change efforts, including improving consumer information, establishing consumer-directed programs and assisting individuals moving institutions to the community."

Arkansas received a state innovations grant under the federal Independence Plus program to develop a 1915 (c) Medicaid waiver program called "Next Choice." Under this program, nursing home residents who want to return to the community to live will be able to keep their monthly income and receive some additional cash for their living expenses. The state has set a goal of helping 5 percent of the nursing home population to make this transition.

State officials also point to the development of a Web-based system that will help Arkansans know what their choices are for services and assistance. A DHS services directory in circulation. A DHS Division of Developmental Disabilities directory will be completed in conjunction with a $900,000 federal grant that will correlate with information on the Web site for people with development disabilities. DHS also plans to offer a toll-free telephone number through which individuals can obtain the same information about services that is available on the Web.

The 2003 legislature enacted House Bill 1194 to direct the Department of Human Services to establish rules concerning prior authorization for Medicaid ElderChoices, a community-based service, that are identical to those in effect for nursing homes.