COLORADO

Although the state does not have an Olmstead plan as such, state officials say Colorado " ... is committed to the principles and intent of the Olmstead decision, and has had a long history of providing viable options for people with disabilities." The Colorado departments of Human Services and Health Care Policy and Financing have been developing initiatives to expand community access to services for people with developmental disabilities, mental illness, and physical disabilities and aging.

The Department of Human Services (DHS) reports in a 2003 issue paper, for example, that the state has reduced the number of people with developmental disabilities (DD) in institutional settings by 82 percent in the past 21 years. "This progress demonstrates both a strong commitment to community-based services," the report noted, "and is evidence of 'an effectively working plan' (as suggested within the Olmstead decision)." For the DD population, Colorado provides Comprehensive Services (24-hour supervision and other supports for people with DD who cannot live safely without such assistance) and Supported Living Services that enable people with DD to live in their own homes or in family homes.

The General Assembly appropriated additional resources to reduce the number of people with developmental disabilities on waiting lists for community services for three years in a row: $4.3 million in FY 2000-2001; $3.7 million in FY 2001-2002; and $1.1 million in FY 2002-2003. However, due to the state's budget problems, the 2003 legislature did not appropriate any further increases toward reducing the waiting lists. As of March 2003, DHS reported that 667 people with DD were waiting for Comprehensive Services; 1,310 for Supportive Living Services; and 2,383 for Family Support Services. Approximately 50 percent of those currently receiving Supported Living Services are eligible for and are awaiting Comprehensive Services, according to DHS.

The legislature also appropriated two rate increases for FY 2001-2002 and FY 2002-2003 as a means of addressing the turnover problem with direct care workers who serve people who are receiving publicly funded home and community care services. The wages of community direct care staff increased by 6.2 percent from 2000 to 2002. Although DHS recommended a plan to increase wages over five years, the 2003 legislature did not approve any further wage increases for these workers, and turnover remained high at 58 percent on average during 2002.

Medicaid mental health services in Colorado are delivered through a managed care capitation program. As a result of revenue shortfalls, Medicaid capitation rates were reduced for FY 2003-2004 from previous years' levels, leading to program reductions.

A Community Personal Assistance Services and Supports (COmPASS) project, funded by federal grant, was fully staffed in January 2003. A major activity of the grant is to provide training on consumer direction. The project is developing a train-the-trainer component and is recruiting consumer trainers to provide assistance in consumer direction, primarily for participants enrolled in the state's new Consumer Directed Attendant Support program (CDAS). The first participants in this five-year demonstration program began training in December 2002. CDAS participants hire, train and supervise their own workers.

A $1.1 million Systems Change Grant has involved conducting two surveys. One is of 750 consumers receiving home and community-based long-term care services (HCBS) under Medicaid waiver programs and/or consumers receiving home health services through the Medicaid state plan to determine the services they believe they need to remain in their homes. The other survey, sent to 370 Medicaid providers of home and community-based services, asked the providers about staffing issues, issues they face in providing services to Medicaid clients, and their perception of the services that clients need but cannot access through Medicaid programs.

The state also is designing a feasibility study of community-based respite care for the Mental Illness and Elderly, Blind and Disabled waivers programs, which currently can be delivered only in a nursing facility and/or assisted living facility. Other grant money is being used to evaluate a group of clients with mental illness who were deemed eligible for nursing home care to determine whether they were adequately evaluated for community-based services. As a follow-up to this study, the state will conduct training sessions with case managers on the appropriate use of a new assessment instrument the state has developed for individuals with mental illness.