FLORIDA

Several key entities and strategies shape the Florida response to the Olmstead decision: the Working Group on the Americans with Disabilities Act (ADA) and the Clearinghouse on Disability Information Office that is one of its central activities, and the Real Choice Partnership Project.

Governor Jeb Bush created the 15-member working group by executive order in the summer of 2001 to advance the goals of the ADA (to increase the independence and quality of life for people with disabilities). On the ADA anniversary (July 25, 2003), Governor Bush updated the executive order to reflect an emphasis on community services and partnering with the disability and aging communities to facilitate systems change. The Clearinghouse on Disability Information provides a 1-800 toll-free number for Floridians to use as a central point of contact for long-term care information and referral services.

The Real Choice Partnership Project for which the state received a $2 million grant from the Centers for Medicare and Medicaid Services is designed to implement improvements in community long-term care systems so that people with disabilities can live and participate in their communities. Progress continues on one of the activities under the grant three pilot projects to help people who wish to move into the community from long-term care facilities.

Requests for proposals for the pilot sites went out in the summer of 2003, and the state hoped to begin activities at the sites in October 2003. Key to these sites, say state officials, are grassroots long-term care networks composed of community organizations and people with which the state is forging partnerships. "The state can't do it all," said one state official, but is, instead, "collaborating with the community long-term care network to take advantage of community resources."

Community resources can help supplement state and federal funds that will follow the person making the transition from a nursing home to a community setting. The state hopes to move 1,200 people out of institutions at these sites and elsewhere in the state during FY 2003-2004, incorporating the concept of "the money following the person" for these transitions. (The concept involves funds that had been allocated to the care of the nursing home resident following that person into community care, at least for the first year or two.)

Although funding has increased for home and community-based services for people with disabilities said a state official, "money is not the only solution." The challenge is to find new ways to accomplish these goals, she said, such as the collaboration between state agencies and community organizations on a study of accessible and affordable housing.

Providing services for people with developmental disabilities (DD) continues to be a top priority. The number of individuals with developmental disabilities being provided home and community-based services (HCBS) under the Medicaid waiver program during the last five years has doubled to more than 24,000 individuals. During the last year, Florida's Developmental Disabilities program has convened more than 60 stakeholder meetings (including individuals with developmental disabilities, family members, advocates, providers and representatives of state agencies) that have been focusing on program changes to increase individual control, choice and flexibility. The statewide redesign initiative specifically targets the enhancement and expansion of home and community options through the Developmental Services HCBS waiver program, Consumer Directed Care Waiver program, and Independence Plus.

Oversight of Americans with Disabilities Act initiatives is vested in Florida's Department of Management Services. Officials believe that that agency "comes to the table with neutrality," and thus can help ensure that the ADA is implemented throughout state government agencies.

The 2003 Legislature enacted two laws that are specifically aimed at directing home and community-based services toward those at risk of nursing home care.

• Senate Bill 2a states that the Agency for Health Care Administration, in consultation with the Department of Elder Affairs, shall develop a statewide plan for reducing the proportion of total Medicaid long-term care funds committed to nursing home care to increase future resources available for home and community-based care. It appropriates $5.6 million for an Alzheimer's Medicaid home and community-based waiver.
• Senate Bill 642 states that the Department of Elder Affairs is required to determine an order of prioritization for all non-vulnerable functionally impaired elderly people who are seeking community care for the elderly services that is based upon the potential recipient's frailty level and likelihood of institutional placement without such services. Should further prioritization be required, those who are less able to pay for such services must receive higher priority than those who are better able to pay for such services. Ability to pay may be based on the potential recipient's self-declared statement of income and expenses.