LOUISIANA

As of September 2003, the Disability Services and Supports System (DSSS) Planning Group and Consumer Task Force in Louisiana were still active but had not issued a final report. The DSSS and task force submitted short-term recommendations for systems change to the Louisiana Department of Health and Hospitals in both October 2001 and October 2002 so the department could include funding for implementation in its budget request for the pending fiscal year. In February 2003, the DSSS used a strategic planning template to develop a more comprehensive planning document that will be used to draft a multi-year plan for systems change.

The current plan does not include priority populations and although, the plan does and will identify priority recommendations, those priorities are not population-based. According to planning officials, many participants in the DSSS planning process and most Task Force members have expressed a preference for prioritizing systemic changes that produce substantial benefits to all populations.

Louisiana has two pilot projects that are funded by the 2002 Real Choice Systems Change (RCSC) grant and are being carried out through a subcontract between the Governor's Office of Disability Affairs and the Louisiana State University Human Development Center. One project is a work force development project to develop and implement a competency-based curriculum for direct support professionals. The other is a housing coalitions demonstration project to support and encourage the development of community coalitions and to provide these coalitions with tools to identify area housing needs and advocate for the allocation of community resources so that individuals with disabilities have access to community-based housing.

In addition to these programs, the state has program initiatives that are administered by the Department of Health and Hospitals. The programs include an Independence Plus waiver, the Real Choice Nursing Home Transition grant, and the Louisiana Medicaid Buy-In program.

In 2003, numerous legislative acts were related to Olmstead. One act changed the composition of the consumer task force and required that expenditures proposed by the consumer task force be submitted to the Joint Legislative Committee on the Budget for approval prior to payment. Another act exempted certain large ICFs/MR from the moratorium that prevents certification of new beds. The Legislature also requested a study of Medicaid funds while helping a recipient make the transition from an institutionalized setting. Other legislative actions include the approval of additional waiver slots for adult day health care, elderly and disabled adults, and personal care attendants and the authorization of Louisiana's Medicaid Buy-In program for implementation in 2004. Another bill failed that aimed to eliminate pay disparities between direct support workers who are providing community waiver services to people with developmental disabilities and those employed at state developmental centers.

The Legislature appropriated approximately $28 million of the $38 million requested by the Department of Health and Hospitals to add personal care attendant services as a Medicaid state plan benefit. The Legislature also instructed the department to delay implementation of the personal care option until October 2003 and to seek a renegotiation of the settlement that would allow the state to implement 2,000 additional Elderly and Disabled HCBS waiver slots instead of the personal care state plan benefit.

The state does not currently have a strategy in place for a systematic evaluation of plan implementation, but the Department of Health and Hospitals regularly responds to DSSS and task force recommendations and provides periodic reports on increases in the provision of home and community-based services. In addition, the Governor's Office of Disability Affairs (GODA) recently hired a full-time project director for long term care systems change to oversee three RCSC grant-funded and facilitate the DSSS planning process; the director has additional other staff support.

The state's fiscal situation and the lack of new funds to implement home and community-based services are seen as barriers to long-term care reform in the state.

In addition opposition from the for-profit nursing home association, the group home association, and some of the family organizations associated with group homes and developmental centers may cause some problems with implementation.

According to state officials, the current planning document has several shortcomings that will be addressed in the coming months. It does not include all the previous recommendations made by the DSSS and the Consumer Task Force, no specific benchmarks and timelines have been developed, and recommendations have not been fully prioritized to reflect a coherent, overall strategy and timeline for systems change. The next step for the task force is to address the gaps in the current planning document.