MARYLAND

Maryland has been developing several community services initiatives for people with disabilities as an outgrowth of the work of a Community Access Steering Committee that provided recommendations to the governor in July 2001. The recommendations focused on the goals of building community capacity, helping people in institutions to move to the community, and helping people to stay in the community.

State officials say that the work of the steering committee led to the development and approval of a federal nursing home transition grant. Another initiative was the establishment of a hospital discharge pilot program targeted to individuals with physical disabilities who are being discharged from hospitals and who may be at risk of entering a nursing home. A case manager is assigned to help specific hospitals locate appropriate community-based services for these individuals.

The pilot project also includes an educational component to inform hospital social workers and case managers about community alternatives to nursing home care. The goal of the project is to determine whether individuals can be successfully diverted from nursing home placements when given sufficient information about alternatives. Also, peer support counselors have been placed in three state mental health hospitals as another initiative to aid people who are making the transition from institutions to the community.

In October 2003, the state received an $800,000 federal grant for the development of two Aging and Disabilities Resource Centers. State officials said the grant will help Maryland enhance its existing infrastructure by creating a single point of entry at the local level to coordinate access to long-term care supports and services. Another goal for the project is to streamline the state's Medicaid financial and programmatic eligibility determination process to make access easier and less cumbersome for consumers.

In 2003, Maryland was in the fifth and final year of its Developmental Disabilities Waiting List Initiative, which was designed to reduce the wait for community services. By the end of FY 2003, the project had served almost 6,000 people. The initiative has been extended through FY 2004. The state also began the first phase of a five-year initiative to increase wages for community-based direct care workers in the developmental disabilities field.

Other initiatives include the expansion of home and community-based waiver services in 2001, which included implementation of a waiver for adults with physical disabilities and one for children with autism. The third waiver program is an expansion of a Senior Assisted Housing waiver, renamed the Waiver for Older Adults, which serves people age 50 and older who require nursing home level of care. The FY 2004 budget proposed the addition of 1,000 slots to the existing 3,135 slots for the Older Adults waiver, but the proposal fell victim to the state's budget crisis during the 2003 legislative session. The program had 2,000 applications in process by May 2003, with only 80 remaining openings.

The 2003 legislature enacted House Bill 478 saying that the Department of Health and Mental Hygiene may not deny an individual access to a home and community-based services waiver due to lack of funding if he is transitioning to the community from a Medicaid-paid nursing home stay. The department must notify all nursing home residents whose nursing home services were paid for by the Maryland Medical Assistance Program about the opportunity to apply for participation in the home and community-based services waiver. The department must submit a report by January 1 of each year, outlining state efforts to promote home and community-based services and the number of individuals who have made the transition from nursing homes to home and community-based waiver services.