MISSOURI

Planning 

As established in Executive Order 01-08, Governor Bob Holden (D) instituted the Personal Independence Commission (PIC) of the Governor's Council of Disability with the aim of "monitor[ing] Missouri's implementation of Title II of the Americans with Disabilities Act (ADA), with guidance provided by the U.S. Supreme Court" decision in Olmstead v. L. C. The PIC is charged with advising the governor on necessary policy and program changes to ensure that Missourians of all ages and disabilities have access to a range of community support services. The commission is building on the work of the previous Home and Community-Based Services and Consumer-Directed Care Commission, which issued a report of 76 recommendations in December 2000. The PIC includes people with disabilities, family members of people with disabilities, advocacy groups, the lieutenant governor, four members of the General Assembly and representatives from the departments of Social Services, Mental Health, Health and Senior Services, and Elementary and Secondary Education. The PIC began meeting in March 2002 and meets every other month. Olmstead reports and documents are located online at http://www.dolir.state.mo.us/gcd/olmstead/olmsteadwebpage121401.htm.

PIC created an action plan that includes timelines, deliverable products and monthly progress updates on priority issues. To follow up, work groups are working on action steps to implement the recommendations.

In addition, the Missouri Division of Social Services received a $2 million Real Choice Systems Change grant from the U.S. Department of Health and Human Services, and PIC serves as its Consumer Task Force to provide input and guidance on implementation of the grant objectives.

PIC's informed choice subcommittee created an informed choice training curriculum for volunteer trainers to educate those living in institutions about their options. The curriculum includes a community resource guide outlining all available community services that help people with disabilities and senior citizens stay in homes and communities of their choice. The Guide to Home and Community-Based Services published in March 2003, can be found at http://www.dolir.mo.gov/gcd/forms/gcdservices.pdf. The state's systems change grant funded the guide and curriculum. Because of demand and popularity, the guide is going into its second printing.

The state also has been implementing its Medical Assistance for Workers with Disabilities program under the Ticket to Work and Work Incentives Improvement Act. As of December 2002, roughly 8,000 people with disabilities paid premiums to buy into Medicaid coverage. 

Missouri because the first state in the nation to include legislative language (in 2001) that allows for money to follow the individual. Now individuals who are Medicaid eligible and meet the nursing home level of care can choose to have that money pay for community- based options. However, there are gaps in the continuum of community options. In its 2002 annual report, PIC states that there should be options for people who may not be able to direct their own services but could designate someone to direct their services on their behalf.

State agencies often overlap resources, so PIC is working to improve interagency coordination. It is currently considering a universal application form that has to be processed only once and that could replace the application procedures for each department. It also believes that a lead agency should be designated when an individual receives services from more than one agency so the individual does not have to spend time with each case manager.