NEW HAMPSHIRE

New Hampshire does not have an official Olmstead task force. Advocates and state officials agreed a long time ago that another commission and plan were not necessary. The Developmental Services Division has a five-year plan-issued in November 2002-to reduce the waiting list. The Elderly and Adult Services Division has a plan entitled "Shaping Tomorrow's Choices," and the Behavioral Health Division has a five-year plan to change its financing structure to give people with mental illness more choice. In addition, the state's Real Choice Advisory Council for its federal grants is playing that role.

Despite its budget crisis, the legislature appropriated $6.6 million in fiscal year 2004 and $9 million for FY 2005 to serve people with mental retardation and developmental disabilities (MR/DD) who are on the waiting list for home and community-based services in accordance with the five-year plan. The MR/DD population has made much more progress toward community-based care than the other long-term care populations, primarily because the families are strong advocates. During the legislative session, vital programs for other long-term care populations sustained cuts while the MR/DD population made progress toward reducing the waiting lists. The Department of Health and Human Services told the legislature that it would serve 110 more people in day services, 50 people residentially for FY 2004 and another 80 people with day services for FY 2005 because of the appropriations.

However, the Department of 'Health and Human Services planned to create a waiting list in October 2003 for elderly and disabled residents who looking for home care in the Medicaid waiver program because of a lack of funds. Legislators were outraged and, as a result, this state waiting list has been put on hold. The legislature had figured on a 2.5 percent growth rate in the caseload and added $800,000 to the original budgeted amount to cover it during the 2003 legislative session. It also planned on some cost containment to the program by shifting case management to outside providers. Department officials claim that the funding is insufficient. The legislature, in the meantime, is demanding that the services be provided within the framework of the budget.

In addition to the budget crisis, the state also has a state employee hiring freeze in effect. Turnover in state agencies is high because of low morale, but the state cannot fill these positions because of the hiring freeze. This is affecting not only Olmstead-related activities, but a number of other activities as well. 

The state received a Systems Change grant for $2.3 million to move toward more consumer-directed care. The state also applied for additional Systems Change grants from the federal government. As a state official acknowledged, the Systems Change grant "is the only thing that is keeping things going."