VERMONT

Without a formal Olmstead planning process, Vermont continues to develop programs that are intended to expand community services and supports for people with disabilities. For example, on October 1, 2003, the state submitted a proposal for a long-term care demonstration program, the result of a yearlong planning and development initiative. The goal of the demonstration program is to give adults with physical disabilities and the frail elderly the option 1) to receive long-term care services in a home and community-based setting without having to wait for a slot to open in an existing waiver program, or 2) to choose care in a nursing facility.

The state describes the demonstration waiver proposal as constituting a "wholesale replacement" of most of Vermont's existing long-term care Medicaid program. All individuals who currently are eligible for Medicaid and are receiving services in a nursing facility or waiver program will be enrolled in the demonstration program. The program will be administered by the Department of Aging and Disabilities within the Vermont Agency of Human Services.

The program categorizes eligible people into three groups: highest need, high need and moderate need. The state says that, since "funding constraints are a reality," it has developed a prioritization strategy that ensures those with the highest needs are served first. The other two groups are further prioritized; individuals in these groups will be served based on the level of available resources.

The state estimates that an additional 800 "highest need" individuals will become eligible each year for either nursing facility or home and community-based care. Demonstration participants in this group who elect home-based services also must meet Medicaid financial eligibility criteria, except that they will be allowed to retain up to $10,000 in resources.

The "high needs" group year will not have care needs at a level that meets the existing clinical criteria for long-term care Medicaid, but will meet Medicaid financial eligibility requirements. This group, which the state estimates will total about 200 to 300 people a year, will be served to the extent that funds are available. The moderate needs group will include individuals who meet neither current nursing facility non waiver eligibility criteria but are believed to be at risk of institutional placement based on their assessed care needs. They will be provided with preventive and supportive services so that their conditions can be stabilized or improved, thus avoiding or delaying more costly institutional care.

In other actions that affecting people with disabilities, the Agency for Human Services (AHS) is engaged in a reorganization planning process that's expected to run through 2006. In the FY 2003 appropriations act, the Vermont General Assembly instructed the AHS to recommend a "comprehensive plan" for reorganization of the agency's operations. AHS is the largest agency in Vermont state government, with 3,000 employees and a $1.2 billion FY 2003 budget.

One issue the agency said needed to be addressed through reorganization was reform of the agency's approach to substance abuse treatment. The state must examine ways, the agency said, to coordinate its response to substance abuse with related efforts, such as mental health treatment, physical health care, and the judicial and corrections systems. Another issue the agency identified was ".... the need to integrate the state's approach to long-term care so that consistent supports and services are available, based on the need of the individual or family, rather than by diagnosis or geographic region of the state."