ODDC- Update Ohio Access for People with Disabilities, November 2002

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Title: Update Ohio Access for People with Disabilities, November 2002

Author: Office of Budget and Management, (KACW 11/11/03) This summary assumes that the reader has read the summary of The Ohio Access Report and understands its basic goals.

The Environment: Since the Ohio Access for People with Disabilities was issued on February 28, 200l, consumers continue to call for a system change that supports community living for people with disabilities; but several things in the external environment have changed, including:

The state's economic recovery has been more sluggish than expected, causing state revenue receipts to fall short of expectations.
In balancing the budget for SFY 02 and 03, Ohio has made significant uses of one-time revenue sources available to it.
The Ohio Supreme Court has yet to rule in the latest school funding case before it. The ruling may require that significant new revenues fund primary and secondary education.

Progress Toward Short-Term Goals:

Improve Information Access- The Department of Aging has developed an Internet-based Long-Term Care Consumer Guide. Ohio is also planning to use its "Real Choice/Systems Change" grant to provide a single portal for information about community services and supports.
Expand Current Home and Community-Based Waiver Programs (HCBS)- SB 261, the budget correction bill, made more funding for PASSPORT, eliminating the waiting list in most of Ohio by July. Am. Sub. H.B. 94 mandates that MR/DD serve an additional 500 consumers by the end of June 2003 though Medicaid waivers. Other waiver slots are being added due to the reorganization of the MR/DD system. The Home Care waiver (administered by ODJFS) has approximately 1200 slots available for new enrollees in SFY 2003. A new "transitions" waiver has been created (with 2000 slots) for those on the Ohio Home Care waiver with an ICF/MR level of care.

MR/DD Redesign: MR/DD continues its redesign activities including a new Medicaid HCBS waiver that covers "basic" services and will have 6000 slots, with 3000 expected to be available the first year. MR/DD has expanded capacity within the IO waiver by 4500 slots. The MR/DD redesign as driven by the passage of H.B. 94, alters the service delivery system by redefining the roles of the key stakeholders in the MR/DD system and through the strengthening of the monitoring and quality assurance system.

Correct Inefficiencies in Current Long-Term Care Facilities Reimbursement: As part of the '02-'03 budget process, the administration proposed critical adjustments to the current formula used to determine nursing facility reimbursement, but the Legislature did not pass most of them. Statutory increases guaranteed to nursing facilities are instead largely financed through a "franchise fee" paid by the nursing facilities (through the '04-05 biennium). This fee cannot be passed on to private pay consumers.

Match Capacity with Demand: Ohio is still heavily dependent on the federal government for long-term services, which still has a bias towards institutional care. This is in direct opposition to the expectations and desires of consumers. While progress has been made on specific recommendations and more Ohioans are served in community settings, the debate over spending levels for institutional care continues. The Nursing Facility Reimbursement Study Council has been asked to expand its focus to the appropriate role of nursing homes in the future delivery system considering the declining demand for its services. Ohio nursing home occupancy was at 84% in the spring of 2002 - an all-time low. At the same time, there are still waiting lists for both the IO and Ohio Home Care waivers.

Generate and Sustain the Necessary Resources to Expand Community Services: Several Ohio Access recommendations have been implemented including:

The Choices waiver (administered by ODA) gives consumers more control over service providers - selection, hiring, and firing. Choices has 50 participants already enrolled with an initial limit of 200.
The Olmstead Consumer Task Force marks an unprecedented joining of consumers and advocates from many perspectives, including seniors and people with disabilities. The consumer task force will give input on new strategies for Ohio Access and will be involved in the CMS grants.
Ohio has added a Medicaid state plan amendment protecting two currently operating PACE sites in Cincinnati and Cleveland; providing acute and long-term care services to nursing home-eligible consumers.

Overcome Federal Policy Constraints: In spring of 2001, CMS announced that it would make available competitive "systems change" grants to states. Ohio's original applications were unsuccessful, but in spring, 2002, CMS offered Ohio two specific grants for a three-year period.

Nursing Home Transitions Grants: Funding had already been provided for the Ohio Access Success Pilot in the biennium budget to defray the one-time expenses for people relocating. CMS has recently announced that states may cover transition costs through a Medicaid waiver. Ohio proposes to amend the PASSPORT and the Ohio Home Care Waivers to take advantage of this flexibility and hopes this flexibility would allow the Ohio Access Success Pilot to serve more than its original goal of 200.

Real Choice/Systems Change: With the help of the Olmstead Consumer Task Force, efforts under this grant will concentrate in two areas. The "No Wrong Door" strategy acknowledges that the consumer often confronts the system through many different pathways and the there is a need for a single body of knowledge. Second, to increase suitable housing options, a housing coordinator will be hired to assist those wishing to move out of nursing homes by working with housing authorities to develop new opportunities in the community.

Address the Health Care Workforce Shortage: The Ohio Department of Health convened a task force to study the workforce shortage across several health care disciplines and recommended strategies. The task force reviewed a variety of issues including: licensing standards, recruitment and retention and education.

The Department of Aging also received short-term funding through the Governor's Workforce Policy Board to focus on the shortage of nurses and professional caregivers. The Department of Aging has formed the Ohio Health Care Workforce Advisory Council to:

Advise ODA and the Governor's Workforce Policy Board on the needs and concerns, innovative approaches and research designed to eliminate the workforce shortage including recruitment, retention, training and best practices related to direct care workers
Represent several organizations affected by the shortage including hospitals, long-term care facilities, residential care facilities, and home health agencies
Consider the needs and choices of constituents
Advise workgroups focused on describing the extent of the shortage, collecting information about best practices and developing specific approaches and completing specific tasks
Work collaboratively with the "one stops" created by the Workforce Investment Act
Disseminate results of best practices, special projects, demonstrations and/or initiatives undertaken to help resolve the healthcare workforce shortage to their constituents, colleagues and administrators

The COALA (Council on Aging Learning Advantages) program in Cincinnati, a centralized recruitment, training, and mentoring program, has graduated 349 professional caregivers in its first two years. Training classes are full with a waiting list of 96 applicants. The COALA concept is now expanding to other areas of the state, 92% of those starting the classes have graduated with over 70% gaining employment as professional caregivers. Finally the LEAP program in Cleveland is training people with disabilities to be professional caregivers and attain certification.

Overcome Policy Constraints on Self-sufficiency and Personal and Family Responsibility: Ohio received a CMS grant to study Medicaid issues related to the federal Ticket to Work program. CMS has granted Ohio permission to conduct two studies. The first study catalogues the Medicaid eligibility options available to the Ohio under the Social Security Act. A second study would make recommendations to enhance the Ticket to Work.

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