Slide One
State Legislatures and the Olmstead Decision :
What's the Latest-

Independent Living Research Utilization Webcast
July 17, 2002

Jo Donlin
Senior Policy Specialist
National Conference of State Legislatures

Slide Two
Goals of this Presentation
-Summarize survey results from The States' Response to the Olmstead Decision
-Highlight opportunities and challenges
-Review  the role of state legislatures in implementing the Olmstead decision  
-Summarize current NCSL Olmstead activities

Slide Three
The States' Response to the Olmstead Decision	
-NCSL Survey - An Ongoing Project
-1st Report Released March 2001 
-2nd Report Released December 2001
-New Update in Progress - More to Come

Slide Four
The States' Response to the Olmstead Decision	
-Bulk of activity has been in the Executive Branch
-40 states plus D.C have established task forces, commissions or state agency work groups (as of December 2001)
-Appointed by governors, legislators and health commissioners
-Few involved legislators
-Broad scope

Slide Five
The States' Response to the Olmstead Decision 
-States are focusing efforts on developing state plans
-18 states have some type of written report or plan: AZ, CT, DE, GA, IL, IN, IA, KY MD, MO, MT, NC, OH, OK, SC, TX,WI, WY
-4 stand out as "comprehensive and effectively working": MS, MO, OH, TX
-8 other states have plans in the works
-States are not required to do a state plan

Slide Six
State Plan Guiding Principles
Jan. 14, 2000 Guidance letter from HCFA & OCR
-Develop & implement a ... plan for ... services ... in more integrated, community-based settings
-Involve consumers in plan development and follow-up
-Prevent or correct unjustified institutionalization
-Ensure availability of community-integrated services
-Provide opportunity for consumer informed choices
-Address quality assurance & sound management

Slide Seven
The States' Response to the Olmstead Decision
-Housing
-Transportation
-Waiver program expansion
-Transitioning individuals
-Data collection
-Staffing
-Assessment
-Consumer/provider/ agency education & outreach

Slide Eight
The States' Response to The Olmstead Decision
-In 2001, little legislative activity directly related to Olmstead but...
-MO enacted a wage pass through for MR/DD caregivers;  funds for training staff and individuals; $$ for transition costs and added a personal care benefit to the Medicaid plan
-MD expanded its waiver to 300% of the supplemental security income eligibility level
-TX expanded all six waiver programs	

Slide Nine
Challenges and Opportunities	
- Challenges
- Budget Shortfalls 
- Housing
- Workforce Shortage
- Transportation
- Data Collection

Slide Ten
Challenges and Opportunities
- Opportunities
	.Everyone's Involved - Working Together 
	.Federal Government is Helping
- CMS Guidance Letters
-  "Real Choice Grants"
- New Freedom Initiative
- Administration's policy on removing barriers to equality for 54 million Americans living with a disability
- Latest development, new independence template waivers

Slide Eleven
Legislature's Roles in Implementation
	
- If you haven't involved your legislature, now is the time!
- Why Should you Care-
- Control the purse strings
- Establish programs
- Enact requirements
- Provide oversight


Slide Twelve
Legislature's Role in Implementation
- Medicaid
- long-term care accounts for 35% of all state and federal Medicaid funds.
- Olmstead  will affect Medicaid budgets
- Other State Programs are Involved
- Housing, Transportation, Vocational Rehabilitation

Slide Thirteen
Term Limits, Elections & Redistricting - Oh My!
- Combination could cause 25% turnover
- AZ, AR, CA, CO, FL, ID, LA, ME, MI, MO, MT, NE, NV, OH, OK, OR, SD, UT, WY
- Opposition and supporters leave
- Continuing education process
- Severe transitions in some states
- Michigan Senate:  71% new
- Missouri House: 45% new


Slide Fourteen
Dos and Don'ts
DO: 
- Get involved (year round)
- Be accurate, reliable, honest, concise, and vigilant
- Build relationships early
- Offer to be a resource
- Be inclusive of others
- Have written materials
- Personalize the issue/take a field trip
- Thank your audience

Don't:
- Assume you don't count
- Wait Until Session
- Mislead or give false information
- Make enemies
- Be too narrowly focused
- Refuse to compromise
- Go on and on . . .
- Give up

Slide Fifteen
NCSL Olmstead Activities
- The jury is still out.  Early stages of implementation.
- Continue to Educate Legislatures about Olmstead vs. L.C.- publications, meeting, website
- Tracking State Activities
- state plans
- legislative activity
- Providing technical assistance


Slide Sixteen
Resources
- NCSL Olmstead website
  http://www.ncsl.org/programs/health/disabil2.htm

- Centers for Medicare and Medicaid Services
- http://www.hcfa.gov

- National Technical Assistance Exchange
  - Susan Reinhard, Rutgers University, Center for State Health Policy, 732-932-3105, x230
  - Richard Petty, Independent Living Research Utilization, 713-520-0232
  - Home and Community Based Services Web site http://www.hcbs.org
  
  Jo Donlin
  National Conference of State Legislatures
  jo.donlin@ncsl.org or 303/830-2200, ext. 130
  or
  Wendy Fox-Grage
  National Conference of State Legislatures
  wendy.fox-grage@ncsl.org or 202/624-3572