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On Feb. 4, 2000, a group of individuals and organizations held the first meeting of the Olmstead Stakeholders Group. This group continues to hold monthly meetings. The governor signed an executive order on April 18, 2000, to establish the Home and Community-Based Services and Consumer-Directed Care Commission. The objective of the commission was to develop Missouri's "comprehensive, effectively, working plan," as recommended by the U.S. Supreme Court. The commission issued its final report on Dec. 31, 2000.
On April 10, 2001, the governor issued an executive order establishing the Personal Independence Commission to implement the recommendations of the original commission and to advance Missouri's compliance with the Supreme Court decision. The commission includes the lieutenant governor, four department directors or their designee (departments of Elementary and Secondary Education, Social Services, Mental Health, and Health and Senior Services), four members of the Missouri General Assembly, and 10 public members (people with disabilities, parents and other advocates). The purpose of the Personal Independence Commission was to select the top priorities from those identified by the previous commission and draft an action plan. Olmstead reports and documents are located online at http://www.dolir.state.mo.us/gcd/olmstead/olmsteadwebpage121401.htm
The 2002 Implementation Plan
Major recommendations of the Personal Independence Commission reflect priorities for better serving people with disabilities. They include:
Major priorities include:
The 2000 Plan
The former commission studied all disability groups, regardless of age or residential setting, before it issued its recommendations. The original plan issued in 2000 focused on the following eight activities and corresponding recommendations. Specific timelines and budgets for each item are contained within the plan.
Activity 1: Identify the current number of and current level of funding for home and community-based services and consumer-directed care programs for individuals with disabilities in the state of Missouri.
Activity 2: Develop a tool or mechanism for assessing the effectiveness of these services and programs in addressing the needs of individuals with disabilities.
Activity 3: Identify the number of individuals with disabilities in the state of Missouri who are institutionalized.
Activity 4: Identify the number of waiting lists for home and community-based services or consumer-directed care programs and evaluate the pace at which individuals move from these lists.
Activity 5: Examine whether existing programs and services provide individuals with disabilities who may be eligible for community-based treatment with information regarding this option.
Activities 6 and 7: Recommend any modifications or changes that may be needed to improve existing home and community-based services and consumer-directed care programs and recommend any potential means of expanding home and community-based services or consumer-directed care programs.
Activity 8: Develop a process for helping individuals with disabilities who are institutionalized and who are eligible for community-based treatment to make the transition into community-based treatment settings.
In the 2000 and 2001 sessions, the legislature enacted appropriations language that allows money to follow the individual. An individual who is eligible for or is receiving nursing home care must be given the opportunity to have those Medicaid funds follow him or her to the community and further be allowed to choose the personal care option that best meets his or her needs. During the 2001 session, the legislature passed SB 236, which included several recommendations from the original commission. The bill established Missouri's Medicaid Buy-In Program. It created a grant fund to assist individuals who are making the transition from nursing homes with costs associated with setting up a home of their own. It mandates training for representatives of the disability community to provide information on community-based options for individuals in institutions.
Senate Bill 923 was signed by the governor on July 2, 2002, with a provision relating to parents relinquishing custody because they cannot acquire the mental health services needed for their children. The bill states that in these cases, courts can order that the child receive mental health services in the least restrictive setting based on an individualized treatment plan.
Community Counselors: A $1 million general revenue grant, appropriated by the General Assembly with a federal Medicaid match, will be used to hire 75 community counselors who will work 1) with people in nursing homes who want to make the transition to the community and 2) with hospitals and other community agencies to divert people from entering the nursing home.
The Medical Assistance for Workers with Disabilities (Medicaid buy-in): was funded. Working age people with disabilities who make below 250 percent of the federal poverty level will be able to keep their health care, attendant services and prescription drug coverage when they return to work.
The state has faced a variety of Medicaid rate, service and eligibility reductions that may affect the state's capacity to implement its plans.
There are no current or pending lawsuits related to the Olmstead decision.
The Missouri Department of Social Services received a $2 million Systems Change Grant. Some of the activities that this money supports include the following: