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Legislation enacted in 2002 established a legislative committee to study the development of home and community-based long-term care supports for the elderly and adults with disabilities. The committee must solicit such information from the Department of Health and Human Services' Office of Community Supports and Long-Term Care, service providers, and consumers as may be helpful to the committee in the performance of its duties.
New Hampshire is not involved in traditional Olmstead planning efforts, but state officials are engaged in significant planning efforts that are based on developing community-based services for people with disabilities. Although the state is working to reduce the developmental disability waiting list for people who are living at home and waiting for community services and to divert people from nursing homes, the state would have undertaken these activities regardless of Olmstead.
The governor signed House Bill 1182 on April 26, 2002, which establishes a study committee to look at the status and development of various home and community-based service alternatives throughout the state. This legislation, based on the progress of 1989 legislation (S 409), is attempting to rebalance the service availability in the long-term care system in New Hampshire.
The 2001 session passed other initiatives that are not directly related to Olmstead, including the creation of a study committee to consider proposals to reduce the developmental services wait list to zero and to allocate $4.5 million for direct care provider salary increases for providers for individuals with developmental or acquired brain disorders.
The Legislature appropriated $5 million in fiscal years 2002 and 2003 to serve developmentally disabled people who are on the waiting list for home and community-based services and $3 million for people with acquired brain disorders.
New Hampshire does not operate institutions for people with developmental disabilities, and individuals with mental illnesses are served primarily in the community with acute hospitalizations for crisis stabilization provided at the state hospital. The state has been working to reform home and community-based care for elders and adults with physical disabilities and has reduced the number of people in nursing homes by about 100.
During the 2001 session, legislation passed requiring the Department of Health and Human Services to submit a plan to reduce the waiting period for developmental services to 90 days over a five-year period. The Division of Developmental Services (DDS) has held community meetings to gather input into this plan. The final plan, Renewing the Vision: New Hampshire's Plan to Provide Essential Community Supports for Individuals with Developmental Disabilities, was completed and submitted to the Legislature in November 2001. It can be found at the New Hampshire Developmental Disabilities Services System Web site: http://www.nhdds.org
Planning and development continue with a goal of providing community services to allow elders to remain home rather than be admitted to nursing homes. The Legislature also approved a Work Incentive Program that will allow people with disabilities to purchase Medicaid coverage if they are employed and their income makes them ineligible for Medicaid.
State officials note that consumers, advocates and family members are intimately involved in ongoing planning. Using a combination of existing groups (the Family Support Council for Developmental Disabilities, the Brain Injury Advisory Council, the Governor's Long-Term Care Task Force, and the Alliance for the Mentally Ill), town meetings and individual consumer feedback, they are able to assess and improve their system.
The lack of funding for these programs is the most significant barrier.
In the case Cumming vs. Shaheen, New Hampshire is being sued by the Disability Rights Center regarding people with developmental disabilities who are awaiting community services. The proponents argue the state of New Hampshire has failed to provide adequate community-based services for people with developmental disabilities. The case was filed in 2001 for people with developmental disabilities who are waiting for community services, or who are dissatisfied with their current services. A preliminary hearing was held in April 2002, and the judge denied injunctive relief. A class action suit, Bryson vs. Shumway, is pending in federal court on behalf of 42 adults with acquired brain disorders who reside in nursing homes and are on Medicaid waiver waiting lists. For an update on lawsuits in New Hampshire and other states, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at http://www.hsri.org/index.asp?id=news
The next step for implementing the plan is budgeting to meet the timelines outlined in the developmental disabilities waiting list plan and advocating for adequate funding. The state will continue the work of various coalitions to develop consumer-directed community-based supports for everyone. To date, no timelines have been established.
The state of New Hampshire received a $2.3 million Systems Change Grant. This money is being used to fund the Facilitating Lifespan Excellence (FLEX) Program. The purpose of the program is to develop a statewide system that puts into operation the concepts of consumer-directed services and supports; individualized budgeting; service brokerage (i.e., allow individuals to hire their own personal care attendants); and to ensure quality care for people with disabilities, elders and those in need of long-term services and supports.