PowerPoint Presentation Rhode Island DD Network

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Rhode Island

• Population 1,057,832 (2007)
• Increase of .9 since 2000
• Female 51.6
• Male 48.4
• Under 18 22
• Over 65 13.9

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Rhode Island

• 1,214 square miles
• 1,044 square miles of land
• 170 square miles of water
• Density 1003 per square mile (U.S. 79)
  Average Commute to Work 22 minutes

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Income

• Median Income - 52,755
• (U.S. - 50,740)
• Per Capita Income - 21,688
• Percent below Poverty 11.9
• (U.S. 13)

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Diversity

• White/Non-Hispanic 80
• Hispanic 10.6
• Black 6.2
• Asian 2.6
• Native American - .6
• Languages OtherThan English 20

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Early Intervention

• Lead Agency RI Dept of Human Services
• 10 Provider Organizations
• 2 Specialty Provider Organizations
• Sherlock Center Training/Technical Assistance
• RIPIN Parent Mentors

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Early Intervention

• 1690 families
• 4.6 of children Birth-3 (4th in U.S.)
• 64 of children - developmental delay
• 26 - single established condition
• 10 - multiple conditions

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Early Intervention

• Receiving Timely Services 83
• Natural Environment 86
• Transition Steps 94
• Transition Conference 91
• The Data System for Part C Indicators
• re Child Change is Being Refined

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Early Intervention

• Families Reporting thatEI Helped Them
• Know Their Rights 89
• Communicate Needs 94
• Help Their Child Develop 94

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Rhode Island Schools

• 36 School Districts
• (4 state districts,8 independent charters)
• 308 Public Schools
• 148,474 students
• 14,224 Teachers
• 22 Commended Schools (7)
• 58 Low Performing schools (19)

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Rhode Island Students

• 38 Eligible for Free/Reduced Lunch
• (District Range 3 - 73)
• 17 Children under 18 Living in Poverty
• 31 from minority races and cultures
• 3.6 ESL, 1.4 Bilingual
• 15 Births to Mothers less than High School
• (26 Core Cities, 7 Rest of State)

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Special Education

• 29,612 students 18.04
• Range by District 11.57 - 23.75
• Less than 40 time in regular class 21.68
• Separate School 3.85
• Graduation rate all 73.9
• Students with disabilities 55.9

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Primary Diagnosis

• Learning Disability 42
• Speech Impaired 18
• Health Impaired 17
• Behavior Disorder 11
• Autism 5
• Intellectual Disability 4
• Multiple Disability 1
• Developmental Delay 1
• All Others 1.4

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Special Education by Race

• White 69.67
• Black 9.49
• Hispanic 18.27
• Asian 1.54
• Native American 1.03

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Special Education by Service Type

• General Education with Supports 12.33
• Self Contained 5.68
• Homebound/Hospitalized .04

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Special Education by Placement

• Regular Class gt 80 70.67
• Regular Class 40-79 7.65
• Regular Class lt 39 14.71
• Separate School 3.85
• Residential .91
• Homebound/Hospitalized .18
• Correctional Facility .25
• Parentally Placed Private 1.78

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Students in Segregated Settings

• Students with intellectual disabilities 88
• Students with multiple disabilities 84
• Students with hearing loss 43
• Students with physical disabilities 32

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Proficiency on State Assessments

• Reading Grades 3-8 68 30
• Math Grades 3-8 53 23
• Reading Grade 11 65 29
• Math Grade 11 27 5

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Proficiency Alternate Assessment

• Reading Grade 4 43
• Math Grade 4 41
• Reading Grade 7 46
• Math Grade 7 28
• Reading Grade 10 37
• Math Grade 10 29

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Post School Outcomes - All

• Employed 30
• Post Secondary 21
• Both 28
• Neither 21

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Post School Outcomes Intellectual Disability

• Employed 15
• Post Secondary 17
• Both 23
• Neither 45

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Description of the RI Developmental Disabilities
Adult System
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• DDD Responsibilities
• Planning/administration of community system of
  services/supports for people with developmental
  disabilities
• Safeguarding the health/safety of people
• Ensuring equitable access to and allocation of
  available resources to meet the needs of people
• (DDD is a division within the state department
  of Mental Health, Retardation and Hospitals
  (MHRH) )

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• System Information
• DDD funds a statewide network of community
  services/supports
• Services are privately and publicly operated
• People can choose services from 41 different
  community provider agencies OR
• People can choose to self-direct their own
  services through a fiscal intermediary
• RI uses the federal definition of developmental
  disability to determine eligibility

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• Services/Supports Funding (Three broad
  categories)
• Residential Services,
• Day/Employment
• Services, and
• Family Supports

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• General Information
• 4390 Adults with developmental disabilities
  receive case management services
• 3552 People receive services funded from
  community agencies
• 41 Licensed community providers (1 public State
  Agency and 40 Private Agencies)
• 18 Agencies authorized as Shared Living Providers
• 2 Agencies authorized as Fiscal Intermediaries

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• Eligibility
• People applying for services annually
• (FY 08)277
• People found eligible for DDD services annually
  (FY 08)221
• Caseload ratio1 170 people

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MHRH FY 09 BUDGET 457.5 Million
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• The RICLAS Budget funds mainly 24-hour
  residential services.
• The Privately-Operated Services Budget funds a
  variety of Day/Employment Services,
• Family Support, Non-24 Hour Residential, Shared
  Living Arrangements, and 24-Hour
• Residential Services.
• DD Administration includes only the DD Central
  Office.

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• Budget
• Total DDD 09 Budget (State and Federal)246.8
  million
• Enacted budget included savings of 32.9 million
  and 15.6 million from general revenues by
  providing services in the least restrictive
  setting
• (Source MHRH FY 2010 Budget Presentation to
  House Finance Committee)

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• Almost three quarters of the 246.8 million
  of the DDD Budget is spent on various types of
  Residential/ Housing Services.

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• FY 2009 and 2010 Budget Changes
• Reductions in the DDD Budget are planned to
  be implemented for 09 and 10 through the newly
  approved Global Waiver and Governors revised
  budget through the following
• Increasing Shared Living Arrangements
• Utilizing new criteria for Levels of Care to
  determine what types of services people will be
  eligible for
• Rate reduction for private community providers
  for Residential and Day Support Services
• Elimination of Group Home Tax collected through
  previous HCBS Waiver
• Other cost savings ideas identified by community
  providers

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• Residential/Housing Supports
• Residential/Housing Supports includes people
  with developmental disabilities living
• with their family,
• in independent apartments,
• in group homes,
• in Special Care Facilities,
• in fully and semi-supervised apartments,
• in Shared Living, etc.)

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Residential/Housing Supports
Number of People With Families1920 Group
Homes1514 Apartments460 Shared
Living128 Nursing Homes100 Out of
State3 Unknown229 Special Care36 Total People
4390
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• Day/Employment Supports
• Day Supports includes personal development,
  community involvement, service learning,
  supported employment, competitive employment and
  sheltered workshops)
• Number of people in Supported Employment659
• People receiving services through funded day
  supports3300

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• Family Support
• Family Support includes in-home services
  provided to families for support/assistance such
  as respite, personal care, LPN, homemaker
  services, agency support staff, assistive
  technology, transportation, assistive technology,
  home modifications, etc.
• Number of people receiving Family Supports880

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• Self-Directed Supports
• Number of agencies authorized to provide
  self-directed supports2 (OSCR and Trudeau
  Center)
• Number of people receiving supports through the
  Options Program 265 people
• Approximate 09 Budget (state and federal) for
  self-directed supports 5.5 million

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• Continuous Quality Improvement
  
• Trends Data (FY 05-08)
• People with disabilities want to develop new
  relationships and friendships with other
  individuals beyond paid persons (staff)
• People with disabilities are interested in
  accessing more options for employmentto earn
  better paychecks in jobs in the community
• Transportation options need expansion beyond
  individuals family and staff
• People need additional opportunities to learn
  about human rights and responsibilities

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• Other Services Provided to Individuals With
  Developmental Disabilities in RI

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• ICF-MR Residential Services Administered By
  Zambarano Hospital/MHRH
• Number of group homes4
• Number of adults with developmental disabilities
  living in group homes18
• Rate/day  1,035.72
• Total 2008 Budget .1 million

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• Tavares Pediatric Center ICF-MR
• Number of individuals served from age 18 months
  to 3123
• 4 individuals go off site for day program
  support
• On site day program24 (3 from community)
• 10 children are on ventilators (life support)
• Licensed by DOH for 30 residential beds
• Rate/per day (2009)942.00
• 2008 Annual Budget 6.155 million

The Tavares Center opened in 1983 and is
certified as RIs only 24 hour skilled pediatric
nursing facility and ICF-MR for very medically
fragile young individuals with developmental
disabilities whose needs cannot be met in less
restrictive settings.
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• Medicaid Reform in Rhode Island
• (Global Consumer Choice Waiver)
• MTARS
• June 4, 2009

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Medicaid Reform The Global Consumer Choice
Waiver

• Medical Assistance (Medicaid) is jointly funded
  by
• the federal government the Centers for Medicare
  Medicaid Services (CMS) within the U.S.
  Department of Health and Human Services, and
• The state. In Rhode Island, the Department of
  Human Services (DHS) and the Executive Office of
  Health and Human Services (OHHS) operate Medicaid.

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Medicaid Reform The Global Consumer Choice
Waiver

• Who is covered by Medicaid in Rhode Island?
• Nearly 200,000 Rhode Islanders (Almost 1 in 5)
• Low-income children and families (Rite Care or
  Rite Share) 134,400 (2006)
• Elderly adults, 65 -- 18,166 (2006)
• Children with special health care needs 12,353
  (2006)
• In foster care or receiving adoption subsidy
• On SSI or through Katie Beckett
• Adults with disabilities 27,334 (2006)
  including DD
• On SSI, spend-down eligibility, or Sherlock Plan

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Medicaid Reform The Global Consumer Choice
Waiver

• Beginning in mid 2000s state policy makers
  concerned about Medicaid growth
• SFY 2005 24 of general revenues
• Decreasing federal matching rate (FMAP)
• Growth in Medicaid costs higher than growth in
  state revenues (although rate of growth declining
  and about half of that of private insurance)
• In 2008 predicted state budget deficits in excess
  of 350M each year for next 5 years

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Medicaid Reform The Global Consumer Choice
Waiver

• In 2008, DHS sought permission from CMS RI to
  operate all of its Medicaid programs under one
  Global Consumer Choice Waiver
• Capped amount of federal funding over the next 5
  years
• No more discrete waivers for specific populations
  (e.g. DD/MR waiver)
• All populations and services through one wavier.

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Medicaid Reform The Global Consumer Choice
Waiver

• RISK If more people become eligible or health
  care costs rise the state will have to
• Fund the extra costs with state dollars only,
  or
• Cut back on who is eligible for Medicaid,
  and/or services provided
• CMS approved Global Consumer Choice waiver,
  effective 01/16/09.

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Medicaid Reform The Global Consumer Choice
Waiver

• Will have three levels of care for long-term
• care services
• Highest -- will have access to group homes and
  all community-based services
• High -- will have access to community-based
  services (including shared living, assisted
  living and home services and supports) as long as
  funding is available and
• Preventative -- will have access to services like
  home care services, home modifications or
  physical therapy services, as long as funding is
  available.

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Medicaid Reform The Global Consumer Choice
Waiver

• Several important legal protections waived so
  that
• Can have waiting lists for home and community
  based services, for all but highest level
• Can carve out different benefit plans for
  specific groups and
• Can restrict choice of providers.

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Medicaid Reform The Global Consumer Choice
Waiver

• Current status
• DHS formed Task Force of providers, individuals
  and advocates (RIDLC, Sherlock Center)
• Proposed rules regarding waiver, but only define
  level of care for those needing nursing
  facility (not DD population)
• Further state budget cuts to Medicaid for SFY 09
  and 10

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• Vocational Rehabilitation Services
• MTARS
• June 4, 2009

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Vocational Rehabilitation

• VR is jointly funded federal/state program
• U.S. Rehabilitation Services Administration, U.S.
  Department of Education (RSA), and
• in Rhode Island, the Office of Rehabilitation
  Services within the R.I. Department of Human
  Services (ORS).

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Vocational Rehabilitation

• As permitted by federal law, ORS utilizes an
  order of selection for services.
• Currently serving individuals who are
• 1. Individuals with a Most Significant
  Disability and
• 2. Individuals with a Significant Disability.

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Vocational Rehabilitation

• Individuals with a Most Significant Disability
• a severe physical or mental impairment which
  seriously limits three (3) or more functional
  capacities (e.g., mobility, communication,
  self-care, self-direction, interpersonal skills,
  work tolerance, or work skills) in terms of an
  employment outcome
• requires multiple VR services over an extended
  period of time and
• one or more physical or mental disabilities
  (descriptive list).

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Vocational Rehabilitation

• Individuals with a Significant Disability
• a severe physical or mental impairment which
  seriously limits one or more functional
  capacities (e.g., mobility, communication,
  self-care, self-direction, interpersonal skills,
  work tolerance, or work skills) in terms of an
  employment outcome
• requires multiple VR services over an extended
  period of time and
• one or more physical or mental disabilities
  (descriptive list).

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Vocational Rehabilitation

• Supported Employment services are available to
  individuals with Most Significant Disability in
  Rhode Island
• Primarily for
• individuals with developmental disabilities or
• Individuals with serious mental illness

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Vocational Rehabilitation

• Supported Employment
• Competitive employment in an integrated setting
  with on-going support services
• When competitive employment has not traditionally
  occurred or been interrupted or intermittent as a
  result of disability
• Because of nature and severity of disability need
  intensive supported employment and extended
  services thereafter in order to perform
  integrated and competitive work

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Vocational Rehabilitation

• To be considered competitive must
• Be full or part time in competitive labor market
  in an integrated setting
• Paid at or above minimum wage, but not less that
  usual wage paid to other employees

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Vocational Rehabilitation

• Length of services
• ORS generally limited to 18 months
• Extended services from state agency (e.g. DODD),
  private non-profit, or employer

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Vocational Rehabilitation

• ORS Cooperative Agreement with MHRH
• (being updated for 2010)
• Identify and provide intensive supports for 100
  individuals with DD
• Expand services and promote more choice for youth
  with DD transitioning from school to adult life

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Vocational Rehabilitation

• State Data on Employment
• 2003 DDD-State-wide Quality Consortium
• Employment Survey
• 30 of 35 DD agencies responded
• 21 (699) of people receiving services from DD
  agencies (3,365) held at least one job (112
  people held more than one job)

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Vocational Rehabilitation

• 2003 DDD-State-wide Employment Survey
  (continued)
• 252 worked in individual supported employment
  jobs
• 428 worked in group supported employment settings
  (employees of provider agencies working at sites
  in the community)
• 131 worked in competitive settings (e.g. without
  supports)

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Vocational Rehabilitation

• 2003 DDD-State-wide Employment Survey
  (continued)
• 80 of jobs (648) are less than 20 hours per week
• 20 of jobs (131) are more than 20 hours, with 4
  (3) full-time (35 or more hours per week)
• Average hourly wage of 7.14

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Vocational Rehabilitation

• State Data on Employment
• 2008 PAL Quality of Life Indicator Survey on
  Work
• The state funds the PAL Quality of Life
  Initiatives (QLI) annual statewide assessment of
  services for people with developmental
  disabilities and their families. The QLI project
  is also part of the Core Indicators Project
  (CIP). QLI visitors meet with 400 people
  selected each year complete a summary of their
  findings.
• Coordinated by the Human Services Research
  Institute (HSRI) -- a national effort in which
  Rhode Island participates for comparison with
  approximately 22 other participating states.

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Vocational Rehabilitation

• 2008 PAL Quality of Life Indicator (continued)
• Average number of hours per week for those in
  supported employment is 12.96 down from 15.9 in
  2005
• Steady decline in full-time supported employment
  from 16 in 2003 to 7.02 in 2008

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Vocational Rehabilitation

• 2008 PAL Quality of Life Indicator (continued)
• Increase in part-time employment from 60 in 2003
  to 75.44 in 2008
• Satisfaction indicators Most people liked their
  jobs, but almost 33 indicated some
  dissatisfaction, e.g. wanting to earn more money,
  work in the community, or work more hours

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Olmstead v. L.C.

• Impact in Rhode Island

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Olmstead in Rhode Island

• Prior to the Olmstead decision, Rhode Islands
  institution for individuals with developmental
  disabilities had closed in 1994.
• The institution had closed pursuant to a consent
  decree entered in Iasimone et al. v. Garrahy et
  al., filed in federal court in 1977 and settled
  in 1982.

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Olmstead in Rhode Island

• The DD Partners were involved in the lawsuit.
• Two representatives of the DD Partners remain
  involved in the case as court appointed monitors.

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Olmstead in Rhode Island

• Most Rhode Island group homes for individuals
  with developmental disabilities have six or fewer
  residents.
• However, not all Rhode Islanders with
  developmental disabilities reside in the most
  integrated setting appropriate.
• Nor does Rhode Island have a public plan to move
  individuals with developmental disabilities to
  the most integrated setting appropriate at a
  reasonable pace.

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Olmstead in Rhode Island

• The Rhode Island House of Representatives passed
  a Resolution creating a Special Legislative
  Commission to study and establish an Olmstead
  Task Force in the State of Rhode Island. (2007
  -- H 5145 Substitute A)
• In 2008, the House passed a Resolution extending
  the Commission life and amending the Commission
  membership. (2008 -- H 7391)

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Olmstead in Rhode Island

• The DD Partners are all included as members of
  the Special Legislative Commission.
• The Special Legislative Commission has not yet
  met.

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Ladd Center

• 1907 Founded as a farm colony
• Early 1970s Population Approached 1100
• 1976 ARC Class Action Suit
• 1982 Consent Agreement
• closed admission, limited size
• Governor DiPrete announces closing

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1994 Last Person leaves the Ladd Center
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The Rhode Island Economy
Unemployment rate in April 2009 (11.1) was up
0.5 of a percentage point from the revised prior
month. The April 2009 jobless rate was up 4.0
percentage points from the April 2008 rate of 7.1
percent. According to the RI Consensus Economic
Forecast, unemployment rates are predicted to
reach 12.3 in the first half of 2010. Job
growth and personal income growth will lag the US.
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Rhode Island Economy
The Department of Labor and Training reported
there were 10,600 fewer Rhode Island jobs this
March than last March and 25,400 fewer Rhode
Island residents working this March than last
March.The estimated 357 million deficit in the
current state fiscal year will be balanced with
additional programming reductions before year
end the estimated gap in FY2010 is estimated to
be some 400 million.
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People with disabilities, families, advocates and
providers organize a 72-hour silent vigil to
honor the thousands of lives who lived at Ladd
Center and to hold a major statewide rally at the
RI statehouse for June 3, 2009 to oppose proposed
additional budget cuts for services/supports.