Texas’ Findings from the Initial Years and Future Efforts Marc S. Gold Texas Department of Aging & Disability Services Baltimore, MD February 14, 2011 National Grantees Meeting: Money Follows the Person/Aging and Disability Resource Center Track

Texas Money Follows the Person  Populations: Nursing Facility and ICF/MR  Funding: Fee-for-Service and Managed Care  Agencies involved: 4 state agencies and community partners  Original benchmarks: 2,999  Current enrollment: 3717  Specialty projects: housing, behavioral health, overnight supports, and closure of nine+ bed ICFs/MR* * Appendices A-D

Strengths of Texas System *  Consolidation of Health and Human Services  Governor and Legislative Support  Strong response to Olmstead  Very involved high-level multi- stakeholder advisory committee  Regional and local communication  MFP leadership is a direct report to Commissioner and is on Executive Team * See Appendix E

Infrastructure  Outreach and education activities  Relocation contractors*  Post-relocation support  Dedicated housing vouchers  Community Transition Teams  Consumer-directed services in place since 2001  Dedicated budgetary funding in appropriations act  Transition Assistance Services *See Appendix F

Barriers to Relocation   Long-term institutionalization  Information/knowledge of options  Co-occurring behavioral health issues  Lack of a statewide provider base to serve individuals with complex needs  Lack of stabilized direct services workforce  Lack of rural service providers/transportation

Barriers to Relocation   Health and welfare concerns  Family/guardian concerns  Personal fears  Provider liability  Loss of community supports  Lack of service array flexibility  Lack of housing

Barriers to Relocation  Coordination of services/SSI address change  Criminal History Checks  Home Modifications  Durable Medical Equipment

Leveraging Dollars  MFP Demonstration rebalancing and administrative dollars  Community Living Program  MDS 3.0 Section Q supportive grants  ADRC funding  Managed care (STAR+PLUS)

100 Administrative Dollars  ADRC – housing navigators  ADRC - options counselors/hospital discharge planner support  Workforce specialists  Outreach to individuals with intellectual and developmental disabilities  Data support specialist  Expansion to behavioral health pilot  Support to relocation activity  Quality management specialist

Rebalancing Fund  Supportive funding for voluntary closure of ICFs/MR  Supportive employment training  Realistic job previews  Supports for vocational rehabilitation  Behavioral health training for individuals with intellectual and developmental disabilities

Future Initiatives  Fund additional ADRCs from rebalancing fund  Increased housing support  Support for vocational employment

Contact Information Marc S. Gold Special Advisor for Policy and Promoting Independence dex.html

Appendix A Behavioral Health Pilot

MFP Behavioral Health Pilot  Bexar County (2010 expansion in progress)  Goals:  Transition adults with mental health and/or substance use disorders from NFs to the community and help them be successful  Improve services and supports in the long- term care system for people with mental health and substance use disorders

A True Collaboration  DADS (long term care) operates the overall MFP Project and provides relocation assistance.  DSHS (state mental health and substance abuse) operates the MFP BH Pilot.  The Local Mental Health Authority provides the BH Pilot services.  HHSC (State Medicaid) provides community- based long term services and supports through HMOs.  UT Health Science Center in San Antonio provides technical assistance, training and evaluation.

Behavioral Health Pilot Services  Substance abuse / dependence treatment services (individual and group)  Cognitive Adaptation Training (CAT)  Pilot services are closely coordinated with acute and long term services  Pilot services are available six months prior to discharge from the NF and up to 365 days after discharge

Substance Abuse / Dependence  Individual and group counseling, including specialized groups  Peer Support  Linkage to community resources

Cognitive Adaptation Training  Evidence-based service, recovery-oriented  Provides assistance and simple environmental modifications to help people establish daily routines, organize their environment and function independently  Uses motivational interviewing to facilitate the person’s initiative and independence  Coordinated with HCBS services

Appendix B Voluntary Closure: ICF/MR

Voluntary Closure of Large ICF/MR   Voluntary process  Use “enhanced funding” to provide incentive  Provider submits plan with state approval  10 large ICFs/MR have/are closing  Taking off more than 800 beds/500 individuals having choice (89% choose waiver)

Appendix C Health and Welfare

 Individual Responsibility Agreement  Overnight Companion Services  Working with provider base to serve individuals with complex needs

Appendix D Housing

  State Housing Agency (TDHCA)  Public Housing Authorities  Disability Advisory Workgroup  Housing and Health Services Coordinating Council  Transition Assistance Services/ Transition to Life in the Community

Texas Dept. of Housing and Community Affairs  Grants to local agencies  Tennant Based Rental Assistance – 24 months (30% of income for rent).  Amy Young Barrier Removal Program – $15,000 w/Additional $5,000  Project Access Vouchers  Only available for NF and ICF/MR relocations  From 65 to 100 on January 1, 2011  80 for non-elderly disabled (<62)  20 for 65+  Registry  Concerted outreach effort to 475 PHAs

Appendix E Interagency Collaboration

 Promoting Independence Advisory Committee (1999)  2004: Health and Human Services Consolidation  Community Transition Teams  Housing and Health Services Coordinating Council (2009)  Several interagency councils on children  Interagency council on behavioral health transformation (2007)

Appendix F Relocation Contractors

 Nine catchment areas:  Centers for Independent Living  Area Agency on Aging  Case Management activities:  Pre-relocation services  Outreach/Education  Facilitation/Coordination  Housing Navigation and Supports  Coordination with local organizations  Post-relocation services  Coordination with managed care