Goal: We envision a state where individuals with mental or physical disabilities have timely access to services that could prevent institutionalization when they find themselves in an emergency or crisis situation.
Problem: Lack of services in a timely manner causes unnecessary removal of individuals from their homes in the community and unnecessary placement in institutional settings.
Recommendations: The Disability Policy recommends:
Background: Texas has undertaken a number of initial steps to relocate individuals in institutions who want to live in the community; however, admission to certain institutional settings has either increased or remained consistently high. Admission generally results from the lack of readily available supports in the community for an individual whose health and safety cannot be maintained while waiting for individualized and oftentimes comprehensive services. The waiting time for such services in the community is lengthy and services are not immediately available to prevent institutionalization when individuals find themselves in an emergency or crisis situation.
We support maintaining a first come, first served overall approach to the waiting list along with an additional funding effort to address those whose emergency or crisis situations which establish a significant and imminent risk of institutionalization. We oppose reconfiguring the entire waiting list into a priority needs-based waiting list in which only select individuals with the most significant needs get services.
Providing services in a timely manner prevents, in many cases, the disability-related needs from increasing and allows for intervention at the earliest possible opportunity. This approach is good for the person and their families. Also, when the state’s Medicaid Waiver programs have a pool of those served that includes individuals with fewer needs as well as those with more needs, the state is better able to maintain cost neutrality for its Medicaid Waiver programs.
Justification: Fiscal year 2008 appropriations to state schools totaled $518.9 million. With about 200 admissions per year, many due to a crisis, money could be saved by diverting these individuals into the Home and Community Services (referred to as HCS) Medicaid waiver where individualized, comprehensive services could prevent their placement. Similarly, individuals who qualify for nursing facility admission could stay in their homes or with their families with Community Based Alternatives (referred to as CBA) Medicaid waiver services that allow for greater access to prescription medications and pay for minor home modifications when needed. At times persons with intellectual disabilities or related conditions experience loss of caregivers while still waiting on a waiting list for Community Living Assistance and Support Services (referred to as CLASS) or HCS Medicaid waiver services. Although the person may have a job in his or her community, life at home without supports is not an option, so the person may be placed in a community based Intermediate Care Facility for persons with Mental Retardation (referred to as ICF-MR) in another town, resulting in loss of a job and all community connections. An additional funding allocation for diversion is cost effective and prevents unnecessary institutionalization.