Background for 1,500 from DHR

When DHR sent Governor Perdue their recommendation for 1,500 new slots for the MRWP in the fall of 2005, they sent him justification as to why these slots were needed. The following is in their own words:

"Currently there are over 6,000 Georgians with MR/DD who are waiting for community services due to a lack of funding for services. Additionally, there are 17,118 Georgians with mental retardation living with caregivers 60 years old or older (Braddock 2004).

Each year, approximately 700 children with MR/DD exit the Department of Education’s special education programs. But due to a lack of funding for community MR/DD services, most of these young adults remain at home while receiving no services. In many cases, this creates a crisis for parents who must work and cannot stay at home and care for their family member with disabilities. Too often, lack of day services leads families to demand more expensive out-of-home residential services for their sons and/or daughters.

Currently, there are approximately 1,100 consumers with MR/DD living in Georgia’s state operated DD institutions. MHDDAD has identified 54 children and adolescents with MR/DD currently living in state hospitals (Intermediate Care Facilities/MR and Skilled Nursing Facilities) whose needs could be best met in community settings that would allow for them to be closer to families and their home communities. Also, there are 19 children and adolescents with mental health and DD diagnoses currently served in a program at Northwest Regional Hospital in Rome and funded with state dollars. These children would benefit from community placements.

The Clinical Team at Central State Hospital has recommended that the Allen Building be closed and that 135 CSH residents be transitioned to more appropriate services in community settings. The number of people with DD served in Georgia’s community DD system has increased substantially since the late 90’s. However, the system’s infrastructure has not experienced a corresponding expansion. The DD system is stretched very thin in terms of its capacity to oversee and monitor the quality and safety of services, to develop new providers, to increase the capacity of
current providers to meet the needs of an increasingly complex consumer population, and to manage the Medicaid Waiver program with has doubled in size over the last five years."

DHR goes on to explain the impact that their recommendation of 1,500 for Georgia...

"This enhancement will provide funding for 1,500 new MR/DD Medicaid Waiver slots. This will allow for increased day and employment services to be made available for young adults exiting DOE’s special education programs; and, at the same time supporting families to continue working while keeping their children at home. Also, additional day services and employment for consumers currently on the waiting list will provide relief for aging caregivers and income for consumers with DD thus making them more independent and self-sufficient.

Natural Support Enhancement Services will support families in maintaining their loved ones with disabilities in their homes. Enhancement funding will provide residential services for consumers on the waiting lists whose families can no longer care for them. 208 children and adults now living in Georgia’s state institutions will get the support they need to return to their communities. This enhancement will provide the opportunity for Georgia to move forward in implementing its Olmstead plan, and move towards joining nine other states that do not have the taxpayer expense of state-staffed institutions for the developmentally disabled.

Due to a very high percentage of federal Medicaid dollars in state-operated hospitals, state funding for this request cannot be re-directed from hospitals to match new federal Medicaid Waiver dollars for community expansion. Also, as a result of earlier revenue maximization efforts, state dollars are inadequate in the community DD system to be used as state match to significantly expand community services.

This enhancement will address system capacity issues by providing funding for enhanced service monitoring and oversight, safer and higher quality services through training and technical assistance for providers, funding to serve consumers with complex medical and behavioral challenges, funding for consumers’ medication not covered by Medicaid and additional staff to manage the Medicaid Waiver programs.

Georgia ranks last among all states in the utilization of community residential settings for persons with mental retardation and other developmental disabilities. A person with developmental disabilities living in South Carolina is twice as likely to be living in his or her own community residence (D. Braddock 2004, State of the States in Developmental Disabilities, AAMR).

The following is a detail of historical funding in Georgia’s community DD services. Funds represented include state grant in aid, Medicaid Waiver and SSBG funds. The detail indicates a trend of decreasing state dollars and increased use of the federal Medicaid Waiver dollars. As indicated, the FY06 improvement represents an increase in funding that will benefit approximately 9,000 consumers currently served on the Waivers through a rate increase, and provide services to 925 individuals waiting for services.

FY 2002- Total Funds $182,882,855 - New MRWP Slots 725
FY 2003- Total Funds $183,539,829 - New MRWP Slots 507
FY 2004- Total Funds $180,484,771 - New MRWP Slots 230
FY 2005- Total Funds $179,887,438 - New MRWP Slots 30
FY 2006- Total Funds $204,643,559 - New MRWP Slots 925"

They stated that this "enhancement will create the opportunity to address continued and new litigation for non-compliance with U.S. Supreme Court decision in Georgia’s Olmstead v. L.C. decision."

Strong case for moving forward with 1,500 new MRWP slots...

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