Agenda

DHS / DDSD Waiting List Meeting

Sequoyah Memorial Office Building

C-47

Wednesday – July 30, 2008

1:30 PM

1.      Welcome

2.      Introductions

The is a time to go around the room and give your name, where you’re from and your interest in the waiting list or DDSD services, i.e. family member, waiting for services, receiving services.

3.      Status of the Waiting List – Jim Nicholson

4.      Status of the Self Directed Services pilot for the In-Home Supports Waiver – Jim Nicholson

5.      Family Questions & Comments

6.      Schedule Next Meeting

7.      Adjournment

**Note:

 I would like to invite any family member who is already receiving services but is affected by the lack of HTS staff , to come to this meeting.  This can be a major problem if we plan to continue to move people off the waiting list, but have no ability to provide direct support staff to fill their support needs. 

If there is a family in this situation, no staff to fill HTS support hours, I would like them to attend and/or contact me so I can share this problem with DHS/DDSD administrators.

Notes from the Waiting List Meeting

April 30, 2008

1:30 pm

Represented in attendance:

4 - DHS/DDSD

3 - OHCA (Oklahoma Health Care Authority)

30 - Parent, Family member or Self advocate

2 - Agencies (SoonerSUCCESS, Phoenix Provider Agency - Tulsa)

(Agencies/Organizations represented by family member in attendance – Oklahoma Family Network, Center for Learning and Leadership/OU Health Science Center, OASIS, Oklahoma Family Support 360’ Center, Down Syndrome Society of Central Oklahoma, Oklahoma Infant Transition Program)

In attendance we had:

11 families/individuals on the DDSD Waiting List

18 families received DDSD services

Status of the Waiting List – There are about 3,854 currently on the Waiting List. Jim Nicholson explained that the budget is at a “stand still”.  The Waiting List is not being worked and has not been worked in several months*.  There is no expectation for improvement because the budget for fiscal year 2009 approved by the Governor has the same amount of funding for DDSD as last year.

He was asked to explain why the waiting list will not be reduced once the fiscal year budget starts. He explained that due to the “federal match” being reduced and the budget from the state not being increased, OKDHS will have a significant loss in available funds.  Additionally, Jim Nicholson explained that the federal agency (CMS) which oversees the Medicaid and Medicare payments to each state had a policy change regarding how states can bill for and be paid for “targeted case management”.  This change in policy could have a financial impact to OKDHS estimated at 24 million dollars.  If this happens, this could be a huge issue in our ability to provide DDSD services to those on the Waiting List.  Jim Nicholson did reassure families that there is NO waiting list for families applying for the Family Support Payment which is funded through TANF dollars. 

There were several family members who were aware of the CMS policy change and explained that there is a legislation** currently approved in Congress but having issues in the Senate that would put a moratorium to “hold” this change in policy. 

Status of Self Directed Services – Jim Nicholson explained that Self Directed Services (SDS) is in the process of being added (amended) to the In-Home Supports Waiver, child and adult.  The Oklahoma Health Care Authority is currently making final adjustments before sending it to CMS (Centers for Medicare/Medicaid) for final approval.  It was explained that once CMS receives the request to amend the current waivers they will have 90 days to make a decision.  It was also explained that CMS can “freeze” that timeline if they need more information from Oklahoma to make a decision. 

TEFRA – Debbie Harmon, LPN from the Oklahoma Health Care Authority was present to explain TEFRA.  TEFRA*** (Tax Equity and Fiscal Responsibility Act) began in October 2005.  It provides Medicaid eligibility for children with high health care needs.  This program does not look at the family’s income, but rather only the child’s income.  Additionally, the child must meet one of three “high” levels of care qualifications to be eligible. Several families at the meeting have children that are difficult to test to obtain an IQ score but are known to have intellectual/cognitive disabilities.  Debbie Harmon explained that for the children who cannot have an IQ test performed and a doctor is not able to give an “estimated” IQ score; there are several ways a child can be evaluated.  She also explained that to qualify under the ICF/MR level of care the child must be “functioning” at least 50% lower than his/her chronological age.  For example, if a child is 8 years old and has an IQ above 70, they must be “functioning” at less than a 4 year-old level in order for the child to qualify for TEFRA under the ICF/MR level of care.  (This was a very technical section and it’s very difficult for me to put into words.  Please if you have any questions feel free to contact Wanda Felty)

Family Question & Comments: One family member discussed the change in her support staff due to them getting older.  She wanted to express her concern that the new staff she has to hire come through an agency as opposed to the staff she currently has which have a direct contract with Medicaid.  Utilizing an agency reduces the hours she can have staff due to the overhead of the agency.  It was explained to her that the federal agency (CMS) that oversees payments will not approve that program any longer.  Several families explained to her that Self Direction would be a similar program, but her children are both on the Home and Community Based Waiver, which will not have SDS at this time.

Another family discussed her issues with county DHS officials who are not familiar with different programs or policy.  She was told by her local office that families on the Waiting List cannot qualify for the Respite Voucher Program.  It was explained to her that people receiving any waiver service cannot qualify but those ‘waiting” can and should apply by calling OASIS 1.888.771.4550 local 271-4550.

Schedule Next Meeting – Wednesday, July 30, 2008 at 1:30 pm.

*According to OKDHS.org the waiting list is stalled working applications at or about April 7, 2004.

**H.R. 5613 – Protecting the Medicaid Safety Net Act of 2008

***More information at www.okhca.org TEFRA

Represented in attendance:
3 – DHS/DDSD
1 – OHCA (Oklahoma Health Care Authority)
1 – TARC
12 – Parent, Family member or Self advocate
Total – 17

Areas represented:
Norman
Oklahoma City
Pawnee
Stillwater
Tulsa

DDSD is currently working applications from April 7, 2004.  We were told the waiting list is virtually stalled at this time.  The only person’s moving onto Waiver services are those who are in DHS custody, those who meeting the Emergency guidelines or those in the Public Guardian program.  We were also told that during the month of December 2007 that a total of 34 people were removed from the waiting list.  Of those taken off the waiting list 21 began receiving services and 13 were either closed, declined, or were not eligible.  Also in the month of December 93 people were added back to the waiting list.  You need to note that some of those who “declined” did so because they were receiving the Family Support Payment which meets their needs at this time.  Thus would then be added to the bottom of the waiting list.  It was also said that of those on the waiting list only about 15% have been waiting for more than three years.Jim Nicholson discussed the issue of high cost to agencies for required training of HTS staff, and the high turnover/retention rate of staff as well.  One of the ways DDSD is trying to help with this issue if by contracting with an online training program what would allow HTS staff and agencies to train at times convenient to both.  The online training would also allow for the HTS to have access to all previous completed courses which will make moving from agency to agency a smoother and less costly transition.  This project is estimated to be released in the next 30 days.  Additionally, he said this training would be available to families as well.

Regarding the Self Directive Services pilot Jim Nicholson said that it is a slow process to begin offering the SDS to the IHSW.  Currently the Health Care Authority is finalizing what they need and then the amendment (request to add this to the IHSW) will be send to the National Centers for Medicare/Medicaid (CMS) for their approval.  Once the amendment is sent to CMS DDSD will begin training of their staff so when approval is received the next plan of cares will have the ability to choose SDS. 

One more note of interest.  It was said that dental services were added as eligible services for those on the Community Waiver as of October 2007.

Sue Robertson with the Oklahoma Health Care Authority,  Child Health Program Coordinator spoke about a request that has been sent to CMS requesting the expansion of eligibility for children (birth – 19) applying for Medicaid.  CMS is still in the process of reviewing and has not made a decision as of yet.  If the request is approved it will change the income eligibility from 180% of poverty to either 250% or 300%.  What this could mean to families, if you had applied for Medicaid in the past and were denied do to your families income being too high, you may qualify once this program comes into effect.  This would help many people waiting for services on the waiting list.

Someone had mentioned to Sue Robertson the difficulties some families are having at qualifying for TEFRA.  The point was made that to qualify for TEFRA under the ICF/MR (Intermediate Care Facility for persons with MR) the person must have an IQ score of 70 or below.  When a child under that age of 6 is applying they are having 1) difficulty in finding someone who will give an IQ score for a person that young and 2) affording the cost of these evaluation.  Director Hendrick said if the problem is affording a Psychologist to perform the evaluation, that DHS could possibly afford to have a Psychologist on staff to do these.  Also, he has asked Jim Nicholson and Sue Robertson get together and figure out what is the issue with getting kids qualified if they should qualify.

The next meeting is scheduled for April 30th at 1:30.