The Washington Post recently reported on the pending court review of Virginia’s 2012 settlement to build and provide more homes for persons with developmental and intellectual disabilities across the state. At question is whether the state is acting fast enough to offer services to individuals on its waiting lists and more rapidly transition individuals out of the state’s five institutional settings and other large nursing facilities to community-based settings, and whether funds from the closure of institutional Training Centers is being used to accelerate the transition to better community-based services for people with intellectual and developmental disabilities. Advocates want the state to do more to meet deliverables sooner rather than later in its ten-year plan to transition from institutional to community-based housing, and are advocating for funds from land sales to be used to prioritize the transtition.
Virginia isn’t alone in finding ways to comply with court guidelines and meeting scrutiny in its process – most states face similar hurdles and while there are some successes across the country, there are too few “Best Practices” models for state transitions that can be easily applied to existing state structures. The intentions of these rulings and compliance with the 1999 Americans with Disabilities Act are in the right place. Implementing such sweeping changes however tend to run across two significant barriers – state budgets and layers of well-intended safeguards and processes that are significantly entrenched. System overhauls are never easy!
Virginia currently has a waiting list of about 10,000 individuals with disabilities on its waiting list for Medicaid vouchers, and in the last three years has increased the number of people participating in Waiver services by about 25 percent. Advocates point to states such as Arizona, Delaware, the District of Columbia, Oregon, and North Dakota, which don’t have a waiting list – success stories in service delivery. These states are among the exception on a national level, as eighty percent of states and an estimated 500,000 individuals with disabilities remain on Medicaid Waiver waiting lists in their state. Nationally, the waiting time to receive IDD HCBS Waiver services is closer to 47 months. While most individuals on waiting lists do receive some non-waiver services, and IDD-screened individuals receive priority, there’s still a chasm between the individual and the best services s/he needs.
Thus far Virginia’s made in-roads in moving individuals to community-based settings, pushing for employment in the community and expediting its closer of the large state-run institutions. We had the opportunity to listen in on some of the guest speakers from the House of Delegates and Virginia Senate last week, along with state department leaders from DMAS and DBHDS at the Virginia Network of Private Providers annual conference in Richmond, and there are definitely advocates at the departmental and legislative level that comprehend the need and requirement. Federal compliance with the ADA goes beyond discretionary funding and we have to be tireless proponents of services while finding ways to reduce costs (without reducing service to those most in need). The task ahead is gargantuan, and the state has a series of hurdles to overcome. We’ll be rooting for their achievements, increased Waiver services for individuals with intellectual and developmental disabilities across the state, and anxiously awaiting the state join some of its neighbors in retiring its waiting list.
We’ll be watching and sharing any changes or new compliance that emerges from this. Virginia’s not only for lovers, but for come-from-behind HCBS Waiver Program success stories. I’m sure that’ll make its way to a bumper sticker somewhere!