In 1999, a historic Supreme Court decision paved the way for people with disabilities to live in the most integrated setting.
In Olmstead vs. L.C. (generally called the Olmstead Decision), the court decided that Title II of the Americans with Disabilities Act required states to serve people with intellectual disabilities in their communities when they chose to do so.
What that meant was that states could no longer segregate people with intellectual disabilities into large, institutional settings unless treatment professionals determined such placement was necessary. The deinstitutionalization that had begun slowly a couple of decades before took on new momentum.
Although the state of Colorado still operates three institutional regional centers for people with intellectual disabilities (in Grand Junction, Wheat Ridge and Pueblo), today, fewer than 100 people are served in these facilities. However, more than 250 people with intellectual disabilities are served in nursing facilities throughout the state, and more than 20 percent of those are people younger than 50.
Some people with intellectual disabilities who are being served in nursing homes are doing so by their choice. Many others are doing so because they do not have another option. Because of the way Medicaid programs are set up, nursing-facility care is an entitlement and must be funded by states. Community-based programs (such as Community Connections locally) are funded by special Medicaid programs called Waivers. Many of the Medicaid requirements for those programs are waived, including the part that entitles any Medicaid-eligible person to access them. So, when states have budgetary constraints, they are required to fund the nursing-facility placements, and community programs get cut. The resulting long waiting lists for community-based care prevent people from being served in integrated settings, which was the right they were afforded under Olmstead.
Enter the Federal Money Follows the Person Program. The idea of this program is that the public dollars being used by a person with a disability to fund institutional care should be available to that person to fund community placement instead. In a 2008-09 survey by the state of Colorado, 68 percent of people in nursing homes said they preferred to live and receive their care in the community. It should be a win-win situation because community-based services generally cost less than two-thirds of nursing-home care.
Colorado received $22 million from Money Follows the Person to help people in institutional settings explore their options for community living, plan for successful transitions and move into the community.
Colorado’s version of the program is called Colorado Choice Transitions, and it is targeting the successful transition of 490 people during a four-year period. The main target populations to transition are people who are elderly or who have physical, mental or intellectual disabilities.
Colorado Choice Transitions is now in the implementation phase. Anyone interested in learning more about options for transitioning from a nursing facility to community living can call the CCT community liaison at Colorado Health Care Policy and Finance at (303) 866-2649 or email Kathy.Cebuhar@state.co.us, or call the local transition coordinator, Barbara Elliott, at Southwest Center for Independence at 259-1672.
Tara Kiene is director of case management with Community Connections Inc.