We are people who want to be the nation's leader in implementing the vision of Olmstead.
(Ohio Olmstead Task Force)
Ohio Access is a comprehensive working plan for improving long-term services and supports for people with disabilities. Over the past three years, Ohio Access has served as the primary blueprint for systems change in Ohio's health and human services. During the past five months, the original 2001 plan was reviewed and modified with input from consumers, providers, and other interested parties. The Ohio departments contributing to this strategic plan include:
- Aging
- Alcohol and Drug Addiction Services
- Budget and Management
- Health
- Job and Family Services, including Medicaid
- Mental Health and
- Mental Retardation and Developmental Disabilities.
This section describes the updated strategic framework for Ohio Access, which includes a statewide vision and goals, performance measures, and recommendations to achieve success. Strategies are summarized here and described in detail in the appendices to this report.
Vision
Ohio Access sets a clear vision for Ohio in which:
- Ohio's seniors and people with disabilities live with dignity in settings they prefer.
- They are able to maximize their employment, self-care, interpersonal relationships, and community participation.
- Government programs honor and support the role of families and friends who provide care.
Goals
Every strategy to achieve the vision must contribute to:
- Offering individuals meaningful choices.
- Aligning systems to improve quality and provide better outcomes for individuals.
- Getting the best possible value from taxpayer investments.
Performance Measures
The 2004 Ohio Access update includes a number of statewide measures to gauge Ohio's Olmstead-related progress over time. As the specific strategies listed in this section are implemented over the next few years, Ohioans will be able to refer to the four statewide measures listed below and see the extent to which aggregate progress has been made toward the goals across delivery systems. In some cases, the measures will enable Ohio to compare its progress to the progress of other states.
The following four statewide measures are tied to the goals of choice, quality, and value. State agencies are developing methods to collect baseline data for this analysis. While some delivery systems may interpret each measure somewhat differently depending on the needs of the consumers it serves, the main objective is to assess the state's current position relative to these measures and work to consistently improve choice, quality, and value.
- Ratio of people receiving Medicaid home and community based waiver services to people residing in Medicaid-reimbursed nursing facilities and ICFs/MR.
- Ratio of total public expenditures [1] for community based long-term services and supports to total public expenditures for institutional services.
- Per member per month (PMPM) rate of growth of total public expenditures for long-term services and supports.
- Ohio's ranking on various measures reported by other organizations, like the American Association of Retired Persons (AARP.)
Recommendations
The original Ohio Access report focused primarily on fiscal and policy issues in the health care arena. This report extends that focus to other services critical for a person to live with dignity in home and community settings, like housing, employment, transportation, education, and others. However, the strategies are first steps. The more fully developed strategies—and the majority of this report—continue to focus on improving health care services.
Many of the implementation plans contained in this report are subject to legislative approval via statutory change or the biennial budget process. The last budget proved that budget-related policy decisions are difficult and not without consequence. The next state budget will be introduced in the Ohio General Assembly in January 2005. It promises to be at least as difficult as the last. Updating Ohio Access now is intended to stimulate a policy conversation that builds support for its recommendations in time to be relevant for the next budget. The Administration acknowledges the General Assembly's challenge and is eager to engage members regarding the merits of Ohio Access initiatives, particularly because so many of these proposals respond to Ohioans' preferences for choice, quality, and getting the best possible value for taxpayers.
The rest of this section outlines specific strategies for achieving the Ohio Access vision and goals. Specific strategies are bulleted under each recommendation, and described in detail in Appendices A - F.
A. Give consumers meaningful choices
Ohio Access envisions a fundamental alteration in Ohio's approach to long-term services and supports for people with disabilities. This transformation is necessary for seniors and people with disabilities to live with dignity in the settings they prefer and maximize their employment, self-care, interpersonal relationships, and community participation; and for government to honor and support the role of families and friends who provide care.
Progress toward this vision requires greater consumer participation and control in decisions about their care. It requires detaching funding from particular settings of care, and allowing those funds to follow people into the settings they choose. This concept is consistent with the Supreme Court's Olmstead decision, and in most cases highly cost effective. In order to give consumers meaningful choices, the Ohio Access cabinet will work to:
A.1 Increase home and community based Medicaid waiver programs
A.2 Provide information that consumers need
A.3 Financially support consumer choice
A.4 Support informal caregivers
B. Focus on Behavioral Health
Ohio's "Behavioral Health" delivery system includes publicly funded mental health services and alcohol and drug addiction services. Many persons with serious behavioral health care needs experience long term but episodic illness. The episodic nature of their illness is quite different from the disability experienced by people with mental retardation, and many frail elderly persons. Acute care situations tend to be short (less than a week), but a small number of admissions for acute stabilization of psychosis or addiction last for weeks or even months because treatment proves elusive.
Approximately one in every 10 Ohioans experiences behavioral health care needs at some point in life and, due to a lack of overall insurance or parity for behavioral healthcare, many people are unable to access the services and supports that they need via a private insurance plan. The publicly funded behavioral health system in Ohio functions as a safety net, providing acute care services and supports for indigent and working poor persons and virtually all long term care for persons with serious disorders, since private insurance often does not cover these services.
Ohio is recognized as having one of the strongest community behavioral health systems of any large state. It mirrors the state's general preference for local control with state direction and support and, through a local board system, allows for a unique level of local feedback and decision-making. Yet, that success is tempered by the reality of emerging crises in communities across Ohio.
The Ohio Access cabinet recommends focusing on behavioral health to:
B.1 Increase community based services
B.2 Maintain public/private inpatient capacity
B.3 Strengthen behavioral health Medicaid administrative processes
B.4 Provide access to better care for children
B.5 Implement the President's New Freedom Commission recommendations
C. Improve Quality and Outcomes for Individuals
Ohio Access is clear that publicly funded long-term services and supports need to meet a high standard of quality. Historically, "quality" has been defined as the state's responsibility to ensure consumer safety. However, a new paradigm is emerging that expands the concept of quality to include consumer expectations about autonomy, self-direction, and choice. With these new conceptions of quality in mind, the Ohio Access cabinet will:
C.1 Measure service satisfaction and outcomes
C.2 Address healthcare workforce shortage issues
C.3 Enhance quality in nursing facilities
C.4 Provide training for teachers who work with children with disabilities
D. Get the Best Possible Value from Taxpayer Investments
Ohio Access envisions a fundamental alteration in Ohio's approach to long-term services and supports, focused first on providing meaningful choices for people with disabilities, but also ensuring that taxpayers get the best possible value for their investment. Fortunately, greater consumer choice often leads to improved outcomes and greater cost-effectiveness, which is critically important given constraints on public budgets. The level of reform that is necessary to realign long-term services and supports toward consumer choice and public value can only be accomplished through comprehensive planning, including a participatory stakeholder process and integration with Ohio's legislative process. In this spirit, the Ohio Access cabinet will:
D.1 Articulate clear principles for system design
D.2 Involve consumers in planning and program design
D.3 Coordinate across agencies
D.4 Convene an Ohio Access housing task force
D.5 Implement enhanced care management
D.6 Stimulate demand for long-term care insurance
E. Prevent the Causes of Disability
Disability can enter our life at any point — through accident, illness or age. In some cases, the causes of disability can be prevented. In order to improve the state's effectiveness in helping to prevent the causes of disability, the Ohio Access cabinet will:
E.1 Create a fetal alcohol syndrome prevention initiative
E.2 Pilot community projects focused on prevention
E.3 Expand early intervention for children
F. Support Employment
Most people with a disability between the ages of 21 and 64 work (77 percent according to the 2000 Census). Having a job and being economically self-sufficient are important aspects of personal independence and overall quality of life. However, many people with a disability who want to work are forced to make an economic decision not to because additional income would threaten their health care benefits. Federal welfare programs were reformed in the 1990s to support people who work, but Social Security disability programs and Medicaid were not. In order to support the critical link between work and self-sufficiency, the Ohio Access cabinet will:
F.1 Develop a Medicaid Buy-In program
F.2 Implement Supported Employment in the Mental Health System
F.3 Implement the U.S. Department of Labor Employment Navigator
Enable Every Child to Succeed
Many of the strategies already listed benefit children. These strategies are listed here to emphasize the Taft Administration's highest priority to enable every child to succeed. Each strategy listed below is consistent with Family and Children First, Ohio's statewide initiative to streamline and coordinate services for families seeking assistance for their children.
A.1 Increase home and community based Medicaid waiver programs
A.2 Provide information that consumers need
A.4 Support informal caregivers
B.1 Increase community based services for behavioral health
B.4 Provide access to better care for children
B.5 Implement the President's New Freedom Commission recommendations
C.1 Measure service satisfaction and outcomes
C.4 Provide training for teachers who work with children with disabilities
D.2 Involve consumers in planning and program design
D.3 Coordinate across agencies
E.1 Create a fetal alcohol syndrome prevention initiative
E.3 Expand early intervention for children
[1] All references to "total public expenditures" in this section exclude Medicare expenditures. Medicare is 100 percent federally funded and administered, and Ohio's budget policy decisions have virtually no bearing on Medicare expenditure growth.