Tuesday, March 30, 2010

Waiver Madness

Even though the month is almost over, March Madness (and the corresponding office pools) continues to occupy the minds of many. There have been a number of surprising upsets in this year’s tournament, and a recurring theme has been cropping up when the experts provide analysis of the games – teamwork has often triumphed over individual effort.

Let’s look at the example of Cornell. As pointed out in this blog, when the tournament started, Cornell had never so much as won a game in the NCAA Tournament. Their first round victory over Temple was the first tournament game win for an Ivy League school in more than 10 years. Their second round win over Wisconsin gave the Big Red the Ivy League’s first Sweet 16 berth in more than 30 years. So how were they able to succeed? Teamwork.

Cornell had four seniors in the starting lineup. Of their eight players who play more than 10 minutes per game on average, six were seniors (one was a sophomore and the other a junior). This past year, all the seniors on the team lived together in the same house. They had played together for four years. None of the Cornell players is likely to earn a huge NBA contract, but they knew each other so well and were so dedicated to a team concept that they were able to advance despite playing teams that probably had more individually talented players.

So why am I bringing this up? Well, I have already talked several times about the importance of those of us interested in resolving the short-comings of the DD system in Colorado coming together for solutions. I’ve harped on it so much it is beginning to feel like the Wilhelm Scream. (What’s that? Well, Wikipedia says the Wilhelm scream is a frequently-used film and television stock sound effect first used in 1951 for the film Distant Drums. The effect gained new popularity {its use often becoming an in-joke} after it was used in Star Wars and many other blockbuster films as well as television programs and video games. The scream is often used when someone is either falling from a great height or from an explosion. The Wilhelm scream has become a well-known cinematic sound cliché, and is claimed to have been used in over 149 films. Check out the video.)

But it is not just those of us who provide or receive services that need to work together. The funding mechanisms for service provision also need to be coordinated to provide maximum benefit for the individuals they are designed to support. Sadly, this is not even close to being the case.

For adults with developmental disabilities in Colorado, there two Medicaid Waivers that provide the majority of funding for services, the HCBS-DD “Comprehensive” Waiver and the HCBS-SLS “Supported Living Services” Waiver, and they do not complement one another. Service providers, families and guardians often spend too much time navigating the confusing landscape of getting funds for services and not nearly enough time on the much more important work of providing services.

Even worse, cost thresholds established by the State could work to deny waiver services or entrance into the waivers; thus individuals whose cost of services exceed the specified limit could be denied waiver eligibility. (Read more about this issue by clicking here to see an article by the National Association of State Directors of Developmental Disabilities Services Director of Technical Services Robin Cooper, from the March 2010 issue of Federal Perspectives).

So what happens when someone needs services but doesn’t fit into the current adult service models? I wish I had an answer. As far as I can tell, an adult who is eligible for services is entitled to residential services through an Intermediate Care Facility (ICFMR). However openings in ICFMRs are not available. As state support continues to be a struggle, and the patchwork of service options is over-worked, I am afraid we will learn what happens when someone needs a service and doesn’t fit. Similar to Cornell’s basketball team, we need to coordinate services and funding mechanisms as a team, or we risk facing a growing number of individuals who really need support but don’t have any way of getting that support.

Then again, what do I know?

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