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Supporters look to build on Olmstead Plan

Mike Mullen//November 13, 2013

Supporters look to build on Olmstead Plan

Mike Mullen//November 13, 2013

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Roberta Opheim, the state ombudsman for mental health and development disabilities, said agency heads have begun to discuss rewriting their rules and redesigning their budgets to comply with the Olmstead Plan. Another planning challenge: identifying legislative changes that would need to be enacted. (Staff photo: Peter Bartz-Gallagher)
Editor’s note: This is the second of a two-part story. The first part ran in Nov. 7’s Capitol Report.

The release of Minnesota’s Olmstead Plan on Nov. 1 was met with guarded enthusiasm by many of the state’s advocates for improved services for the disabled. The plan, a court-mandated strategy to improve long-term services for people with disabilities, is a broad, ambitious outline, and was arrived at after nearly a full year of cooperation among eight state agencies.

A sub-cabinet chaired by Lt. Gov. Yvonne Prettner Solon took input from commissioners and top staffers from the Department of Human Services (DHS), the Department of Employment and Economic Development (DEED) and the Minnesota House Finance Authority (MHFA), among others. Gov. Mark Dayton heralded their work, saying the plan would pave the way for Minnesota’s disabled citizens to “live with dignity, be valued members of their communities and make choices to improve the quality of their own lives.”

The plan has been submitted to a U.S. District Court of Minnesota judge for review. Its central intention is to give people in the state’s care more independence and greater agency over where and how they live and receive services. Advocates consider this an admirable goal, but point out that the Olmstead Plan fails to specify how the state will work to alleviate vexing problems like the lack of affordable housing or competitive employment opportunities for people with disabilities.

Pamela Hoopes, an attorney with the Minnesota Disability Law Center, said the document  lacks a basic accounting of how many people might be affected by some of the programs.

“Some of the data might be available in other places, but wasn’t included, and other data hasn’t been collected and analyzed yet,” Hoopes said. “I think it, clearly, is a work in progress.”

Prettner Solon, for her part, said the document is not “static,” and will be subject to changes in the coming months and years.

“It’s meant to be a fluid plan,” Prettner Solon said.

Jobs, housing key

The Olmstead Plan’s top two initiatives, as determined by the amount of feedback received during the public comment period, deal with employment and housing. The proposal calls for similar “Employment First” and “Housing First” approaches to those topics, meaning the state should presume disabled people want to hold competitive-wage jobs and live independently, as opposed to a more sheltered lifestyle at a state-run facility.

That effort is in keeping with the state’s movement toward shifting more disabled residents out of larger hospitals and into home- or community-based settings. Of $3.6 billion the DHS spent on disabled and elderly care during fiscal year 2012, about three-fourths was for community based care.

Sen. Tony Lourey, DFL-Kerrick, said that spending ratio was arrived at through an effort to winnow down the number of people who spent years or decades living in state hospitals. Minnesota has the lowest percentage of disabled people receiving treatment in institutional settings in the country, according to Lourey, and spends more on  home-based care than any other state.

“It’s by design,” Lourey said. “We do work so hard on these issues.”

More hard work will be needed to satisfy the Olmstead Plan’s objectives, though just what shape it will take has yet to be determined. The Olmstead sub-cabinet held an organizational meeting on Nov. 5, its first since the plan’s release. There, agency heads began to discuss efforts to rewrite their own rules and redesign their internal budgets to comply with the plan, according to Roberta Opheim, the state ombudsman for mental health and developmental disabilities.

“It was more of a structural meeting,” Opheim said. “It was about, how are we going to initiate first steps of implementation, and how will we fund those before a permanent funding source is available.”

Rebecca Covington, a lobbyist with the Minnesota Consortium for Citizens with Disabilities, said the policy goals laid out in the document are good, and said the next step would be finding money to pay for those ideas.

As written into the plan, objectives are subject to change if the necessary funding does not materialize. Covington hopes that if that situation arises, advocates and plan authors take it as an opportunity to build support for new funding priorities.

“If the funding isn’t there, we don’t want to change the plan,” she said.

Policy proposals coming

Minnesota has a chronic shortage of affordable housing options, meaning disabled people looking to move into a home or community-based setting typically have limited options.

The state currently provides housing aid to more than 20,000 disabled adults and elderly citizens in about 5,700 group residential housing facilities, while another 527 Minnesotans receive monthly stipends to help afford their rent or lease payments. Under the plan, the state is tasked with offering each disabled individual the most integrated setting he or she wants, while still providing the necessary services.

Housing options should also include a broader geographical range, said Opheim, who points out that people might choose to live in a rural area, or closer to family members, rather than simply being assigned a unit that is most convenient for service providers.

“We have, for so long, been used to putting people in congregate setting,” Opheim said.

Aside from reviewing their internal rules and budgets, sub-cabinet members are also beginning to look for legislative changes that would need to be enacted. Some policy proposals could be suggested for the coming session, which begins in February, Opheim said. But the larger set of priorities are expected to arrive in time for the 2015 session, by which point the various agencies will have collected data and surveyed disabled Minnesotans to inform policy and budgeting ideas for the next biennial budget.

Steve Larson, senior policy director at the ARC of Minnesota, said the collection of that input from the disabled, their families and service providers will be essential in drafting appropriate legislation.

“Minnesota is good at being able to monitor money spent, but not as good at measuring outcomes,” Larson said. “On things like adequate housing and employment, we haven’t really measured that very well.”

Opheim sympathizes with the frustration of some in the disability community who wish the state would move faster on enacting changes to the current approach.

But, she said, the scope of the Olmstead Plan, and the amount of coordination involved to change the way the state delivers services will take time to achieve fully.

“That’s that rub between individual rights and a system’s ability to transform itself,” she said.

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