HOUSING AND TRANSPORTATION

Integrating Strategies Within

Virginia’s Cross-Governmental Strategic Plan for Continued Community Integration (Olmstead Plan)

and the MFP Demonstration Operational Protocol…

…with support and assistance from theStatewide Plan for Independent Living

April 24, 2008

Virginia’s Cross-Governmental Strategic Plan for Continued Community Integration is a comprehensive, ongoing plan, updated every year, designed to provide individuals with disabilities of all ages more opportunities to: • choose to move from institutions to appropriate,

more integrated, settings, and • avoid unwanted institutionalization.

Money Follows the Person is a 4-year Demonstration program designed to assist seniors and individuals with disabilities who currently live in institutions to transition to the community if they wish to.

The Money Follows the Person Demonstration Program

will help Virginia implement the Cross-Governmental Strategic Plan for Continued

Community Integration

Both the Money Follows the Person Demonstration Program

and the Cross-Governmental Strategic Plan for Continued

Community Integration

contain multiple strategies to address housing and transportation needs of individuals with

disabilities

Statewide Plan for Independent Living, Goal 2

Work in conjunction with the Office of Community Integration to assist in implementing the housing and transportation initiatives identified in the Strategic Plan and the Money Follows the Person Demonstration

Overview:

Strategic Plan

What is the Strategic Plan?

• 2003: The Olmstead Task Force recommended that Virginia develop a blueprint for implementing the recommendations contained in the Task Force Report. “For this to happen, State administrators, policy makers, and agency officials must work together, with people with disabilities and service providers, to consistently collaborate; make needed changes in practices, policies, regulations, and legislation; and assure sufficient funding to implement the recommendations contained [in the] Report.”

• 2004-2005: Executive Orders 61 and 84 responded to this recommendation by establishing:

– A multi-agency, multi-secretariat Implementation Team

– A cross-disability, multi-stakeholder advisory group

– A Director of Community Integration for People with Disabilities

What is the Strategic Plan?, continued

• 2006: Governor Kaine issued Executive Order 2, continuing the Olmstead initiative and directing the Implementation Team to work with the stakeholder advisory group (now the Community Integration Advisory Commission) to develop a cross-governmental strategic plan for continued community integration.

• 2007: Governor Kaine issued Executive Directive 6, which directs state agencies and entities to be involved with the implementation of Olmstead and to annually update the strategic plan and report on progress in implementing it.

What is the Strategic Plan?, continued

• In 2007, Governor Kaine invited representatives of six organizations to join the Team:– Virginia Association of Centers for Independent Living– Virginia Association of Community Services Boards – Virginia Association of Counties– Virginia Association of Local Human Services Officials– Virginia First Cities– Virginia Municipal League

What is the Strategic Plan?, continued

• The Strategic Plan is developed with all state and local disability stakeholders working together as a Team.

• The Team develops the Strategic Plan in close coordination with the Community Integration Advisory Commission.

• The Team and Commission jointly adopted the Plan in 2007.

Strategic Plan Goals

• #1: Create opportunities for individuals of all ages to leave institutions if they want to live in the community

• #2: Assist individuals of all ages who live in the community to avoid unwanted institutionalization.

Strategic Plan Critical Success Factors• The Strategic Plan is organized into seven “Critical

Success Factors” that reflect the seven major premises of the Olmstead Task Force Report’s Vision and Goals Statement. Virginians with disabilities should be able to:– #1 Plan, fully understand and choose among services

and supports they need, self-directing them to the extent possible

– #2 Choose among individuals and agencies qualified to provide the services and supports they select

– #3 Locate and obtain housing appropriate to their needs and preferences

Strategic Plan Critical Success Factors, continued

– #4 Locate and obtain a job, if appropriate.

– #5 Access transportation appropriate to their needs.

– #6 If they lack capacity to make decisions, have the same choices, options and benefits as other Virginians with disabilities through a surrogate decision-maker qualified to act on their behalf.

– #7 Access ongoing supports in order to stay in the most integrated setting of choice, self-directing them to the extent possible.

Strategic Plan – Getting the Work Done

• Action Plans developed for each Critical Success Factor serve as a template for agency program and policy development, review and development of regulations, coordination with other agencies, and participation in federal initiatives. The Action Plans include:

– Expectations of individuals with disabilities

– Strategies to meet those expectations

– Measurable outcomes

– Multiple implementation steps with projected due dates and responsible state agencies

Strategic Plan – Current Activities

• In March 2008, the Team adopted proposed updates to the 2007 Strategic Plan.

• The Commission will consider these updates in May.

• A public comment period on the proposed updates is expected this summer.

Overview:

Money Follows the Person (MFP)

Demonstration

MFP is a Federal Initiative• Centers for Medicare and Medicaid Services• Largest investment ever in Medicaid Long Term

Supports ($1.75 billion)• 37,000+ individuals to transition nationally• Designed to eliminate “institutional bias” in the

Medicaid program • HUD Secretary Alfonso Jackson contacted

public housing agencies twice last year about the importance of the Demonstration

MFP is a State Initiative• Demonstration awarded in May 2007 to Virginia’s

Department of Medical Assistance Services• Eight state agencies (including VHDA, DHCD,

DPOR’s Fair Housing Office and DRPT) have been working closely for 10 months to prepare for transitions to begin this summer

• Governor Kaine contacted public housing agencies in Virginia last Fall to underscore importance of the MFP Demonstration

MFP is a Community Initiative• Local service agencies have partnered

with state agencies and others to plan the transition process– Centers for Independent Living– Community Services Boards Local– Area Agencies on Aging– Departments of Social Services

MFP is a Personal Initiative• In Virginia, over 1,000 people are projected to

move to the community from nursing homes, long-stay hospitals and Intermediate Care Facilities for Individuals with Intellectual Disabilities (formerly Mental Retardation)

• Participation is completely voluntary—each individual’s choice

• Each person will have an individual plan, services and supports that they need, and someone to

work with them before and after they transition

MFP Services and Supports• Case manager, health care coordinator or transition

coordinator to plan and assist in transitions• Personal assistance services• Assistive technology• Personal Emergency Response Systems• Supported employment • Environmental (home) modifications• Rent during modifications period if necessary• Payment of utility and security deposits and

other up-front household expenses• Medicaid transportation

Where Will People be Living?• Under MFP, each individual who

transitions must move to a “qualified residence” in the community– Home owned or leased by the individual or a

family member– Apartment leased by the individual or a family

member– Setting in which no more than four unrelated

individuals reside

Qualified Residences in Virginia

• Homes

• Apartments

• Group homes (4 or fewer beds)

• Sponsored residential settings

• 4-bed Assisted Living Facilities

• Adult Foster Care

Why are Housing and Transportation Important?

• For individuals transitioning from institutions (under MFP or not), renting a house or apartment may be the best - or only - option

• Homes and apartments may - or may not - be located on public transportation routes

• Many individuals transitioning are expected to have very low income

• There are no funds available under the MFP Demonstration to pay for ongoing rental expenses or non-medical transportation

What Are We Doing to Address the Housing and Transportation Challenges?

• Action plans within Strategic Plan– Housing Accessibility, Availability, and Affordability

– Transportation Accessibility, Availability, and Education

• Money Follows the Person– Puts in place environmental and supplemental home modifications,

rent during modifications period, and transition services

– Creates Housing and Transportation Task Force under Secretaries of Health and Human Resources and Commerce and Trade

• Includes federal, state, local, private, and self-advocate partners

• Will develop annual housing and transportation action plan this spring

What the SPIL is Doing to Address theHousing and Transportation Challenges

• Determine local housing capacity needs and develop and pursue strategies to address those local housing needs with appropriate local, state and federal policymakers

• Improve housing policy on the local and state levels by ensuring that the housing needs of people with disabilities moving from institutions to the community are included in local plans and planning processes

• Enhance the knowledge of HUD and local housing authorities on the housing/community living needs and preferences of people with disabilities

What the SPIL is Doing to Address theHousing and Transportation Challenges

• Create a mechanism to track local changes in public policy and relate ongoing needs/solutions to statewide and national housing funding agents and authorities

• Support development of the MFP Operational Protocol to identify means of informing residents of institutional settings of community living options and assist them in becoming better self-advocates when they make the transition into the community

Let’s Talk About Housing

Housing Accessibility Strategy• Eliminate physical, social and other barriers that

impede a person’s ability to live in the most integrated environment possible. – Accessibility means different things for different

people. For a person with a mobility limitation the elimination of structural barriers might result in accessibility. For a person with a developmental disability, accessibility might be a system of supports that reduce limitations and perhaps include a congregate living model.

Housing Accessibility Action Steps

• Work with MFP Housing Task Force to standardize data collection

• Identify barriers and how to address them– Building Code compliance– Universal Design

• Evaluate need for new resources

• Monitor work of the MFP Housing Task Force

• Add environmental mods to waivers • Provide supplemental DHCD mods• Provide rent during mods period• Provide housing education—in

person, on Easy Access, and through interactive map

• Review housing plans• Develop strategies for increasing

adult foster care• Develop strategies for auxiliary

grant portability• Encourage use of accessva.org

Housing Affordability Strategies• Produce more units for people above 60%

of the area median income (AMI) that can be occupied using no more than 30% of their available income.

• Provide income supplements to people below 60% of the AMI such that no more than 30% of their available income is spent for housing.

Housing Affordability Action Steps

• Determine people needing affordable housing

• Determine number of units needed

• Evaluate need for additional program subsidies

• Preserve affordable housing where it exists

• Develop affordable housing where it does not exist

• Add transition benefits to waivers

• Provide housing education—in person and on Easy Access

• Educate and develop partnerships with public housing agencies

• Document changes in public policy as they relate to housing for people with disabilities

• Explore community living supplement

Housing Availability Strategies

• Make specific financing resources available.

• Increase local capacity to undertake development.

• Insure appropriate enforcement of laws and regulations.

Housing Availability Action Steps

• Assure Consolidated and Public Housing Agency Plans address needs

• Work with local agencies to determine local housing capacity needs

• Provide outreach and awareness on applicable laws

• Develop methods of enhancing enforcement of laws and regulations

• Ensure citizen participation in housing planning

• Expand www.vaaccess.org

• Provide housing education–in person, on Easy Access and through an interactive map

• Explore amendments to QAP• Explore below-market loans• Increase housing stock• Create incentives• Insure citizen participation in

housing planning• Determine local housing capacity

needs• Remove prohibition against waiver

users living in ALFs and adult foster care

Let’s Talk About Transportation

Transportation Education Strategy

Educate and publicize available transportation options to people with

disabilities

Transportation Education

• Examine existing data and determine its usefulness

• Support DRPT in coordinating local plans

• Develop a mechanism to educate people with disabilities and other stakeholders about transportation access and opportunities

• Make recommendations for the use of vouchers and other incentives for transportation

• Create User’s Guide to Logisticare

• Provide transportation education—in person, on Easy Access, and through interactive map

• Disseminate New Freedom Grants information

• Provide orientation to transportation planning

Transportation Training Strategy

Train CILs, CSBs, AAAs, ESOs, case managers and other key personnel to

train end users

Transportation Training Action Steps

• Identify training needs; create a training model and tools

• Train CILs, CSBs, AAAs, ESOs, case managers and other key personnel, to train end users on how to use existing transportation and how to file complaints

• Identify processes to redress ADA violations

• DMAS will train case managers and transition coordinators to give comprehensive information to individuals who transition

• Provide transportation information, including how to file a complaint—in person and on Easy Access

• Logisticare User’s Guide will contain information on how to file a complaint

Transportation Availability Strategy

Coordinate transportation services to maximize efficiencies to support

additional transportation services

Transportation Availability Action Steps

• Identify needs and barriers• Improve efficiencies• Develop State Human

Services Transportation Plan • Establish mobility goals for

statewide Transportation Plan• Develop accountability

strategy for failure to provide agreed services

• Consider incentives for providers

• Add environmental mods to waivers -- primary vehicle

• Use Transportation and Housing Alliance Toolkit

• Recommend incentives for coordination across geographic boundaries, door through door, housing developments on public transportation routes, and voucher system

Accomplishments to Date: Tools We Can Use

• Secretary Jackson’s letters to PHAs• Governor’s letter to Virginia PHAs• Presentations to PHAs• MOU on human services transportation coordination• Medicaid Primer for Housing staff• THA Toolkit• Virginia Easy Living Coalition• Easy Access• 211 Virginia• www.accessva.org• User’s Guide to Logisticare• ABC’s of Transition

PHAs’ Involvement in MFP Annual Housing and Transportation Action Plan

• Centers for Independent Living will contact PHAs to ask them to partner with them and other local agencies to support individuals transitioning under MFP. They will:

– offer assistance to PHAs in understanding community living needs and preferences of people with disabilities and seniors

– assess local housing capacity needs and work with PHAs to develop strategies to address the needs identified in future plans and planning processes

– document local changes in public housing policy, and work with PHAs to foster and sustain increased housing options

• A directory of services agencies will be disseminated, along with a Medicaid services primer, to all housing agencies

How Will This Benefit PHAs?• Opportunity to play a valued and integral role in a national long-term

support systems change initiative that can influence development of a housing policy for the disability and aging communities in Virginia

• Existing communication and policy gaps between some service providers and some housing agencies can be bridged

• PHAs can gain increased knowledge about the housing choices, preferences and barriers faced by people with disabilities and seniors who are of low income, while educating Medicaid and long term support systems advocates and professionals about the housing barriers they face as well as their current practices and policies

• Medicaid services will be offered not only to individuals in institutions, but also to individuals currently using Medicaid “waiver” services in the community, thereby benefiting people already living in the community who may have an existing relationship with a PHA.

For Further Information

Visit the Olmstead Website—”One Community”http://www.olmsteadva.com

E-mail julie.stanley@governor.virginia.gov

Visit the Money Follows the Person Website http://www.olmsteadva.com/mfp/

E-mail MFP@dmas.virginia.gov