Roadmap to Change:

Updating Maines Response to the Olmstead

Decision

Project Overview

What is Olmstead?
1999 Supreme Court decision
States must provide services to
individuals in the most integrated
settings appropriate to their needs
Values of integration and inclusion

Why is Olmstead Important?

The Supreme Court decision has
directed the evolution of services for
persons with disabilities throughout the
U.S. since 1999
It has guided the Centers for Medicare
& Medicaid Services (CMS) of the
federal government in supplying funds
to the states
The federal Department of Justice has
required many states to implement it.

Maine DHHS Vision and Mission

Vision: Maine people living safe,
healthy, and productive lives in the
most independent way possible
Mission: To promote safe, healthy,
independent lives for all, while
ensuring efficient and effective use of
resources for Maines most vulnerable

Maine Is National LTSS Leader

In top 10 LTSS expenditures per state
resident nationally
#1 for mental health services
#2 for 1915(c) I/DD waivers
#7 for all 1915(c) waivers
#10 for all LTSS expenditures

High proportion of LTSS expenditures

on LTSS
#15 for % HCBS v institutional
#7 for growth in HCBS % 2010-2012

Maines Response to Olmstead

In 2003 Maine DHHS released the
Roadmap for Change: Maines
Response to the Olmstead Decision.
Product of 3 years of work by a broad
stakeholder group.
Provided vision and direction over
the last decade for all people with
disabilities.

2003 Roadmap Recommendation

Areas
1. Voice and self-advocacy
2. Control over services and supports
3. Person-centered
4. No wrong door
5. Coherent IT systems
6. Responsive service coordination
7. Waiting list
8. Funding and planning
9. Direct care providers
10.Quality of services
11.Transportation
12.Housing

Progress Report
Built on 2014 I/DD Olmstead update
Analyzed all populations receiving long
term services and supports
Aging population
Adults and children with physical disabilities
Adults and children with intellectual/
developmental disabilities and autism
spectrum disorder
Adults and children with mental/behavioral
disorder
Individuals with substance use disorder

Progress Report Approach and

Structure
Review secondary source
documentation
Examine administrative data
Conduct stakeholder interviews
Conduct survey
Progress and opportunities for each
LTSS population within 2003
Roadmap recommendation area

Progress Report Findings

2015:

2013:

2009:

2003:

Pre-Olmstead
Roadmap Publication:

Housing with
supports established
BRAP program

established
Shelter Plus Care
established
IHSP established
10-year vocational
policy establishing
community
employment as state
value published
Closed one state-run
sheltered workshop
WIPA funding
received to provide
benefits counselor/
system

Olmstead roadmap
published
ADRC grant awarded
Privatized children's
targeted case
management for ID/
Autism
Participated in NCI

2005:

Funded family
support I&R, youth
self-help/peer
support, and crisis
stabilization
ID/Autism shared
living model
developed

2007

2006:

2004:

DHHS merger
ID/Autism community
case management
implemented
Instituted central
enrollment for
children's services

Bates consent decree

updated plan
published
211 formed
Community
employment
specialist program
started
ID/Autism began
individualized
planning

Community consent
decree (Pineland)
finalized
DHHS contracted
with ASO, APS
Healthcare
Transition to
Independence
SAMHSA grant
awarded

2008:

Section 29 Support
Services waiver
implemented
Funding discontinued
for sheltered
workshops

2010:

Continuum of care
model developed

2011

Employment First
became law
Section 20 Other
Related Conditions
waiver implemented
SIM grant awarded
Moved to single
assessing agency
Updated ID/Autism
person-centered
planning
Invested an
additional $28 million
into Sections 21 and
29 waivers
WIPA funding
awarded again

2012:

OADS created
SAMHS created
OCFS created
Bates consent decree
money first
established
MFP grant obtained
BIP awarded
HRSA grant awarded
Oversight Advisory
Board formed
Disability Rights
Maine contract
expanded to include
advocacy functions
Created Maine
Business Leadership
Network
Required all newly
hired state case
managers to be
licensed social
workers

Adding employment
support programs to
1915(i) SPA
Bill passed to
increase direct care
worker
reimbursement
TIP case
management pilot
expansion funded
$5.7 million invested
to alleviated mental
health wait list
Growing BRAP
budget and
geographic reach
Work Opportunities
and Innovation Act
supporting school to
work transitions
Shared living
demonstration project
for Section 19 waiver

2014:

Section 18 Brain
Injury waiver
implemented
Aging and physical
disability waivers
merged into Section
19 waiver
Section 19 waiver
wait list ended
HCBS settings
transition plan
published
Restarted
participation in NCI
Added new career
planning service to
18, 21, and 29
waivers
Maine Can Work
began work

Updating Olmstead Roadmap

Facilitate meetings with DHHS to
define parameters of roadmap changes
Facilitate series of external stakeholder
meetings
Synthesize information collected
through meetings and research into
report
Public comment

Updated Olmstead Roadmap

1. Support individual choice so
individuals can effectively make
decisions about issues that are
important to them
Further develop the system of choice to
meet individual needs
Expand person-first, individual-driven
treatment/care plans

Updated Olmstead Roadmap

2. Improve systems coordination to
improve delivery and management
of long term services and supports
Improve statewide access to information
and resources
Support seamless transitions
Continue to expand conflict resolution
Improve and integrate information
technology systems

Updated Olmstead Roadmap

3. Improve community integration so
individuals are able to meaningfully
participate in community life
Develop and enhance natural supports
Increase community-based housing
options
Increase vocational and employment
opportunities
Improve statewide transportation services

Updated Olmstead Roadmap

4. Create efficient and effective policies
and regulations to manage the
implementation of long term services
and support and achieve intended
outcomes
Support access to and capacity of
innovative services and supports
Support value-based services
Address unique needs of people in remote
areas

Updated Olmstead Roadmap

5. Promote continuous quality
improvement to ensure high quality
long term services and supports and
the prudent use of public funds
Increase preventative and evidencebased/informed community services
Invest in workforce development
Increase and improve regulatory and
quality review

Where Olmstead Fits in DHHS

DHHS Strategic Plan

Olmstead Roadmap

Ofce of Aging and

Disability Services
Strategic and State Plans

Ofce of Substance
Abuse and Mental Health
Services Strategic and
State Plans

Ofce of Child and

Family Services Strategic
and State Plans

Evaluating Implementation
What does success look like to you?
Outputs products or deliverables the
organization intends to provide; measured by
count or other data
Outcomes: Results or consequences of an
action or intervention; represented as shortterm (1-3 years) or long term (4-7 years)
Indicators: A measurement of the outcome;
outcomes stated in measurable and
observable terms to help stakeholders assess
achievement toward intended outcome