With paintbrushes and stamps in hand, adults with developmental disabilities created colorful flags this week at the Durango Arts Center.
Just as the class brings people with a range of needs together but allows them to craft their own art, the state of Colorado plans to consolidate the programs that fund their care and give them more control over their activities.
For years, those with developmental disabilities have needed to qualify for Medicaid funding for either residential services, or, for those who don’t need full-time care, supportive living services.
By July, the state is expected to submit a plan to the federal government to abandon these two silos because they don’t work.
“People aren’t able to get the level of care they need,” said Tara Kiene, president and CEO of Community Connections.
The new program, which could be rolled out in a year and half, will also eliminate the waiting lists for residential services.
“It’s 99 percent great,” Kiene said.
Locally, fewer than 10 people are waiting for this kind of care, Kiene said.
As part of the changes, agencies statewide are allowing developmentally disabled adults set their own goals and their own path to attain them. The goal is to help them become as independent and self-sufficient as possible, said Julie Hutson, assistant director of adult services for Community Connections.
This means learning to cook, drive, take the bus and volunteer in the community.
While Community Connections was providing these services before, clients are meant to be even more in charge.
As part of this change, the nonprofit has started offering more learning opportunities, like the art classes, beyond the Community Connection’s Holly House Community Center.
Persistent bureaucracyWhile the changes are well-intentioned, Kiene and others are concerned the changes to Medicaid funding could be flawed.
To determine how many hours of care Medicaid will cover, the state may continue to test applicants using the Supports Intensity Scale.
Advocates are fighting the test because it tends not to be administered consistently and it cannot take into account all behaviors, said Martha Mason, executive director of the Southwest Center for Independence.
“Behaviors come and go and could be dormant at the time of assessment,” Mason said.
While the test was never intended to determine how much service providers should be paid to care for an adult with developmental disabilities, a better alternative does not exist, Kiene said.
In addition, all the levels of care are under-funded.
“The rates across the board are inadequate,” she said.
Billing may also create a problem because once accepted into the program, clients may have to be scheduled in 15-minute increments, Kiene said.
This is currently in place for those people who need help for a few hours at a time, but it could be extended to those receiving 24-hour care.
“It does create this potential over-categorization of somebody’s life,” Kiene said.
In addition to this a new model, the state could also be required to split up organizations like Community Connections that provide both case management and direct services because it can present a conflict of interest.
But no other agency provides the same services as Community Connections. So if it was split up, all the case managers would potentially be referring clients to one agency.
Because the group of people Community Connections works with is so small, providing both creates efficiency.
The state is expected to ask the federal government for an exemption that would apply to rural areas, Kiene said.
One way to create more choice would be to allow Medicaid clients to hire anyone they feel is qualified, said Julie Reiskin, executive director of cross-disability coalition in Denver.
Local challengesThe state provided enough funding to eliminate wait lists in 2014 for supportive living services, allowing Community Connections to place 12 new people.
But staffing shortages have created a local waiting list. Five people are waiting for new staff members to be hired and trained, Kiene said. The wait list restarted three and a half months ago.
“I have always been horrified by the waiting lists,” Kiene said. She started March 1 and has began working on the staffing shortage and turnover problem.
In 2015, Community Connections had 56.7 percent turnover in field staff.
The nonprofit has not finished analyzing why the turnover is so high, but it corresponds to the national average for similar organizations, which is 50 percent.