HOUSE OF REPRESENTATIVES

H.C.R. NO.

103

TWENTY-SECOND LEGISLATURE, 2004

H.D. 1

STATE OF HAWAII

 
   


HOUSE CONCURRENT

RESOLUTION

 

requesting the department of health AND DEPARTMENT OF HUMAN SERVICES to examine the federal independence plus initiative to determine if hawaii can benefit from applying for and obtaining a waiver or waivers to provide individuals with disabilities with services in the community.

 

WHEREAS, states spend at least a third of their Medicaid budgets on long-term care for the elderly and people with disabilities; and

WHEREAS, as states continue to find ways to move people from institutions into the community, they want to provide the most flexibility for consumers; and

WHEREAS, the new federal Independence Plus Initiative gives states tools to create programs that allow people with disabilities and their families to decide how to use community-based services; and

WHEREAS, the Independence Plus Initiative provides new flexibility to states as they seek to strengthen services in the community to comply with the United States Supreme Court Olmstead v. L.C. ruling and its interpretation of the Americans with Disabilities Act; and

WHEREAS, consumer-directed care (or self-direction) refers to individuals with disabilities making their own decisions about the types of services they want and how they want to receive them. For example, they can hire and fire their own workers -- often friends, family members, and neighbors -- who typically provide personal assistance at home; and

WHEREAS, this concept promises to provide more services for the same amount of money and reduce unmet needs in a cost-effective way; and

WHEREAS, the Independence Plus Initiative is part of the "New Freedom Initiative," a multiagency federal initiative to reduce obstacles to full integration into the community for people with disabilities. The waiver program offers states the opportunity to give people who require long-term services greater control over what services they receive; and

WHEREAS, the Independence Plus Initiative consists of two waivers that enable states to tailor their community-based programs to their preferences and provide flexibility for states seeking to increase consumer direction in their long-term care systems. The waivers also encourage cost effectiveness in supports and services; and

WHEREAS, the waiver options consist of a 1115 demonstration waiver and a 1915(c) home- and community-based services waiver; and

WHEREAS, the 1115 demonstration waiver provides the most flexibility by making cash directly available to participants requiring any level of care. States can use this waiver to establish a community-based program serving different populations, such as people with mental retardation and people with physical disabilities; and

WHEREAS, under this waiver, states can choose to give cash directly to participants. States also can cover an eligible population other than those who need an institutional level of care. The 1115 waiver has budget neutrality requirements that limit federal expenditures over a five-year period to the amount a state would have spent without the waiver; and

WHEREAS, the 1915(c) waiver meets the needs of people who need institutional care. States can use this waiver to create an alternative to placing Medicaid recipients in hospitals, nursing facilities, or intermediate care facilities. Participants receive an individual budget and use a fiscal agent or broker to manage their money directly; and

WHEREAS, states can apply for waivers using a standardized template, submit waivers electronically, and expect a speedy review of their proposal. With every state now operating at least one home and community-based services waiver, some may choose to use Independence Plus to change the operation of an existing waiver rather than develop a new one; and

WHEREAS, Florida, Louisiana, Missouri, New Hampshire, and South Carolina have received federal approval for Independence Plus waivers as of May 2003; and

WHEREAS, New Hampshire's 1915(c) waiver serves children and their families. The program, "in-home support waiver for children with developmental disabilities," provides personal care, respite care, and home and vehicle modifications for children with developmental disabilities. Families help create an individual budget, choose the type of service they want, and select a provider. A "support broker" and a financial management service help them with the process and handle payroll tasks; and

WHEREAS, South Carolina's 1915(c) waiver, "SC Choice," is similar to New Hampshire's, but serves the elderly and adults with disabilities and will initially be offered in only three counties; and

WHEREAS, Florida's 1115 demonstration, "Consumer Directed Care," allows people with disabilities to direct their care and control the budget allocated for their needs. Consumers, with the help of a trained consultant, decide what type of services, equipment, or other purchases will best meet their needs. Consumers also hire, train, and, if necessary, terminate their service providers, which may include independent workers, family, friends, or traditional home care agency staff. The majority of Florida participants use a fiscal intermediary to handle payments for services and other purchases; and

WHEREAS, it is in the interest of all individuals with disabilities in the State to be accorded all the flexible services that can be made available with the federal Independence Plus Initiative; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-second Legislature of the State of Hawaii, Regular Session of 2004, the Senate concurring, that the Department of Health and the Department of Human Services are requested to examine the federal Independence Plus Initiative to determine whether individuals with disabilities in the State can benefit from that initiative through the acquisition of federal waivers for flexible home- and community-based services for those individuals requiring long-term care; and

BE IT FURTHER RESOLVED that the Director of Health and Director of Human Services are requested to submit a report to the Governor and the Legislature no later than twenty days prior to the convening of the Regular Session of 2005, recommending whether the Department of Health and Department of Human Services should participate in the federal Independence Plus Initiative through application for waivers, including details of the waiver or waivers sought, together with descriptions of services to be provided and how the waivers will operate; and

BE IT FURTHER RESOLVED that the Director of Health and the Director of Human Services are further requested to submit any proposed legislation, if necessary to proceed with any application for waivers, to the Legislature for consideration of passage during the Regular Session of 2005; and

BE IT FURTHER RESOLVED that the Director of Health and Director of Human Services are requested to keep the Governor and the Legislature appropriately apprised of progress concerning the application for any waivers sought; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Director of Health, Director of Human Services, and the Chairperson of the State Council on Developmental Disabilities.

 

 

Participation

Report Title:

Independence Plus Disabilities Waivers; DOH; CONSIDER