Montana

Task Force

Due to the diverse Medicaid programs within Montana's Department of Public Health and Human Services, several Olmstead plans were developed. They include:

• Senior and Long-Term Care,
• Disability Services (includes Developmental Disabilities and Vocational Rehabilitation),
• Mental Health Services, and
• Basic Medicaid.

Each division has developed a task force consisting of consumers, legislators, advocates, family members, state staff and providers. The groups have met several times and have generated planning documents. Each program has a plan and an accompanying timetable. Referrals are being made for community services, which continue to be developed. However, the timetables will be affected because state officials do not expect to gain increased funding during the 2003 session of the Legislature.

The Plan

Montana's Senior and Long-Term Care Advisory Council released its final Olmstead report in December 2001 for public review and implementation.

The key elements of the final Olmstead plan for senior citizens are as follows.

• Ensure that appropriate stakeholders participate in the development of the plan and conduct follow-up.
• The Senior and Long-Term Care Division will share the Olmstead plan with other DPHHS divisions.
• Share its plan with the Olmstead Council for the Disability Service Division and the Division for Addictive and Mental Disorders.
• Prevent and correct current and future institutionalization of individuals with disabilities.
• Conduct a thorough assessment of individuals in nursing facilities in a timely fashion.
• Pursue creative ways to use existing funding to address unmet needs.
• Educate consumers and the health care community regarding the service options.
• Access and availability of services.
• Address the need to find innovative ways to find, hire and retain caregivers for long-term care services.
• Collaborate with agencies that address these issues:
• Licensing of personal care facilities,
• Housing to ensure the availability of HUD housing,
• Transportation,
• Durable medical equipment for those individuals with disabilities, and
• Medicaid application process.
• Informed choice.
• Establish educational materials in all formats, readily accessible and obtainable.
• Target the consumers, medical professionals and others who come in contact with individuals with disabilities.
• Educational materials should be standardized and presented in a positive light.
• Quality Assurance.
• Increase adult protective services and ombudsman networks to ensure individuals in the community are free from abuse, exploitation and neglect.
• Review current services and backup systems to ensure individuals are not left without support.

Implementation

There is no specific legislation regarding the Olmstead decision.

Each program is having success in terms of developing plans and implementing service delivery strategies that focus on community-based services. The state is continuing efforts to move people into these types of services wherever and whenever possible.

The major problem at the present time is funding. The state is in a serious budget crisis and programs are being cut. These cuts make Olmstead planning very difficult.

One lawsuit was scheduled to go to trial in November 2002. Filed in 1996 by the Montana Advocacy Program, it is class action litigation that seeks community-based developmental disabilities services for people who currently are residing in state-run residential facilities and for individuals in the community who are at risk of institutionalization. For an update on lawsuits in Montana and other states, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at http://www.hsri.org/index.asp?id=news

Each program is moving forward with action steps regarding Olmstead implementation. For example, the developmental disabilities system is moving away from a \"contracting\" model of slot-driven services to a more individualized, choice-driven approach.

Montana's Department of Public Health and Human Services, Disability Division, received a $1.385 million Real Choice Systems Change Grant.