The Developmental Disabilities Waitlist Report
Recommendations for Change
The Developmental Disabilities (DD) Waitlist is a process that was established in 1989 because insufficient resources exist to serve all consumers found eligible for DD services in Alaska. However, since few people have been moved from the waitlist to receive services in recent years, there is a backlog of eligible people waiting for needed services. On June 30, 2005, there were 1,233 people on the waitlist.
In an effort to come with recommendations for better managing the waitlist and ensuring that people get needed services at the right time before they are in high-cost crisis situations, the Governor's Council on Disabilities & Special Education (GCDSE) and the Division of Senior & Disabilities (DSDS) established an ad hoc committee for the DD waitlist. The committee met to review existing data and consider a wide variety of recommendations. The following outlines those recommendations on which the committee reached consensus:
Variables to Factor into Waiting List Prioritization and Selection
Ideally, the waitlist should serve as a management tool that provides DSDS with:
- A way to differentiate when people need services
- A way to determine who meets the level of care for waiver services
- An algorithm to determine placement on the waitlist
- A way to better determine what services people need
- A way to better determine what services people already receive (including natural supports from family and friends)
- A way to get information to people about what other services they might access while they are waiting
- A way to plan and budget better
- A process for data-based decision-making
- A way to best target resources in non-crisis situations and avert future crisis (e.g., students transitioning from school to adult life, people with aging parents, those with minimal or no supports)
- A way to target requests for increments
THREE-YEAR PHASE-IN PLAN
DEVELOPMENTAL DISABILITIES WAITLIST MANAGEMENT SYSTEM
FY 07
- Continue to manage waitlist reduction initiative (existing resources)
- Continue to coordinate ad hoc committee meetings (existing resources)
- Continue to develop database (existing resources)
- Change DD eligibility to match national definition (existing resources)
- Conduct ICAP assessments on all persons currently on the waitlist to assess functional abilities and identify level of care for the MR/DD waiver ($400,000 increment request)
- Use algorithm to determine waitlist placement and selection (existing resources)
- Create a secondary list or registry for people who do not meet the level of care for the MR/DD waiver (existing resources)
- Develop active referral procedures for people found not eligible for DD services so they can linked to other resources for which they might be eligible (existing resources)
- Use suspend or inactive status for non-responders to the waitlist survey (existing resources)
- Establish appeals methodology (existing resources)
- Develop policy and procedures manual (existing resources)
- Using historical data for actual utilization of MR/DD waivers, dedicate a certain percentage of existing waiver funds to taking people off the waitlist (existing resources)
- Identify ways to more efficiently manage DD grants to maximize the number of persons served (existing resources)
- Work with stakeholders to develop a tiered service delivery system (existing resources)
- Work with stakeholders to investigate Supports Waiver options (existing resources)
- Work with stakeholders to investigate 6086 provisions of the Deficit Reduction Act of 2005 (existing resources)
- "Jumpstart" the new waitlist management system and reduce the backlog of people waiting for services by prioritizing removal from the waitlist to the roughly 100 individuals who will be exiting the special education system or who are 40 years of age or older ($3,000,000 increment request)
FY 08
- Continue to manage waitlist reduction initiative (existing resources)
- Continue to coordinate ad hoc committee meetings (existing resources)
- Begin using database to manage waitlist activities (existing resources)
- Conduct ICAP assessments on all new eligible applicants for DD services to assess functional abilities and identify level of care for the MR/DD waiver (existing resources)
- Continue to use algorithm to determine waitlist placement and selection (existing resources)
- Continue to use a secondary list or registry for people who do not meet the level of care for the MR/DD waiver (existing resources)
- Implement active referral procedures for people found not eligible for DD services and refer them to other resources for which they might be eligible (existing resources)
- Continue to use suspend or inactive status for non-responders to the waitlist survey (existing resources)
- Evaluate appeals methodology and revise as necessary (existing resources)
- Revise policy and procedures manual as necessary (existing resources)
- Continue using historical data on the actual utilization of MR/DD waivers to dedicate a certain percentage of existing waiver funds to taking people off the waitlist (existing resources)
- Implement ways to more efficiently manage DD grants to maximize the number of persons served (existing resources)
- Pilot a tiered service delivery system (existing resources)
- If warranted, apply for a Supports Waiver from the Centers for Medicare & Medicaid Services (CMS) (existing resources)
- If warranted, revise State Medicaid Plan in accordance with the 6086 provisions of the Deficit Reduction Act of 2005 (existing resources)
- Work with legislature to determine an annual appropriation that would prevent substantial growth of the waitlist such as providing funds to serve individuals existing the special education system (amount to be determined based on findings from the implementation of the DD waitlist management system)
FY 09
- Continue to manage waitlist reduction initiative (existing resources)
- Continue to coordinate ad hoc committee meetings (existing resources)
- Revise database as needed to better manage waitlist activities (existing resources)
- Continue to conduct ICAP assessments on all new eligible applicants for DD services to assess functional abilities and identify level of care for the MR/DD waiver (existing resources)
- Continue to use algorithm to determine waitlist placement and selection (existing resources)
- Continue to use a secondary list or registry for people who do not meet the level of care for the MR/DD waiver (existing resources)
- Continue to provide active referral for people found not eligible for DD services and refer them to other resources for which they might be eligible (existing resources)
- Continue to use suspend or inactive status for non-responders to the waitlist survey (existing resources)
- Evaluate appeals methodology and revise as necessary (existing resources)
- Revise policy and procedures manual as necessary (existing resources)
- Continue using historical data on the actual utilization of MR/DD waivers to dedicate a certain percentage of existing waiver funds to taking people off the waitlist (existing resources)
- Evaluate ways to more efficiently manage DD grants to maximize the number of persons served and revise as necessary (existing resources)
- Evaluate the pilot tiered service delivery system and if warranted, expand statewide (existing resources)
- If application submitted and approved by CMS, begin using the Supports Waiver to take people off the waitlist who do not require 24-hour services (existing resources - may be able to draw down additional federal funds)
- If the State Medicaid Plan is amended to reflect the 6086 provisions of the Deficit Reduction Act of 2005, begin providing services to people on the waitlist in accordance with the amended State Medicaid Plan (existing resources - may be able to draw down additional federal funds and reduce paperwork associated with waivers)
- Continue to work with legislature to determine an annual appropriation that would prevent substantial growth of the waitlist such as providing funds to serve individuals existing the special education system (amount to be determined based on findings from the implementation of the DD waitlist management system)