Monty Blanton Testimony
Ohio Civil Service Employees Association/
AFSCME Local 11

Gallipolis Developmental Center
House Finance Committee
Chair, Representative Matthew Dolan
April 19, 2007

INTRODUCTION
Chairman Dolan and members of the House Finance Committee, my name is Monty Blanton and I work at the Gallipolis Developmental Center where approximately 250 individuals with MR/DD reside. I am also president of the Ohio Civil Service Employees Association MH/MR/OVH Assembly. I represent 2600 employees statewide who work in the 10 state-operated Developmental Centers and ODMR/DD Central Office.

PURPOSE
The purpose of my testimony today is to voice OCSEA’s support for the ODMRDD Line Item called “Martin Settlement” that appropriates funds to settle the Martin lawsuit, and to give a recommendation about how to successfully implement the waiver program it will create.

FAIR SETTLEMENT/ DCs AS CHOICE
The $37 million appropriated to settle the Martin dispute will finally put a long-standing lawsuit to rest by creating 1,500 new waiver slots funded by the state. 280 of these slots are earmarked for individuals living in Developmental Centers, ICF/MRs or Nursing Homes. OCSEA believes it is a fair settlement because it not only creates new waivers for individuals on waiting lists, but it also allows for the continued choice of Developmental Centers (DCs) as an option, which we believe is a vital choice in the residential continuum.

HISTORIC OPPORTUNITY FOR STATE-OPERATED COMMUNITY SERVICE
More importantly, we believe the settlement creates an historic and unique opportunity to develop a stable, high-quality and accountable community waiver system that is state-funded as well as state-operated.

MONEY CANNOT ENSURE QUALITY/SUCCESS
Even though the settlement creates 1,500 new waiver slots, money alone cannot ensure quality or success of the settlement. For this reason, we would like to propose that a number of these 1,500 waiver slots not only be funded by the State but be operated by the State using state employees.

40 PERCENT OF STATES OFFER THIS OPTION/OHIO LAGS BEHIND
We believe it’s important for the State of Ohio to step up to ensure successful community integration by becoming a waiver service provider. As persons with MR/DD have increasingly moved from large state institutions to smaller facilities, over 40 percent of the states have maintained a role in the provision of services in providing community-based settings, rather than relying solely on the private sector for community services. Ohio has already moved away from large institutional warehousing, but it lags behind in offering any state-operated community programs in MR/DD. The best way of ensuring the health and safety of individuals taking the “Martin” waivers is to provide a real choice. A real choice can only be achieved by offering a continuum of service options that include both qualified private providers and state-operated community services.

The Ohio Department of Mental Health has already invested in a community state-operated system called the Community Service Network (CSN). 600 employees in that agency service individuals with severe mental illness who live in home and community settings. This is in addition to the nine behavioral health hospitals the ODMH also operates. I’ve attached some information about this and other community state-operated service models throughout the country.

PROBLEMS COULD DERAIL PROCESS
Several realities of the Ohio system could derail the process of implementing the “Martin” waivers, forcing the State of Ohio back into the court system. 1) A well-trained, long-term and qualified workforce is not readily available, even for those currently on a waiver, let alone for expanding the system. 2) Providers in many rural counties are practically non-existent. This fact will continue to keep the waiver program from being statewide and consistent across counties and will put the Martin settlement in jeopardy. 3) Private providers can choose not to serve individuals with profound and severe needs. The state, on the other hand, is required to provide services for all those eligible. Without a state-operated community system, individuals with severe needs who are costly, will continue to be overlooked and shut out of community placement.

WORKFORCE ISSUES
High turnover and difficulty recruiting qualified direct care staff is a system-wide problem that will be compounded by the creation of 1,500 new waiver slots and the increased demand on this pool of caregivers.
An inability to ensure a living wage and benefits, and the isolation of direct care staff with no supports, have plagued Ohio’s ability to develop qualified, long-term direct care staff.  An aging workforce will continue to impede efforts to recruit staff in the future unless we make an effort to develop this employee population.

STATE WORKFORCE SOLVES RETENTION
A state-operated community system staffed by state employees would significantly address the problems of retention and recruitment by providing the workforce with a living wage and benefits as required by the Collective Bargaining contract between the OCSEA/AFSCME Local 11 and the State of Ohio. In part because of collective bargaining, state employees who work in the 10 Developmental Centers have the lowest turnover rates in the entire MR/DD system.

OTHER PROBLEMS, NO PROVIDERS, ESPECIALLY RURAL
One the most common reasons waiver settings fail for individuals is lack of providers, particularly in rural communities. Because of this, when emergencies do arise or when individuals are in crisis, they often must return to nursing homes, DCs or ICF/MRs. This is particularly true outside urban areas where providers are few and levy money scarce. Offering state-operated services in the community could prevent their return to one of these settings.

LACK OF STATEWIDENESS
CMS is concerned that Ohio fails to offer a system of statewideness. CMS has cited Ohio’s waiver program for its lack of uniformity in training, implementation, enforcement of health and safety and Medicaid policies and the fact that the same services are not offered in all 88 counties.

State-operated community services could alleviate CMS’s concerns by allowing waiver growth in counties that previously had none.

COUNTY BOARDS ADMIN COSTS
The counties’ ability to provide non-Medicaid match is already being jeopardized by the state’s dependency on locally generated funds administered by county boards. While the proposed $37 million allows for Ohio to significantly grow its waiver program without requiring additional major revenues from the county boards, county boards would still be burdened with administrative costs associated with implementing the waivers in their counties. In a state-operated system, administrative costs would be borne by the state, allowing the county boards to better address the needs of their non-Medicaid population.

LACK OF REAL CHOICE
Because private providers can choose not to serve high-cost individuals, there is virtually no program in Ohio for individuals with profound and intensive needs who wish to live on a waiver. A state-operated community program could bring real choice to this group of individuals.

IN SUMMARY
Development of state-operated community services would:

• Require no additional county board revenues;
• Will expand poorer counties’ ability to reduce waiting lists and allow for a statewide system;
• Would help to develop a statewide system of long-term, qualified community direct caregivers;
• Would allow the hardest to serve individuals to have real choice.