The Vision Statement for the Montana Department of Public Health and Human Services/ Developmental Disabilities Program states: “People in services have a voice and the support to live productive, healthy and fulfilled lives in the community of their choice.”
Further, DDP’s Mission is to “Create a system that coordinates resources, supports and services for people to have meaningful lives in their communities.”
Noble words. How does the department deliver on this promise to eligible Montanans with a developmental/intellectual disability? Through a network and coalition of private (mostly nonprofit) direct care providers, targeted case managers (state and contracted) in partnership with DDP/DPHHS; most of it funded through state general funds and Medicaid dollars. You can find the full Vision, Mission and Value Statement at http://dphhs.mt.gov/dsd/developmentaldisabilities
The “system” referred to in the above Mission is like a three-legged stool: the State of Montana through DDP, the direct care providers (mostly private non-profit agencies) and case management (state and contracted agencies). After the last session, the Legislature gave direction to DPHHS to find money to cut; DPHHS chose to cut one leg of the stool: contracted case management. Case management was a successful, cost-effective system that helped to keep people safe and lessen impact of other systems (law enforcement, APS, hospitals, OPA, etc.) Life is hard enough for families and individuals living with an intellectual disability; with this decision, it just became harder. Contrary to what many people think, there are no entitled services once a person finishes public education. The only entitled component, if eligible, was a case manager. Now, that support is being drastically changed. Why?
In my opinion, the recent decision to eliminate contracted agency case management services puts into question how DDP will be able to continue to meet their stated Vision and Mission to the most vulnerable citizens of Montana. In the Butte/Anaconda/Dillon area, the elimination of the contracted services of HI Case Management affects nearly 300 individuals and their families, this includes people on the wait list as well. Why was this done?
Since the early 1990s Montana has successfully worked to create a case management partnership of state and private agencies to serve the needs of this targeted population. The case manager (CM) embodied Montana’s promise to individuals and families; in turn, the face and voice of the people the CM served was reflected back to the state. The four contracted agencies were an independent voice for all people in services. What does a CM do? Simply stated: Assess a person’s needs, link and refer that person to all appropriate services (not just DDP funded), work with the individual to develop an appropriate person-centered plan of care, and follow up and monitor that plan of care, as well as assist in any crisis. The CM helps to give people “a voice”; the CM is the “support,” on a daily basis, to help people “live a productive, healthy, fulfilled” life in the community. The CM provides the support that often can keep a person from becoming homeless, safe from predators, connected to health care, find a meaningful job and be connected to a community. The CM knows your name and what’s important to you. Much better than the institutional life that used to be the fate of a person with an intellectual disability.
Montana has partnered with the federal government to care for this targeted population through a Medicaid Waiver. The funds from Medicaid pay for the direct care services (group homes, activity and work programs, transportation and more) comes with strings attached. Those strings are called Assurances. Acceptance of Medicaid Waiver funding says: We’ll give Montana money, but we want to be sure people are:
1. In the right kind of care,
2. That there is an individual appropriate plan of care,
3. That the plan is followed,
4. That the money is only spent with qualified providers,
5. That people are protected from abuse, neglect and exploitation,
6. That the money is accounted for through documentation.
Reasonable requirements in exchange for millions of dollars. DPHHS/DDP gave a huge responsibility to the case management system to make sure those Assurances are met on a monthly and yearly basis. Everything the case manager does is related to those Assurances. In 2007, a caseload of 35 was determined to be reasonable to meet the health, safety and care needs of the individuals Montana serves. As a former CM and CM supervisor, I know that task to be difficult on many days. I would also like to believe that Montana, even if there was no Waiver funding, would find these Assurances to be valuable because the people served are valuable. On March 31, 2018, those are the standards, on April 1 when the contracts end, and caseloads grow, are those still going to be the standards?
The state has now determined that one CM can now do those tasks for many more people when they eliminated the contracted CM agencies. Why? What has changed with Medicaid? What has changed with the Vision and Mission of DDP? The 70 people across the state who will lose their jobs will, hopefully in time, find other work. However, the experience, knowledge, dedication, and compassion will be lost to the thousands of people they have served.
To DPHHS, DDP, the Governor, the Legislature, I would ask “Why? Why do this to the most fragile of our fellow Montanans?”
-- Rose Brock, Butte, a retired contracted case manager/supervisor