Louisiana’s Office for Citizens with Developmental Disabilities (OCDD) initiated a partnership with self-advocates, families and other stakeholders to address needed system reforms related to a lengthy waiting list for HCBS services and a fiscally unsustainable picture for its support system. For years, OCDD maintained a Request for Services Registry (RFSR) for individuals who had requested/were waiting for the New Opportunities Waiver (NOW), its most comprehensive waiver; however, despite efforts to fund additional NOW offers periodically since its inception in 2004, the RFSR remained lengthy and growing. Estimates for funding the RFSR using the average NOW annual plan cost involved an additional $832 million. Stakeholder engagement, system analyses, and exploration of various support and funding options occurred between 2012 and 2015.
OCDD worked collaboratively with its Core Stakeholder Group to propose efforts to address the RFSR waiting time and fiscal challenges while assuring recipient/family needs remained at the forefront of the system efforts. The new process involved a stakeholder developed tool/process to screen for unmet needs and urgency of need, move to a prioritized approach to offering HCBS support options, and a move away from a focus on the NOW to use of the most appropriate waiver to address the needed balance in cost effectiveness and access to needed supports. OCDD and its stakeholder partners utilized a statewide intensive outreach approach to educate Louisiana’s citizens with DD, their families and other stakeholders on the proposed new process and to refine the tools and operational aspects of its implementation. Significant effort throughout this partnership/process has been devoted to assuring that all tools, changes in processes, prioritization criteria and the most appropriate waiver evaluation remained rooted in a person-centered approach to planning and delivery of supports.
The new screening and prioritization process was implemented in 2017 and resulted in a responsive DD support system with no individual/family waiting for currently needed service and the ability to adjust urgency of need and meet new/changing needs for a family within each year. This system change occurred while expanding the number of individuals receiving HCBS, decreasing the average cost of services and stabilizing the fiscal picture for the DD support system. Louisiana’s team will present tips for stakeholder engagement/partnership, screening tools and guidelines, and support considerations for determining most appropriate service options to meet an individual and family’s needs. Future directions to continue quality initiatives and stakeholder partnerships will be addressed.