Here are some of the major problems with the DHS proposal to switch from the PCA program to CFSS:
• “Stuff happens” to everyone, but the unexpected calamity frequently falls most heavily on people with disabilities. To enable a person to move into a more integrated community than the one he or she left, or to enable a person to remain at home and in such a community even when disaster strikes requires a backup interdisciplinary team which is available 24 hours a day, seven days a week, and is flexible enough to timely and effectively respond to an individual’s emergency situation. Enabling the person to remain home is the best outcome. If a person must leave home for treatment, the second-best outcome would be to do what is required to allow the person to come back to his home and community after treatment.
These rapid response teams exist in many states, but Minnesota’s emergency reaction program is only limited to persons with mental illness.
• Unfortunately DHS’ state plan amendment completely lacks such supports and services for people with other disabilities which are necessary if home- and community-based living is to be a reality for many people. This failure will inevitably result in loss of housing and re-institutionalization or homelessness for many people with disabilities.
• In addition, the DHS proposal limits personal assistance to 275 hours per calendar month. Paid family members, likewise, are not allowed to work more than 40 hours a week. An exception to these restrictive limitations should be allowed when a crisis or emergency may require the aid of personal assistance beyond what is permitted.
• A person needs hands-on assistance or constant supervision and cueing in order to be eligible for CFSS. This highly restrictive service definition particularly penalizes persons with mental and cognitive disabilities, including mental illnesses, developmental disabilities and brain injuries, who require assistance with supervision and/or cueing, but who do not need constant supervision to do so.
• The CFSS proposal may be interpreted to exclude paying for Internet access. The proposal should be revised to make clear that payment for Internet access is available under CFSS.
DHS claims that its state plan amendment should take effect on April 1, 2014. This self-imposed deadline cannot be met if the CFSS program is to get off to a good start. MnChoices is a tool to be used to assess eligibility, as well as an individual’s abilities and limitations and their desires and goals although this program is not specifically mentions. MnChoices will not be rolled out to all of the counties until June 2014 under the existing DHS timeline, assuming there are no more delays. Under an April 1 effective date, persons with disabilities will be assessed or reassessed by a variety of different tools until MnChoices is fully implemented.
One concern is that assessment of individuals with disabilities between April 1 and June 2014 may lead to different and inferior CFSS services. Whether or not this result would violate Medicaid nondiscrimination law or the ADA, it is poor policy. It is hard to see what harm would be if the start of CFSS was delayed until MnChoices is implemented in all 87 counties. The inadequacies of the current draft amendment may be inconsistent with the state’s Olmstead Plan and this question cannot be answered without a thorough review of both the Olmstead Plan and the CFSS proposal.
Christopher Bell is a retired attorney, former co-chair of the Minnesota Consortium for Citizens with Disabilities and board member for the American Council of the Blind of Minnesota.