A final consent decree in Ligas v. Hamos, formerly Ligas v. Maram, a lawsuit filed in 2005 against the State of Illinois, was entered yesterday. Nine people with developmental disabilities sued the state in order to receive community-based services rather than having to reside in larger, more restrictive ICFDDs (Intermediate Care Facility for Developmentally Disabled).
The terms of the settlement create the largest one-time increase in services for people with developmental disabilities ever in the state and promises to make inroads in reducing a waiting list of more than 21,000. The question is, "where will Illinois, already facing a $13 billion shortfall, find the money for this expansion of services ordered by the court?" As the Chicago Tribune noted yesterday,
http://articles.chicagotribune.com/...
The governor's office praised the settlement, which will expand services to new residents on a 21,000-member waiting list — but officials offered no answers on how they expect to pay additional costs during Illinois' fiscal crunch.
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The terms of the settlement include:
ICF-DDs residents who desire community placement would receive an individualized, independent evaluation and the opportunity to live in the community with appropriate services.
Over a six year period, any of the approximately 6,000 ICF-DD residents who desire placement in the community would transition to the most integrated community-based setting appropriate for their individual needs.
All ICF-DD residents who are happy with their current placement would not be part of the proposed class and would not be required to move. The proposed Consent Decree ensures that resources necessary to meet the needs of those who choose to continue to reside in ICF-DDs will be made available.
Over a six year period, 3,000 people with developmental disabilities currently living at home without services would be given community services.
The Judge will appoint an Independent Monitor with expertise in developmental disabilities to oversee implementation and compliance with the Consent Decree.
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One thousand people are targeted to received services over the next two fiscal years beginning July 1st. Services are paid through Medicaid Waiver, a state-Federal cost sharing mechanism which in Illinois is a 50-50 split. A quick and dirty calculation ($25,000 (the state's share of an average cost of $50K/year for a group home placement) times 1000 people = $25M to be added over the next two years. By the end of the six year period of the settlement an estimated $225M in services will have been added.
While we must applaud the suit and the terms of the settlement, this dramatic increase in community-based services has some potentially serious problems:
1) If the state treats it as a zero-sum game and merely shifts dollars around without adding new service dollars, we lose--although I don't think any amount of shifting current dollars around can satisfy the court's mandate.
2) Some service providers have already maxed out lines of credit to continue operating because the State of Illinois is seriously delinquent in payment for services and accounts payable from the State that are 6-12 months old are not uncommon. Now we are asking them to go even deeper in debt on the promise that they'll get paid someday.
3) The sheer number of people covered in the scope of the agreement necessarily calls into question the capacity of the service delivery system to absorb this many people in this amount of time. Where will we find the direct care staff to whom we entrust so much responsibility for inversely proportional pay? How can quality of care not be compromised to some degree?
4) The settlement in no way prevents the backfilling of beds in ICFDDs of people who choose community services, thus ensuring more costly, more restrictive settings will continue. Although from a different pool of money, this will continue to stress the DD service delivery system in Illinois.
In order to become a class member of Ligas (and the class is limited to adults age 18 and older) two conditions must be met:
1) You must be on the State's official waiting list, often referred to as the PUNS list (an unhappy acronym for Prioritization of Unmet Need for Services). If you are not already on the list, contact your local PAS/ISC (Pre-Admission Screening/Independent Service Coordination) agency, which you can find by going to http://www.dhs.state.il.us/....
2) You must become a class member of the settlement. You can do this at any time, even though the settlement became final yesterday. Sooner is better than later in order that you are in the first group of class members to be chosen for services. To become a class member, contact http://www.equipforequality.org/ and you can download the one-page form to mail in to become a class member.
I am hopeful this is a significant step in providing services to people with developmental disabilities who want to live, work and recreate in their own communities. However, disability advocates will need to be as vigilant or more so than the court-appointed monitor to be named if the implementation of Ligas is going to be successful. We can start by looking at the line item in the upcoming budget starting July 1st to see what is requested for community-based services and whether it reflects anything close to reality in a post-Ligas Illinois. Illinois still spends way too much to support people in state-operated facilities vs. community services, but I am cautiously optimistic this is a step in the right direction.