"The intent is not that that next person won't get services, but they might not get NOW." -- Health and Hospitals Secretary Kathy Kliebert.
Louisiana's top health official has indicated that over the next year the distribution of the state's disability waiver list will shift from first-come, first-served to needs-based. While acknowledging such a move would be a positive one in the long-term, some lawmakers and disability activists say it's also meant to quell outcry after vetoes to disability programs.
Over 10,000 members of the Louisiana disabled community are currently on the waiting list to receive a NOW, or New Opportunity Waiver. The waivers provide in-home services, community integration and work-related support to the disabled.
While services provided are needs-based, the waiting list itself is first-come, first-served -- a method both health officials and disability advocates agree has led to congestion, confusion and an unnecessary drain on funds.
Health and Hospitals Secretary Kathy Kliebert hopes shifting the list to needs-based will both better utilize finite resources while making headway through the list in a timelier manner.
"The list is very misleading," Kliebert said Wednesday, adding many of those waiting are already receiving some services. Some might be eligible for other waivers, such as Children's Choice, which are more abundant and less costly than a NOW and others might not be eligible at all.
Around 45 percent of those offered a NOW ultimately take it, Kliebert said, but once turned down, that waiver wallows in the system for six months before it can offered to someone else. The result is a delay in services and an ever-burgeoning waitlist.
"The intent (of the shift) is not that that next person (on the list) won't get services, but they might not get NOW," Kliebert said. By working with the disabled community, she hopes to push out a new policy in less than six months with full implementation in less than a year.
Kliebert met with members of the disability advocacy community on Monday, and she said the community would be heavily involved in the policy change in the months ahead.
Logistically, shifting the list to needs-based could be made in-house at DHH through an administrative rule-change, Kliebert said. The change would then go to the legislative committees on health and welfare for their approval.
State Sen. David Heitmeier, D-Algiers, who chairs the Senate committee, said he supports the move and hopes the health department continues to be transparent during the process with lawmakers and advocates.
"Kathy's background is such that she's passionate about the disabled community," Heitmeier said Thursday. "I'm hopeful that there are options to maximize our resources, but cautious to make sure that we do it in a manner that's effective."
Heitmeier, an optometrist by trade, said it will be important to determine who is ultimately given the authority to decide how to define "needs-based." He also said both DHH and his committee has to ensure "unintended consequences" are avoided by undertaking the shift too quickly or without proper preparation.
"An effective policy change will take time and will have to have the flexibility to be tweaked by the stakeholders," he said. "I think we need to able to call an audible when we need to."
Heitmeier and Kliebert began discussing the possibility of shifting the list to needs-based after Gov. Bobby Jindal's line-item veto of a 200-slot expansion to the NOW program in June, a move Jindal defended as necessary given budget constraints.
Nearly $2 million was also cut from programs that provide help with at-home care for children with developmental disabilities.
Since the vetoes were announced, disability advocates and Democratic lawmakers have been calling for a veto override session so lawmakers can attempt to reverse the cuts. Spearheading the session is state Rep. John Bel Edwards of Amite, who called the waiting list policy-change a distraction from the NOW expansion cut.
"It's generally bad practice to make radical changes to policy in reaction to things such as what we're going through right now," Edwards said Thursday. "I would be concerned that if you do that too quickly and without enough input it would be very easy to make a mistake."
While the possibility of triggering a veto override session doesn't appear likely, advocates said they would be contacting legislators until Thursday at midnight, the deadline for lawmakers to indicate their support of a session. If unsuccessful, the advocates said they will continue to push for additional funding.
"This does not take away from the fact that we have had drastic funding cuts," Bambi Polotzola, a member of the disability advocacy movement Override the Veto said Thursday. "There needs to be some type of revamping of the system, but I think it needs to be done very carefully."
Lois Simpson, Director of the Advocacy Center agreed, saying she was concerned about changing the goalposts for those who have been waiting for a waiver for up to a decade.
If done slowly and with transparency, she said, she would be for the shift to a needs-based waiting list. But she added, "there's no way that you can do that without additional funding."
Edwards asked, why not do both?
"Even if (Kliebert's) able to improve the program and better allocate resources, she needs more resources than she currently has as evidenced by the waiting list," he said. "There's no change that she can implement that wouldn't benefit from an additional $4 million for NOW."
Source: http://www.nola.com/politics/index.ssf/2013/07/now_waiver_disability_waiting.html
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