Thursday, August 11, 2011

People First Waiver-The Only Constant is Change

How interesting. I had blogged several months ago about stumbling across something called the "People First Waiver" but never had time to do more research until now.  If we ever get hold of Bil's new Medicaid Service Coordinator, we will need to find out more.

One thing seems obvious...they don't seem to be reaching out to the siblings or siblings in law to get their input.  So only now do they have a questionaire?  I'll be filling this out shortly.

August 4, 2011 Dear OPWDD Stakeholder: In recent conversations with members of the OPWDD community, I have learned that some confusion exists about the purpose of the new 1115 waiver and the changes it will bring. We have worked hard to make all the technical information our design teams and staff are using to study options and possible features of the new service system available to everyone on the People First Waiver Web page. While we have provided a lot of complex information, it appears we haven't yet clearly communicated what the new waiver will mean for the individuals and families we support. I will try to address some of the questions I have heard in this letter. Is the 1115 waiver a way to achieve budget cuts? First and foremost, the People First Waiver is NOT a means to cut OPWDD's budget. OPWDD's budget is directly affected by New York State's fiscal situation, tax revenues, and lawmakers' decisions about how to fund, within the limits of those resources, the many services New York State government provides to its citizens. The People First Waiver is not part of the budget process and will not bring further cuts to the OPWDD budget. Likewise, it will not shield our system from the realities of the economy. Will I lose services as a result of moving to the People First Waiver? Although there are many decisions yet to be made, we fully expect that on "day one" of the People First Waiver, all of the services that you or your family member receives will transition smoothly into the People First Waiver. We will continue to meet the same needs for service. However, the new waiver is allowing us to review how well those current options are supporting people and what ways we could do things better and promote better personal outcomes for individuals and families. Over the five-year course of the waiver, we will carefully test ways to better access services, new service options, ways of organizing care, paying for services, and measuring quality by implementing and evaluating pilot projects. The ideas that work well will ultimately be made available on a statewide basis, with careful and thoughtful implementation and continuous dialogue with you, the people we serve. The transition, from testing of ideas to implementation, will take several years. The services you receive may change somewhat, but we promise that the changes that result from the implementation of the People First Waiver will always be done carefully and in a transparent way with advanced notice to all individuals and families. There is a lot of talk about "efficiencies." What exactly do you mean? While the People First Waiver will bring changes in how the system operates, those changes are our opportunity to respond in better ways to the needs of those we support and make sure our service system is robust and stable for decades to come. The reforms of the People First Waiver will allow us to more accurately determine someone's needs for services, and then provide "individualized" services that will best meet their needs. In this way, the system will be more efficient, directing funding to services that are needed, rather than funding programs and levels of service that do not support someone to achieve their personal goals. This increased "precision" in how we target services to peoples' needs will also establish greater equity in the availability of services throughout New York State. To get there, we plan to update and improve how we assess an individual's needs so that we appropriately provide greater levels of service to those with greater needs. This could mean changes for some as individuals move into less restrictive settings and begin to enjoy more inclusive and meaningful lives. For many others, it will mean confirmation of their need for close supervision and support. Again, I assure you we will be careful and cautious as we plan for the implementation of these changes and will communicate with everyone about how the service system will respond to their needs for support. OPWDD stands firm in our commitment to protecting the health and safety of everyone within our service system. The agency that provides services to my family member is like a part of our family. Will I lose that contact? We recognize that service providers have been and will continue to be the foundation of the new service system. As we move from a fee-for-service billing arrangement to a care management structure, we will move slowly over a period of several years to allow the voluntary service providers to adapt and find their most successful and stable position within the new system. As we expand the types of services they provide and develop a new process of coordinating and paying for that care, we will work to ensure continuity of care for individuals and families and avoid abrupt and disruptive transitions. Again, we will communicate openly and continuously as these changes unfold over a period of several years. How can I share my ideas about the 1115 waiver? Finally, I want to assure you that OPWDD is relying on all of our stakeholders, and especially on the people we support, to help us design the details of People First Waiver system reforms. We've held listening sessions and public forums and provided an online survey that gathered many valuable comments and ideas. With this letter, I am announcing a second online opportunity for you to help us design the waiver so that it achieves its objectives with the full support and advice of the people we serve. The survey can be found at the People First Waiver Web page ( I hope this information helps you to understand and support the development of the People First Waiver. It is a vitally important next step in the improvement of our service system, and therefore, it is critical that all of us who know and care for individuals with developmental disabilities understand what it is. Please share this letter and its clarifications about the People First Waiver with your colleagues and take part in the new online survey about the waiver. Thank you. Sincerely, Courtney Burke Commissioner

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