1. Texas’ Fourteen
Year Journey to
Rebalance its LTSS
system
Marc S. Gold
Texas Department of Aging & Disability
Services
Houston, TX
September 30, 2013
One Voice Collaborative
Conference

2. Olmstead to BIP: Rebalancing
1985: First 1915 (c) waiver
1999: Texas embraces Olmstead: Promoting
Independence Initiative
2001: Creates “Money Follows the Person” (MFP):
45,000 relocated
2003: Consolidation of Health and Human
Services system
2006: Aging and Disability Resource Centers
2007 – National MFP Demonstration
1998-2012: Expansion of LTSS managed care
2012: Balancing Incentive Program (BIP)

3. PII: Early Enhancements
Creation of MFP and Promoting Independence
Priority Populations.
Development of relocation specialists statewide
system.
Creation of “Transition Assistance Services” which
allow a one-time expenditure from waiver cost cap
to set-up a new household.
Creation of regional “Community Transition
Teams”.
Implementation of “Project Access” housing
vouchers: dedicated housing vouchers for
individuals relocating from institutional settings.

4. PII: Early Enhancements
Consumer-directed Services.
Expansion of Centers for Independent Living.
Increased support for individuals residing in State
Hospitals with three or more admissions within 120
days.
Family-Based Alternatives.

5. Barriers to Relocation
 Long-term institutionalization
 Information/knowledge of options housing
 Co-occurring behavioral health issues
 Lack of a statewide provider base to serve
individuals with complex needs
 Stabilized direct services workforce
 Service providers/transportation in rural
areas
 Service array flexibility

6. Barriers to Relocation
 Health and welfare concerns
 Family/guardian resistance
 Coordination of services/SSI address change
 Personal fears
 Provider liability
 Loss of community supports

7. MFP Demo: The Next Step
Demonstration:
 took state to the next level in enhancing the
community-based infrastructure;
 increased interagency cooperation across
health and human services enterprise; and
 significantly increased awareness of
behavioral health issues as a LTSS and
began a major collaboration between the
behavioral health agency and managed care
and the long-term services and supports
agency.

8. MFP Demo: Selected Projects
Over 30 projects funded through the
Demonstration to enhance the community-based
infrastructure; examples:
 Voluntary closure of private ICF/IID.
 Behavioral Health pilot.
 Quality Management reporting office.
 Program wide “data mart”.
 Direct service worker initiatives.
 Dedicated specialists to work with individuals
with IDD in publicly operated ICFs.
 Customized employment pilot.

9. MFP Demo: Selected Projects
Over 30 projects funded through the
Demonstration to enhance the community-based
infrastructure; examples:
 Specialized trainings.
 PASRR Webinars.
 Realistic Job Previews.
 Positive Behavioral Management
Workshops.
 Automated contract monitoring instruments.

10. MFP Demo: ADRC Enhancement
Started “no wrong door” efforts.
Refinanced first three ADRCs once ACL start-up
funding was no longer available.
Expanded ADRC system from three sites to
fourteen.
Funded staff to be “housing navigators.
Funded staff to be “local contact agency”.
Funded staff to perform “options counseling” and
to create statewide standard.

11. MFP Demo and Housing
811 Infrastructure Grant.
United States Housing and Urban Development
(HUD award of $12 million in 811vouchers (385).
Regional CMS – Regional HUD – Texas
Department of Aging and Disability Services’
housing initiative with public housing authorities:
thus far it has created more than 140 dedicated
section 8 vouchers.

12. MFP Statistics
 45,071 individuals have relocated
from Texas Medicaid-certified institutions
 NF: 33,421
 ICF/IID: 11,650
 More than 9,000 individuals remain active in
the community.
 49 percent: 0-64 years of age
 51 percent: 65 and older
 14 percent: 85 and old
 21 persons 100 years of age or older

13. MFP Residential Placements
37 percent living with a family member
26 percent living in assisted living
34 percent living alone

14. BIP: Data Follows the Person
$301.5 million award.
External Stakeholders and Executive and
Legislative Involvement and Leadership.
Official oversight:
 MFP Demonstration – BIP Advisory
Committee;
 ADRC Advisory Committee; and
 Promoting Independence Advisory
Committee.

15. BIP: Work Plan Strategy
 Supports TX’ overall goals and strategic
planning in relation to upcoming legislative
session (January – May 2013).
 Pre-legislative proposals: significant ongoing
movement to an integrated and comprehensive
managed care system to serve all individuals
with disabilities regardless of age.
 Movement to integrated IT systems and single-
portals to access services.

16. Partners and Scope of BIP
 Health and Human Services Commission: umbrella
agency; Medicaid agency; operates managed care
programs.
 Department of State Health Services: behavioral health
(BH) operating agency.
 Department of Aging and Disability Services: LTSS
operating agency.
 Department of Family and Protective Services: Child
Protective Services/Adult Protective Services.
 Department of Assistive and Rehabilitative Services:
vocational rehabilitation; sensory disabilities.
 All individuals with disabilities who are eligible for
Medicaid LTSS regardless of age.
 Fee-for-Service and Managed Care.

17. BIP Award Allocation

18. NWD: Data Follows the Person
 Heavy emphasis on “data follows the person”:
providing infrastructure to support individuals
going to one place, giving high-level information
once, and having system data available.
 Expand ADRC system statewide.
 Expansion of TX’ front door web-based portal:
Your Texas Benefits (YTB).
 Development of an interactive Children’s with
Special Needs website.
 Development of interoperability of
financial/functional eligibility systems.

19. BIP: Guiding Principles
 Contracting for several IT projects: initial
analyses of system and development
 Principles:
 to build a system for the next decade that
will be flexible to respond to ever-changing
legislative and federal policy direction .
 Consistent process across TX.
 Transparency and real-time visibility of
data across the enterprise.
 Leverage existing systems.
 Use most advanced technologies that can
be easily adapted and amended.
 Secure privacy and confidentiality.

20. IT System Features
 Single front-door portal which is self-service or
with assistance (ADRC).
 Data warehousing.
 Messaging/reminders.
 Mutual storage and sharing of data
(demographic and assessment) across
enterprise.
Integrity of data (ongoing quality improvement of
system).

21. Beyond BIP: Transformative
 Greater cooperation across health and human
services system – true “enterprise” system
Looking at whole person and reducing “silo”
mentality: impacting every aspect of service
delivery.
Exploring new technologies to support efforts
into the next decade.
Emphasis on overall quality of system/services
to ensure an individual can remain in the
community as long as possible.
Developing extensive data base to make more
precise evidence-based policy decisions.
More productive experience for the individual
and more efficient usage of staff support.
Supporting goals of a comprehensive MC
system.

22. BIP: Project Interdependencies

23. BIP: Vision
 Statewide portal for easy access into the
health and human services system to provide
transparency of all eligibility functions and
data.
 Statewide ADRC to become the lead “NWD”
and to provide information, assistance in filling
out eligibility forms and options counseling.
 Integrated IT support.
 Comprehensive assessment data.
 Managed care delivery system to support the
individual holistically across the acute and
LTSS system regardless of “diagnosis” or
service need.

24. Contact Information
Marc S. Gold, TX Department of
Aging and Disability Services
Special Advisor for Policy
Office of the Commissioner
512.438.2260
marc.gold@dads.state.tx.us
www.dads.state.tx.us/business/pi/ind
ex.html

25. Website Information
Balancing Incentive Program:
http://www.dads.state.tx.us/providers/pi/bi
p/
Your Texas Benefits:
https://www.yourtexasbenefits.com/ssp/S
SPHome/ssphome.jsp
Aging and Disability Resource Centers:
http://www.dads.state.tx.us/services/adrc/
Promoting Independence Initiative:
http://www.dads.state.tx.us/providers/pi/
Money Follows the Person:
http://www.dads.state.tx.us/providers/pi/m
fp_demonstration/index.html