Top Aide To RI Gov. Raimondo To Lead EOHHS; Policy Director For Providence Mayor To Run HHS

By Gina Macris

RI Governor Gina Raimondo has named Eric Beane, the top aide tasked with fixing the UHIP computer disaster, as Executive Secretary of Health and Human Services. 

Courtney Hawkins, chief policy officer for Providence Mayor Jorge Elorza, will become the new Director of the Department of Human Services (DHS). And Zach Sherman, Director of HealthSource RI, will take over the day-to-day management of the UHIP turnaround, according to a statement from Raimondo’s office issued May 12.

“Rhode islanders deserve and demand high-quality public services. I am confident the new leadership for our Health Cabinet will ensure better access to care and better outcomes for Rhode Islanders,” Raimondo said.

There has been a nearly complete turnover in the human services leadership since the start of the year, primarily because of problems with the UHIP computer system and with the management of the Department of Children, Youth and Families.

Beane has been with Raimondo since she took office in 2015, serving first as deputy chief of staff and then as chief operations officer, before the governor put him in charge of running DHS and turning around the $364-million Unified Health Infrastructure Project (UHIP) in January.

Hawkins, a Rhode Island native, “brings more than 15 years of experience working with social service agencies and in public policy” here and elsewhere, Raimondo said.

Hawkins has a bachelor’s degree from the University of Rhode Island and a master’s degree in social work from Columbia University. Before returning to Rhode Island in 2015, she worked as senior vice president at the now-bankrupt FEGS Health and Human Services, one of the largest social service agencies in New York City. The agency closed its doors in 2015.

UHIP, the largest information technology project ever undertaken by the state, has delayed eligibility decisions and healthcare and social service benefits for tens of thousands of Rhode Islanders – including some with developmental disabilities - since it was launched in September, 2016.

The botched rollout also cost the jobs of former EOHHS Secretary Elizabeth Roberts, the state’s chief digital officer, Thom Guertin, and the former DHS director, Melba Depena Affigne. 

In announcing the new appointments, Raimondo’s office said that Anya Radar Wallack, Acting Secretary of EOHHS since February, will return to the Brown University School of Public Health in June.

Beane is to start his new duties June 1 and Hawkins will take office June 12. Both appointments require confirmation by the state Senate.

RI EOHHS Clarifies Status of Probationary DD License Involving Maher Center in Newport

By Gina Macris

The James L. Maher Center of Newport is correct in saying that the state has not downgraded the developmental disability service license of the entire agency, a spokeswoman for the Rhode Island Executive Office of Human Services (EOHHS) said Tuesday, Nov. 15. 

The Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) has put one group home, at 228 Carroll Ave., on conditional, or probationary, status as a result of an internal investigation that found its staff abandoned a resident at Newport Hospital May 3, according to the spokeswoman.

But Jennifer Wood, the Deputy Secretary of Health and Human Services, says that "the accountability for the failure to comply with regulations and requirements at the Carroll Avenue group home resides with the management of the agency as a whole." 

The Maher Center has appealed the conditional license, which lasts for six months. During that period the agency is subject to heightened oversight by the state, according to Wood.

On Nov. 16, Wood elaborated: "In the currently pending matter BHDDH will prove that the agency did not operate that home consistent with the regulations, and unless they prove that they are operating consistent with the rules during the conditional license period, they may not be able to retain a license to operate that home in future.  

"If we also learn that other homes for which they are licensed are not operating consistent with the regulations, then we would take additional action regarding the licenses for those other facilities. We are very committed to more closely supervising the agency and in particular the management of the agency regarding the appropriate operation of the Carroll Avenue group home as well as all homes operated by the agency," Wood said Nov. 16.

The Maher Center will have its say before an EOHHS hearing officer, according to the EOHHS spokeswoman, but that session has not yet been scheduled. 

The Maher Center’s executive director, William Maraziti, issued a statement Nov. 10 denying the agency has ever abandoned any client. 

The agency is “extremely disappointed” with a “flawed investigation” that led to “unsubstantiated conclusions” by the BHDDH investigatory unit, according to the statement Nov. 10. 

Wood has said that even though the case involved the experience of just one client, the investigation raises “systemic issues” about the quality of care and respect for human rights.

The Maher Center has 16 licenses, according to the EOHHS spokeswoman. They cover: 

  • 12 residential licenses (1 for each residential home)
  • 1 agency license (the corporate “overall” license/oversight license)
  • 2 center based day program licenses (for non-residential day programs)
  • 1 service license (license that identifies all services that agency can provide)



Monitor Gives RI Mostly Passing Grades, Except for Failure to Pay Bills

By Gina Macris

Update: At the close of business July 26, all nine developmental disability service providers owed money for start-up costs in converting from sheltered workshops to supported employment had received payment in full, according to a spokeswoman for the Rhode Island Executive Office of Health and Human Services. A list of the agencies and the amounts appear at the end of this post.

With one exception, the state of Rhode Island largely has met the latest deadlines of a federal court order which spells out how it must lay the groundwork for long overdue compliance with a 2014 consent decree meant to desegregate adults with intellectual and developmental disabilities.

The state has until Friday, July 29, to pay up to $800,000 in start-up costs, as specified in the consent decree, for nine private service providers converting to community-based services from sheltered workshops, according to the court monitor in the case, Charles Moseley.

If that deadline is not met, Mosely said in a new report to U.S. District Court Judge John J. McConnell, Jr., the judge should impose fines of $5,000 a day, with an additional $100 per day for each person protected by the consent decree whose employment or integrated day services are delayed or interrupted as a result of the violation.

Those fines, with a maximum of $1 million per year, were set forth in the order McConnell issued May 18.  It is the second time in three months that the state has faced the prospect of fines for failing to pay its bills in relation to implementing the consent decree.

Moseley said he had received assurances from Jennifer Wood,  the Deputy Secretary for Health and Human Services, Jennifer Wood, that the Friday deadline will be met.

The plans for converting sheltered workshop operations to integrated employment services had been approved by the state and the bills for start-up costs had been submitted by the agencies at least three months ago.

The start-up activities are necessary to enable the service providers to meet employment targets in the consent decree. Moseley noted, adding that this point was made during April 8 evidentiary hearing, which McConnell used as the basis for his order, issued May 18.

According to an investigation of the U.S. Department of Justice, the sheltered workshops violate Title II of the Americans with Disabilities Act, which says, in effect, that individuals with intellectual or developmental disabilities cannot be relegated to segregated settings simply because they are disabled.

In the 2014 consent decree, the state agreed to change its services to emphasize integrated employment paying minimum wage or higher and other community-based activities over a ten-year period.

Moseley’s most recent status report was submitted to the court last Friday, July 22.

In it, he said that the budget enacted by the General Assembly, a total of $246.2 million for developmental disabilities, will provide sufficient funding to meet requirements of the consent decree during the current fiscal year, which ends June 30, 2017.

The budget is still a little more than $11 million more than Raimondo had originally requested.

Budget provisions specifically related to the consent decree include:  

  • A total of $9.1 million for wage increases and performance-based contracts for providers offering integrated employment supports.
  • Funding for four state (staff) positions focused on consent decree implementation, including chief transformation officer, consent decree coordinator, employment specialist, and program development director.

Although the General Assembly did not approve Raimondo’s request for $5.8 million for a caseload increase, citing flat enrollment, Moseley noted that the legislature left the door open to reconsider if the numbers changed.

The monitor said 125 new cases had been approved during the fiscal year which ended June 30, although most of them were still in high school and were not expected to need a full array of adult services during the coming fiscal year. (According to the state's report, these cases encompassed ages 17 to 24.) 

Mosely did ask the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to report to him on any individuals protected by the consent decree “whose acceptance into the adult DD system is delayed or deferred due to lack of funding.”

McConnell’s order required the state to develop a management plan for accomplishing consent decree goals and tasks, and while Moseley said the plan met basic criteria, he found it lacking in detail on organizational strategies within BHDDH  and on interagency cooperation.

The lack of specificity is “understandable,” he said, given that three key positions at BHDDH are vacant. They are the department director, the director of the division of developmental disabilities and the chief transformation officer.

Moseley recommended that the state have until December 1 to expand and strengthen the management plan.

Other comments in Moseley’s status report focused on high school students with developmental disabilities who are 14 years and older and of particular concern to federal officials because they are at risk for segregation as adults if they are not afforded transitional services.

He secured a commitment that state employees from BHDDH or from the state Office of Rehabilitation Services in the Department of Human Services would be available to attend all Individual Education Plan meetings for special education students with developmental disabilities who are at least 14 years old.

Moseley noted that BHDDH has developed a protocol for timely communications with individuals having developmental disabilities and their families concerning applications for adult services.

He also recommended that BHDDH develop and distribute a description of the process for determining eligibility that is “clear, easy to access, user-friendly and written in plain language,” including contact information for BHDDH employees who would be able to answer additional questions.

“It is important to note that the eligibility determination process frequently is associated with a great deal of anxiety and concern among individuals with disabilities and their families,” Moseley said.

“By its nature, the process is technical, complicated, and difficult for a lay person to understand. Direct contact with an eligibility determination staff member offers an important opportunity for famelies to learn about the process and have their questions answered,” he said. 

Click here to read the monitor's full report

Service providers that received start-up costs for supported employment, as required by the monitor 

ri executive office of health and human services

ri executive office of health and human services

Attorney General Identifies Group Home Resident Whose Death Prompted Investigations

Rhode Island Attorney General Peter F. Kilmartin has named Barbara A. Annis as the 70 year-old woman whose Feb. 15 death has triggered criminal investigations and unannounced inspections of hundreds of group homes for persons with developmental disabilities. 

Kilmartin’s spokeswoman released Annis’ name April 1, but gave no additional information, according to the Providence Journal. 

Annis lived in the now-closed College Park Apartments at 612 Mount Pleasant Avenue, Providence, a state-run facility built to accommodate patients who have chronic medical conditions as well as intellectual or developmental challenges. 

She was admitted to Roger Williams Hospital Feb. 9 for what the College Park staff reported as a bad bruise, but which the hospital found to be a broken thigh bone that had become infected. After she responded to initial treatment, she was transferred to a nursing home, according to an official of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).  But her condition soon worsened and she was readmitted to the hospital, where she died. 

There have been a total of six allegations of abuse or mistreatment at College Park since January, 2015, including an incident that occurred after Annis died. The State Police and the Attorney General’s Medicaid Fraud and Patient Abuse Unit have begun criminal investigations, and 5 of 27 state employees who worked at College Park were placed on paid leave. 

In addition, surprise inspections have begun of all licensed group homes in the state, about 278 private and state-run facilities, according to a spokesman for Elizabeth Roberts, Secretary of Rhode Island’s Executive Office of Health and Human Services. Nine of the 278 homes are vacant. 

Residents who remained at College Park – a total of 14 people – all have been moved, according to BHDDH, which ran the home. The Rhode Island Disability Law Center has opened an investigation into the welfare of those people.   

After College Park closed March 25, Roberts said, “I remain outraged by the alleged incidents at the College Park Apartments group home.” 

Judge to Consider Remedial Plan

 By Gina Macris

U.S. District Court Judge John J. McConnell, Jr. is poised to consider a remedial action plan to hasten Rhode Island’s compliance with a two- year-old federal consent decree requiring the state to provide community-based daytime services, including employment supports, to people with developmental disabilities.

The U.S. Department of Justice (DOJ) and the state have “jointly determined that, in order to facilitate compliance with the consent decree in this matter, the parties would benefit from a court ordered remedial action plan,” according to a proposed order filed with McConnell in Providence March 1.

 The judge is scheduled to hear the status of the case on Monday, March 14 in Providence, although a spokeswoman for the Court indicated March 8 that the hearing date may be rescheduled. (Update: March 14 at 10 a.m. confirmed as date and time) 

 The proposed Court order, along with a supporting joint motion submitted by the DOJ and the state, spell out a road map for the Court to proceed in considering the facts in the case over the next two months.

In a telephone conference Feb. 24 requested by the state, all sides agreed that three issues stand in the way of full compliance, according to the proposed order. The order and the supporting motion both cite money, the number of integrated, community-based placements, and leadership.


Both sides committed to compliance

"Both Plaintiff and Defendant remain committed to resolving the above listed issues and any other issues identified by the court," according to the joint motion, signed for the DOJ by Vanita Gupta, head of the civil rights division, and for the state by lawyer Marc DeSisto.

DeSisto and lawyers for the DOJ, as well as a Court monitor in the case, have told McConnell that the state budget does not now have enough money allocated to implement the consent decree. The monitor, Charles Moseley, also has said that if the state does not meet certain benchmarks now, it will not be able to comply with the final requirements of the order once the decade of federal oversight concludes in 2024. 

The joint motion and proposed order both call for an evidentiary hearing on April 18 that would require the appearance of the head of the state Office of Management and Budget as well as the directors of three agencies responsible for carrying out the consent decree: the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH), the Office of Rehabilitation Services (ORS) of the state Department of Human Services and the state Department of Education (RIDE). 

 A week before the hearing, the state would provide the judge with a written report on the status of compliance. During the hearing itself, “Defendant will provide the court with the information necessary to issue an order for remedial action to spur prompt compliance,” according to the proposed court order.

 The parties would reconvene May 2 so that the state can report on “progress relating to funding, placements, and the leadership required for full compliance,” as well as any other court order that may be outstanding at the time.

The monitor has sought the appointment of a secretary-level Consent Decree Coordinator who would have the authority to oversee compliance efforts of the three state agencies involved.   A secretary-level coordinator has been appointed only on an interim basis in recent weeks. 

RIDE is involved because it is responsible for providing transitional services, including school-to-work opportunities, for youth in special education as they approach their 21st birthday. These youth are of particular concern, according to the consent decree, because they are “at risk of entering sheltered workshops and facility-based day programs” when they reach adulthood.” 


Origins of the Consent Decree

The federal case started with a U.S. Department of Labor investigation into sub-minimum wages paid to people in one sheltered workshop. An expanded DOJ inquiry found that (Cut: found) teenagers and adults with developmental disabilities were being segregated from the general population in violation of the Americans with Disabilities Act (ADA).

The U.S. Supreme Court clarified the ADA’s mandate for integration in a landmark 1999 decision that many say struck down segregation for people with disabilities in the same sweeping way that Brown V. Board of Education banned “separate but equal” education for black students.

 The 2014 consent decree in Rhode Island, the first of its kind in the nation, spells out a series of specific deadlines for achieving an increasing number of supported job placements and individualized daytime activity plans over the 10-year period of federal oversight. 

Meanwhile, Governor Gina Raimondo has proposed a net increase of $8 million to the developmental disabilities budget now in place, with the total going from $229.7 million to $237.7 million for the period ending June 30. In the next fiscal year, developmental disabilities would receive a total of $235.2 million. 

Over the next 16 months, the governor’s plan would redirect more than $23 million within the developmental disabilities budget toward private agencies providing integrated daytime services. The state would create this financial boost largely by moving people out of group homes into shared living arrangements with families in communities throughout the state. 

This housing shift would involve 500 of 1300 people now in group homes moving into so-called shared living arrangements voluntarily by June 30, 2017, according to a BHDDH spokesman.  

Donna Martin, who represents an association of private agencies that support families offering shared living in their homes, has called the goal “very ambitious.”


RI Senate Committee Gets a Taste of Complex Federal Consent Decree

Charles Moseley, independent federal Court Monitor, left, and RI. Sen. Joshua Miller, D-Cranston and Warwick, chat after Feb. 25 briefing on federal consent decree requiring community integration of people with developmental disabilities. 


By Gina Macris 

Members of a Senate committee began to grapple with the complexities of a federal court case that has the potential to require the state to allocate millions of dollars to reform its services to Rhode Islanders with disabilities.

For an hour on Feb. 25, The Health and Human Services Committee was briefed about a federal consent decree that requires the state to give those with disabilities a chance to work and do other meaningful activities in the community.

 After the briefing, committee chairman Joshua Miller, D-Cranston and Warwick, said it wasn’t clear to him whether the state agency responsible for services to adults with developmental disabilities needed to reorganize, or whether a greater overall allocation is needed to comply with the consent decree.

“At any point will the decree require minimum funding?” Miller asked Charles Moseley, the independent Court Monitor in the federal case.

 Moseley replied that “the consent decree requires minimum funding now.”

Moseley said the “minimum funding” relates to activities necessary to achieve compliance, like an official to coordinate employment services, so that more people who need supports can get “up and working” in the community.

He gave other examples, saying that the key areas are employment and other meaningful non-work activities.

A. Anthony Antosh, director of the Sherlock Center on Disabilities at Rhode Island College, presented statistics which show a smaller percentage of people with developmental disabilities were working in the community in 2015, a year after the consent decree was signed, than were in supported employment in 2011, the year the General Assembly enacted a 13 percent budget cut in services that support them.  

The employment figure decreased from about 23 percent to about 21 percent in four years’ time, according to Antosh’ figures.

“What has increased is the number of people who are essentially doing nothing” during the day, he said.

“Roughly 40 percent are 50 or over, and most of them have very little to do,” Antosh said.

Moseley said that “if the investment is not made now, (the goals) won’t be met in ten years,” the lifespan of the consent decree.

But Moseley did not provide Miller with a dollar amount. 

In a hearing before U.S. District Court Judge John J. McConnell Jan. 26, both Moseley and the lawyer for the U.S. Justice Department, Victoria Thomas, said flatly that the current state budget does not contain enough money to fulfill the requirements of the consent decree.

And a week later, Governor Gina Raimondo made the same categorical statement in her budget message to the General Assembly.

Raimondo’s budget proposal asks for an additional $8 million in in developmental disability funding funding in the current fiscal year, bringing the budget to $237.7 million by June 30. The increase is designed to shore up the developmental disabilities division in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).

In the coming fiscal year, developmental disabilities would receive slightly less, $235.2 million under the governor's plan. However, the administration is proposing a way to sharply increase spending for community-based supports that are required by the consent decree without requesting another budget hike. Instead, the increase would be funded by savings that the administration hopes to achieve through major changes to residential programs, asking 500 adults with disabilities to move voluntarily from expensive group homes into shared living arrangements with families.

Professional Workforce Key to Implementing Consent Decree in Rhode Island

By Gina Macris

Rhode Island faces a crisis in its inability to recruit and retain a high quality front-line workforce to support people with developmental disabilities. 

The problem - substandard working conditions and low pay in a poorly trained workforce plagued by high turnover - must be resolved if the state is to implement a landmark 2014 consent decree with the U.S. Department of Justice that requires dramatic changes in the way services are configured.  

That was the consensus Feb. 23 during the start of a two-day conference at Rhode Island College, where some 75 employers, researchers, state officials and family members brainstormed about how to jumpstart a new way of doing things – and getting the funding necessary to make it happen. 

Maria Montanaro, director of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH)  wondered aloud if her agency could shift funding in the short term to roll out a high-quality pilot program demonstrating the need for better funding of the entire system.                                                               

With perhaps a quarter of the state’s 20 private developmental disability providers participating, she said, the pilot program would offer better salaries and training to motivate staff to show ways that services can be changed to support individual needs rather fit people with developmental disabilities into existing programs.  

That change is a pivotal element in requirements of the Consent Decree that mandate individualized supports in community-based settings.    

Montanaro said a successful pilot program would yield research data that could be leveraged into advocacy for increased funding system-wide during the2017 General Assembly session.  Such a pilot program would not require legislation, she said.  

Montanaro responded to a presentation at Rhode Island College (RIC) by Amy Hewitt, a Minneapolis researcher with a national reputation in identifying effective practices for helping people with intellectual and developmental disabilities live and work in their communities. 

Hewitt, director of the Research and Training Center on Community Living at the Institute of Community Integration at the University of Minnesota, set the tone for discussing advocacy strategies that are based on research statistics gleaned in the implementation of new policies.  

She was hosted by her counterpart in Rhode Island, A. Anthony Antosh, director of RIC’s Sherlock Center on Disabilities, which is charged through the consent decree with showing the way toward greater community integration.  

Montanaro said, “We have to get the advocacy voice mobilized in Rhode Island” so that the message of the disability community gets to the legislature “in a cogent and compelling way.”  

She said she is in a position to speak to Governor Gina Raimondo, but in the executive branch, “they’re responding to the legislative temperament.”  

Governor Raimondo’s latest budget proposal, now before the legislature, asks for some additional funding for developmental disabilities. To a greater degree, however, it would shift residential supports from expensive group home care to less costly shared living arrangements in private homes and use the savings to support employment and other community-based activities.  

The state also could leverage additional Medicaid money in creative ways to provide community-based services, Montanaro said.  

Mary Madden, the state’s new interim Consent Decree Coordinator, noted that expanding the use of Medicaid money still would mean convincing the state to pay for half the new funding.  According to Medicaid rules, the federal government pays for about 50 percent of allowable services, as long as states pick up the other half.  

Hewitt, meanwhile, said legislation and litigation drive public policy, with lawmakers responding only when the the data backs up the argument for change.  

 “The happy stories are not going to get money,” she said. Policy makers don’t make decisions based on the “feel-good stuff. That’s the realist in me talking. They make decisions based on unmet need” that is supported by statistics.  

“We expect the direct service professional to be a little bit of everything,” Hewitt said, referring to the formal title of front-line worker.

The job encompasses the role of teacher, nurse, psychologist, occupational and physical therapist, counselor, nutritionist, chauffeur and personal trainer all at once, she said. 

Yet direct service professionals are paid an average of a little less than $11 an hour in Rhode Island, she said. 

“You have to figure out a way” of changing perceptions so that “these people are not thought of as workers but professionals,” she said.  

The workforce problem in the field of developmental disabilities runs nationwide, Hewitt said.  

“No state has solved this problem, but there are few states further along the path,” she said.  

Hewitt offered a myriad of statistics that link training, supportive supervision, and decent pay to a stable, high-quality workforce that makes a difference in the lives of people with developmental disabilities.  

She is to return Feb. 24 to serve as a resource as the group of about 75 works on specific strategies for stabilizing and improving the system in Rhode Island.  

The conference participants are mostly senior officials of the private agencies that provide services to almost all the 3600 people with developmental disabilities in Rhode Island.  No front-line staff attended.  

Pam Goes, the mother of an adult with developmental disabilities, said families need to be included in policy-making and advocacy statewide.  

“Right now families feel isolated and apart,” said Goes, who is also a former family support director at the Trudeau Center in Warwick.

Developmental Disabilities Budget: Cause for Optimism, Cause for Concern

By Gina Macris

Rhode Island Governor Gina M. Raimondo is moving “in the right direction” by proposing to spend roughly $20 million more on efforts to more fully integrate developmentally disabled adults into the community, says the executive director for a network of private agencies that will do the lion’s share of the work.

 “That is a pretty remarkable show of commitment for this community,” Donna Martin, who oversees the 23-member Community Provider Network of Rhode Island (CPNRI ), said in a telephone interview Feb. 11.

 The community provider agencies, largely dependent on state contracts, have been operating at a loss for several years, and it is not yet clear how far Raimondo’s budget will go in shoring them up financially.

 Martin says she needs to confirm the details of the plan with the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) before commenting further on the prospects of the agencies getting out of the red.

 “Regardless of how we slice it, it’s a big step forward,” she said.

 Accomplishing a court-ordered shift toward community integration depends on millions of dollars in additional funding from the General Assembly and millions of dollars in savings, achieved primarily by moving 500 of 1300 people living in group homes into shared living arrangements with families throughout the state.

 Whether the state can accomplish a voluntary transfer of 500 individuals to new living arrangements in a 17-month period remains to be seen. Martin says the private agencies which arrange shared living situations, support host families, and provide quality control for BHDDH have expressed concern about the pace of the transition. 

Andrew McQuaide, Chief Transformation Officer for BHDDH, says that goal is achievable. No one will be forced to move, he says.

The state finances most supports for adults with intellectual challenges in two ways:  through state-run group homes and apartments, special care facilities and a day site that serve 210 individuals; and through similar residential arrangements and an array of other services run by the private agencies for about 3500 people — nearly everyone with an intellectual disability in Rhode Island eligible for some level of service.


High Court Mandated Change

 Raimondo’s multi-million dollar booster shot for the beleaguered private agencies is intended to help shore up chronic underfunding and launch a transformation of services for people with developmental disabilities that aligns with a 1999 U.S. Supreme Court civil rights decision. 

 Called the Olmstead decision for short, the Supreme Court ruling affirms the rights of people facing intellectual challenges to live, work, and play in their communities, just like anybody else.

 A 2014 civil rights consent decree between Rhode Island and the federal government – the first of its kind in the country – gets its authority from the Olmstead decision.

 Requiring the state to move people with developmental disabilities out of segregated workshops into community-based employment, the consent decree, in effect, results in the federal court ultimately having more power than the General Assembly over the amount of money that goes into developmental disability services and how the money is spent.

As budgetary discussions progress in the state legislature in the months to come, the ramifications are sure to surface at hearings bringing together the U.S. Department of Justice, state lawyers, and an independent Court monitor before U.S. District Court Judge J. McConnell, Jr.

At the first hearing in Providence in late January — about a week before the Governor announced her budget plan — all sides agreed that the state, so far, was making insufficient progress toward the 10-year goals in the consent decree.

 They acknowledged the Court’s authority to find the state in contempt and order any remedies it sees fit. Judge McConnell said he hoped to avoid such proceedings and in the near term would advise the parties at status hearings to be held every three months.


Millions More for Community Services

 In the fiscal year which begins July 1, Raimondo proposes an increase totaling $12.8 million to strengthen and expand community-based services for people with developmental disabilities.

The total includes:

  • $5.8 million to pay for growth in the developmental disability caseload as more children with special needs, particularly autism, reach the age of 21. The increase is now running at a rate of 100 a year, according to a       BHDDH  spokesman. Families are having trouble securing services for which their young adults are legally entitled. In addition, youth in transition to adulthood is one demographic that is a priority in the 2014 consent  decree. 
  • A $1.9-million increase for model programs intended to show the way for private agencies as they shift toward community-based employment and other integrated daytime activities.
  • $5.1 million for wage increases of roughly 4 percent, or 45 cents an hour, for private agency staff, some of whom are making minimum wage and eligible for public assistance.

Depressed wages and eroding benefits have fueled high turnover and caused instability in staffing since 2011, when the legislature enacted cuts that ultimately slashed $26.5 million from the appropriation to the private agencies.

Martin said the state initially calculated the budget cut would mean an average hourly rate of $12, but agencies were forced to further reduce wages to help pay for health benefits and other fixed employer costs, including taxes and workers’ compensation.

The average hourly rate dropped to about $10.50, she said. The rate has inched up to about $11.55 an hour, on average, but employers have had to sharply cut benefits to help offset even these minimal wage increases.

The upshot is this: Private agencies operate at a loss for each person they employ, Martin said.

The $5.1 million line item designated for wage hikes does not cover the related labor costs or benefits, according to McQuaide.


Call for Supplemental Funds Now

Raimondo’s budget message also addresses funding issues in the current fiscal year intended to cover a shortfall of as much as $6 million while also expanding community-based services.

The governor plans to spend an additional $11.3 million for developmental disabilities, with some of that money coming from a supplemental appropriation and the rest from the savings realized by moving 100 adults from group homes to shared living arrangements by June 30, the close of fiscal 2016.

An additional 100 people would move to shared living in each of the four quarters of the next fiscal year to reach the goal of 500 transfers by June 30, 2017. On average, BHDDH saves $19,400 a year for every individual who moves from a group home to a shared living arrangement, according to a department spokeswoman.

The consent decree, which affects only daytime activities, is not the only pressure on the state to make changes.

New federal Medicaid rules for Home and Community Based Services (HCBS) address round-the-clock supports; saying, among other things, that people with developmental disabilities must be allowed to live in the least restrictive settings possible. Developmental disability funding comes from federal and state Medicaid dollars at a ratio of roughly one to one.

The changed Medicaid rules, as well as the high cost of running group homes, are reflected in Raimondo’s planned shift from group home residential care to shared living arrangements.

To help balance the budget, Raimondo would cut an overall $15.5 million in operating expenses for 23 state-run group homes. Non-personnel expenses for these group homes would drop 46 percent, from the current allocation of about $33.2 million to about $17.8 million in the next fiscal year.

The 296 unionized employees now assigned to the state-operated network of facilities would keep their jobs; changes in their duties would be subject to labor-management talks, according to McQuaide.

McQuaide said community living aides on the state payroll who are employed seasonally are paid at a rate that amounts to $35,688 a year. For full-time aides, the annual salary range is $37,280 to $49,618. Those figures do not include overtime.

Employees who do essentially the same work in the private system make an average of $11.55 an hour, which adds up to a little more than $24,000 for a full time staffer.

A pay increase to $12.00 an hour would just put the private agency workers back to where the state figured they would be after the 2011 budget cuts.  “We would like to pay our staff dramatically more,” Martin said.

Ambitious Expansion of Shared Living

The goal of shifting 500 adults to new living arrangements in the next 17 months suggests that dozens of state and privately-operated group homes will be closed. A BHDDH spokeswoman says that number is not immediately available.

“Philosophically the provider community embraces shared living as an element in the continuum of care,” Martin said.

“We’re trying to balance the state’s initiative, which is not unique to Rhode Island, but we will do everything we can to make sure each person has a choice,” she said.

 “That said, the number of 100 a quarter is very ambitious,” Martin said.

Shared living is not foster care, perceived as a temporary arrangement, but instead is based on a lasting relationship that takes time to develop, she said. Many times shared living arrangements occur between group home residents and people who they already know and like, Martin said.

”We really try to stress helping people find that home provider they have a connection with,” Martin said. Even if the private agencies locate 100 potential family providers every quarter, “it doesn’t mean we have 100 matches.”

There is extensive preparation for shared living and the process is stopped if at any time anyone involved – the client, a family member, community provider, or state social worker- forms an opinion that the arrangement would not be a good fit, McQuaide said.

Shared living has been an option in Rhode Island for 10 years, McQuaide said, and in that time 267 people with developmental disabilities have chosen that living arrangement.

The state “has not necessarily done a good job” in making sure that host homes have the supports they need, he said.

Whether or not BHDDH creates 500 new shared living arrangements in the next year and a half, he said, the experience will “provide us with an opportunity to assess what we need to do differently.”

“This is the direction we want to go in and we want to do it right,” he said. 

Will the Budget Pass Muster with the Judge in Disabilities Case?

By Gina Macris

When Rhode Island Governor Gina Raimondo proposes a new state budget on Tuesday, Feb.
2, U.S. District Court Judge John J. McConnell, Jr. will be watching to see how the state plans to keep its promise to reform employment opportunities and other daytime services for people with disabilities.

 Rhode Island isn’t spending enough money to meet the deadlines set out in two and three-year-old consent decrees reached in landmark cases involving the Americans with Disabilities Act (ADA).

 And an independent Court monitor overseeing the state’s efforts has said that if Rhode Island doesn’t meet certain benchmarks now, it will be unable to accomplish long-term goals at the end of the decade-long federal supervision spelled out in the consent decree.  

 But at a hearing Jan. 26, a state lawyer told McConnell that Raimondo’s budget would be a “game changer” in advancing Rhode Island’s response to the mandates.

 An internal committee of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) tasked with redesigning services for people with developmental disabilities recommended $36 million in reforms last May,  but in an interview last Friday, a BHDDH spokesman said it is “very unlikely” that sum might appear in the governor’s proposal. 

If the Governor’s proposal falls short of McConnell’s expectations, it could set the scene for some courtroom drama during the upcoming months of budget deliberations at the State House.

The Court has the power to find the state in contempt – if it comes to that – and McConnell made it clear on Jan. 26 that he would not hesitate to use his authority if it is necessary. But said he hoped to avoid it.

 Let’s follow the case and the money at the heart of the issue before the Court.

The case surfaced in 2013 with a consent decree between the U.S. Department of Justice and the City of Providence over Providence teenagers with developmental disabilities, who had been segregated in a program called the Harold A. Birch Vocational School. Birch prepared them for a lifetime of rote assembly-line jobs –at sub-minimum wage – in a sheltered workshop for adults at an agency called Training Through Placement in adjoining North Providence.

 The 2013 settlement – the first of its kind in the nation - asserted the young people’s right to receive services to support them in employment and day activities in more integrated, community-based settings in accordance with the Americans with Disabilities Act.

 "The Supreme Court made clear over a decade ago (in the so-called Olmstead decision of 1999) that unnecessary segregation of people with disabilities is discriminatory. Such segregation is impermissible in any state or local government program, whether it be residential services, employment services or other programs,” a U.S. Justice Department spokeswoman said at the time.

A year later, in June, 2014, the Justice Department’s Civil Rights Division reached a statewide agreement with then-Governor Lincoln Chafee which mirrored the Providence settlement.

Today, 31 percent of Birch graduates are employed in community-based settings – up from 14 percent six months ago – but those numbers fall far short of the mandated goal of 100 percent, according to the independent Court monitor, Charles Moseley, whose oversight continues through 2024. 

 He and a Justice Department lawyer, Victoria Thomas, each laid out a laundry list of other deficiencies in the Jan. 26 hearing before McConnell, who said he wanted to see the parties before him again in three months. 

 Now to the money:

 In the fiscal year that ended June 30, 2005, Rhode Island paid $187.3 million in state and federal dollars to private agencies providing services to Rhode Islanders with intellectual disabilities, according to state figures. Currently, the state allocates $188.4 million to those services.  It’s all Medicaid money, with the state providing 45 cents on the dollar and the federal government paying the rest, according to the BHDDH spokesman.  

In the meantime, the number of people reaching adulthood with developmental disabilities has been increasing. The current annual rate is about 100, and the average yearly cost of supporting one person is $55,000. 

 From 2005 through fiscal 2008, the DD budget rose to $215.3 million. But as the shockwaves of the 2008 economic crash reverberated, the budget shrank, as did DD allocations in other states.

 While some other states started restoring money to DD services, Rhode Island slashed further.

 For the fiscal year ending June 30, 2012, the Rhode Island General Assembly chopped nearly $26.5 million off the allocation, reducing it from $206.5 million to just under $180 million. That’s a cut of 12.8 percent in one year.

And BHDDH put in place a reimbursement system that does not cover all the services that agencies provide during daytime activities – only face-to-face contact with clients. The legwork necessary to set up job interviews or community activities, for example, is excluded. This arrangement “incentivized” the segregation of people with developmental disabilities in sheltered workshops and day facilities, Thomas, the Justice department lawyer, told McConnell on Jan. 26.

 Even though the BHDDH administration changed with the inauguration of Raimondo as Governor in 2015, the reimbursement system remains in place. Moreover, BHDDH allows agencies to collect the money owed for daytime supports only through a burdensome reporting process that requires documenting each worker’s time in 15-minute blocks, for each client. If a client is sick, the agency does not get its client-specific incremental payment for that day.   

Since 2011,  private nonprofit providers have cut workers’ pay to an average of $11 an hour, staff turnover has skyrocketed, and two agencies have closed their doors.

 In an interview on Friday, the BHDDH spokesman, Andrew J. McQuaide, acknowledged that satisfying the mandate for integration “fundamentally costs more than the system we have now.” He agreed that the system is geared toward “congregate centers for day programs and employment.”  Service providers should be held accountable, though, said McQuaide, the department’s new Chief Transformation Officer.

 Last October, Maria Montanaro, the BHDDH director, told a group of parents that the $36 million in redesign recommendations had been tabled because of the cost.

 On Friday, McQuaide said it’s “very unlikely” the $36 million in reforms would re-surface in the Governor’s budget proposal. 

“I’m unaware of anyone who thinks the state can afford to increase the DD funding by $36 million in a single year,” he said. “It would be unprecedented in a single fiscal year.”

“The question becomes how to sequence this,” McQuaide said.

 He said he couldn’t speculate on how the court will react.

 “There’s no way of knowing what would please the court,” he said. But “at the end of the day I am optimistic we will move in the right direction.”