“We believe that all Coloradans have the right to live a life based on inclusion, not segregation.”
This statement from the final report of the Community Living Advisory Group - created by Governor Hickenlooper in July 2012 to recommend changes to the delivery system for long-term services and supports – sets the stage for a document that aims to improve how Colorado supports its seniors as well as those with disabilities.
The new report, now on the governor’s desk, is the culmination of more than 3,000 hours of work by 190-plus very committed stakeholders. There were many discussions at public meetings about how to redesign the state’s system of long-term services and supports (LTSS). Respect and dignity were at the top of the list.
The passion, intelligence and commitment of the group show through in the report’s recommendations. But like any good system redesign, the devil will be in the details.
Colorado has historically been a leader in providing long-term care. Colorado received approval for the second ever home- and community-based (HCBS) waiver in the early 1980s to serve Medicaid clients in a community setting. From then on, the system was built to take advantage of new opportunities and to accommodate different populations.
That led to where we are today. Picture a house that has been remodeled a number of times over the years. Some owners added bedrooms to accommodate growing families. Some updated the kitchen and bathrooms. Different architects were brought in. Different materials were used. And the work was often done under punishing deadlines. This complex system is often confusing to navigate.
The goal of the Community Living Advisory Group Report is to better accommodate a growing population of people who are aging and who have disabilities. Between 2010 and 2030, Colorado’s aging population is projected to increase by more than 150 percent. As the population ages and more veterans return home, the number of people with disabilities is projected to double over the next 20 years nationally. The underlying principle of all the recommendations is to ensure that people have a voice and a choice in how, where and when their services are delivered.
Improving how Coloradans access LTSS, how their services are coordinated, who provides those services and what living in the community looks like are all important themes throughout the report. There are recommendations to create efficiencies in regulations, as well as in the confusing and often duplicative process to gain entry to the system.
Other recommendations focus on developing a professional workforce trained to work with the growing population of people who are aging and who have disabilities. And still others intend to boost employment among older adults and people with disabilities and increase affordable housing options for them.
While the report is newly-released, much work is underway to get the redesign rolling. Colorado has begun simplifying how people access Medicaid programs that provide LTSS by combining some home- and community- based (HCBS) waiver programs. Colorado has 11 HCBS waiver programs that all require different eligibility criteria, like the Persons with Brain Injury waiver or the Children with Autism waiver. By combining waivers people will be able to access LTSS with fewer restrictions on fitting into one category.
The Colorado Department of Health Care Policy and Financing was awarded a No Wrong Door grant from the federal government for a 12-month planning process to streamline how people access LTSS in Colorado. And the form used to assess eligibility for all HCBS waivers is currently being redesigned.
The final recommendation in the report is about implementation. Many recommendations will take years to implement due to the scale and complexities involved. The Community Living Advisory Group and its subcommittees propose to continue meeting over the next year to oversee the work.
This is a group of people determined to make Colorado a better place to live for some of our most vulnerable residents.