Governor's Council on Disability

Missouri's Olmstead Implementation

Activity No. 3: Identify the number of individuals with disabilities in the State of Missouri that are institutionalized.

Department of Mental Health, Division of Alcohol and Drug Abuse
Department of Mental Health, Comprehensive Psychiatric Services
Department of Mental Health, Division of Mental Retardation/Developmental Disabilities
Department of Social Services, Division of Aging

This activity focused on identifying the number of individuals with disabilities in the State of Missouri that are institutionalized. Each of the agencies that participated in this Commission and its activities did not have individuals in institutional settings. The Division of Aging in the Department of Social Services paid for services in institutional settings. The Department of Mental Health also funded institutional programs for the individuals they served. The following describe these programs.

One critical finding was that agency staff need to better define the term "institutionalization" and review how to more precisely measure these placement activities. The Commission found that there is a wealth of data on state operated facilities, but incomplete or conflicting information on publicly funded placements in private facilities. State agencies must act aggressively to review this population and the programs that serve them.

Department of Mental Health - Division of Alcohol and Drug Abuse

The Division of Alcohol and Drug Abuse projects that 9,187 will be served in community-based residential rehabilitation during FY'01. In residential treatment programs, a person receives around-the-clock care, seven days a week. Residential rehabilitation includes assessment, individual and group counseling, family counseling, participation in self-help groups, and other supportive measures designed to help a person live an alcohol and drug-free life.

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Department of Mental Health - Comprehensive Psychiatric Services

The state-operated psychiatric facilities were treating 1429 individuals on June 1, 2000. Of these individuals, only 319 were classified as either voluntary or voluntary by guardian. Over two-thirds of the 319 individuals were committed by guardians (221 individuals or 69.2%) and 98 (30.8%) had committed by themselves. Of those committed voluntarily 53 (54.1%) have resided in the facility for less than six months and 44 (45.9%) for greater than six months. Of those who are committed by guardians, the majority had resided in state-operated inpatient facilities for more than six months (55.7%). For those under 18 years of age, however, 89.2% (73 out of 82 youth) had been in the state-operated facility for less than six months. Table 1 describes these findings.

Table 1. State-Operated Inpatient Facilities (as of June 1, 2000)"
Comprehensive Psychiatric Services

Age	Length of Stay	Voluntary by Self		Guardian
Under 18	Less than 6 months	NA		73	33.0%
	Greater than 6 months	NA		9	4.1%
18-64	Less than 6 months	53	54.1%	25	11.3%
	Greater than 6 months	44	44.9%	104	47.1%
65 and Over	Less than 6 months	0		0	-
	Greater than 6 months	1	1.02%	10	4.5%
TOTAL		98	30.8%	221	69.2%

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Department of Mental Health - Division of Mental Retardation/Developmental Disabilities

The Division of MR/DD operates six habilitation centers throughout the state which provide institutional care for persons with mental retardation or developmental disabilities. During the past year, 1,322 consumers resided in these facilities. Figure 1 presents the FY 2000 consumer counts for habilitation centers. Approximately one-fourth of the residents reside in each of three habilitation centers: Bellefontaine (29.2%), Marshall (25.6%) and St. Louis DDTC (24.4%).

A comparison of those living in institutions with those in community placement can be found on Table 2.

Table 2. Persons Served in Institutional and Community Settings
Division of Mental Retardation/Developmental Disabilities

Type of Living Arrangement	# of Providers	# of Consumers
*Persons in Institutions:*
State Operated Habilitation Centers (ICFs/MR)	6	1,322
*Persons in the Community:*
State Operated Community Based Waiver	6	185
Contracted Facilities by size:
1-3 Beds	70	88
4-8 Beds	321	1608
9-16 Beds	64	605
Over 16 Beds	146	568
ISL (3 or less)	212 (lead agencies)	2361
Total Community = 5415 Total in State Operated ICFs/MR = 1322 Data as of 6/30/00

The budget allocations for FY 2001 for state habilitation centers can be found on Table 3.

Table 3. Budget Allocations for FY'01 for State Habilitation Centers.
Division of Mental Retardation/Developmental Disabilities

Habilitation Centers
General Revenue	$92,722,484
Federal	$3,900,846
Total	$96,623,330
Intensive Staffing (1)
General Revenue	$145,189
Federal	$1,431,063
Total	$1,576,252
Community Support Staff (2)
Federal	$850,988
Fuel & Utilities (3)
General Revenue	$2,385,470
(1) Intensive staffing funds allow the Division of MRDD to meet staffing needs in the habilitation centers by providing adequate levels of staff to client ratio. Often times, the staff/client ratio is 1:1 and sometimes 2:1. (2) Community Support Staff funding received by the habilitation centers helps support the operations of the habilitation centers, both on-campus and off-campus. (3) Includes funding to allow the Division of MRDD's habilitation centers to purchase fuel and utilities, namely coal, oil, natural gas, water/sewer services, and electricity. Budget data FY'2000-2001

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Department of Social Services - Division of Aging

Figure 2. Sources of Institutional Funding

State General Revenue - 31.0% (140,888,000)
Federal - 61.2% (278,402,068)
State Funding - 7.8% (35,600,000)

The total number of Department of Social Services Division of Aging Medicaid Recipients in facilities is 26,111. The core appropriations for the current year were $454,890,068. Of these funds, 31.0% were from state General Revenue ($140,888,000), 61.2% from federal sources ($278,402,068) and 7.8% from other state funding ($35,600,000). See Figure 2.

Olmstead