Missouri's Olmstead Implementation

Activity No. 4: Identify the number of waiting lists for home and community-based services or consumer-directed care programs and evaluate the pace at which individuals move from these lists.

Department of Elementary and Secondary Education, Vocational Rehabilitation
Department of Mental Health, Division of Alcohol and Drug Abuse
Department of Mental Health, Division of Comprehensive Psychiatric Services
Department of Mental Health, Division of Mental Retardation/Developmental Disabilities
Department of Health, Bureau of Special Health Care Needs, Adult Head Injury Program
Department of Social Services, Division of Aging

Department of Elementary and Secondary Education - Vocational Rehabilitation

Each of the 21 Centers for Independent Living (CIL) maintains a waiting list. Each CIL is responsible for determining priority status on the waiting list based on such factors as the 18 point assessment total, risk factors regarding nursing home placement, and length of stay on the waiting list. Therefore, each CIL would have to be responsible for providing information regarding the pace at which individuals move from the waiting lists. The current verified/unverified number of individuals awaiting services is found in Table 1.

Table 1. Number of  Persons with Disabilities on Waiting List

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Department of Mental Health - Division of Alcohol and Drug Abuse

Waiting list information is maintained by the Division  of Alcohol and Drug Abuse's contracted providers.  These agencies have procedures in place for admitting clients to treatment from the waiting list.  The time period which individuals remain on a waiting list for treatment services varies.  No individual, however,  remains on a waiting list for 90 days or more.  The estimated waiting period is three weeks.

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Department of Mental Health - Comprehensive Psychiatric Services

The Division of Comprehensive Psychiatric Services does not operate any formal waiting lists.  State Operated Inpatient Facilities admit all forensic and civil involuntary detentions regardless of current census.  The nature of virtually all inpatient hospitalizations is emergency; therefore, waiting lists are not appropriate for this service. 

In reference to Medicaid funded services administered by the Division of Comprehensive Services, Medicaid does not allow a waiting list.  Although some of our contracted providers do have waiting lists at various times for state general revenue funded outpatient services (services that are not an entitlement), the Division does not compile these local lists. 

The situation with regard to the Division's Supportive Community Living Program is more complex.  The Supported Community Living (SCL) program provides funding for a variety of housing and residential alternatives.  Our regional SCL offices report that they do not maintain waiting lists because they are able to place most referrals within 30 days.  However, the lack of referrals who are awaiting placement is more likely a function of the general awareness of the limited resources available to the SCL program, and the limited availability of affordable housing, than it is an indication of the ability to adequately meet the need for supported community living services.  Generally, the Division of Comprehensive Psychiatric Services' Supportive Community Living Offices report that they are able to place most individuals within 15 to 30 days of referral.

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

Table 2. Waiting Lists by Program 8/25/00

The Missouri Division of Mental Retardation/Developmental Disabilities maintains several waiting lists for services.  (See Table 2.)

A current waiting list and a list from several months ago were provided identifying individuals waiting for residential supports and for individuals waiting to leave state operated habilitation centers.  At the time this report was finalized, two periods of data were not available for Consumer and Family Directed Supports and Autism Services.  One period of data was available for Consumer and Family Directed Supports.

Waiting to Leave State Operated Habilitation Centers

The first waiting list to be examined was the listing of those in a habilitation center who requested placement in the community.  The way in which this list was examined was to look at those on the waiting list as of August 25, 2000 and compare them to those on the waiting list as of November 13, 2000.  Table 3 describes the differences in the lists. 

Table 3. Movement from Waiting Lists

Another analysis looked at those still on the list in November 2000.  The length of time that they had remained on the list was calculated. 

Table 4. Length of Time on Waiting List: MRDD

Waiting for Residential Support

The waiting lists of individuals who currently reside at home, but who are waiting for community residential supports were examined.  The first list consisted of individuals who were on the waiting list as of May 23, 2000 and the second list included those on the waiting list as of September 30, 2000.  There were 32 individuals added to the waiting list between these two dates and 33 taken off for a net loss of one person.  Approximately 6% were removed from the waiting list over a 120-day period.  (See Table 5.)

Table 5.  Community Waiting List:  MRDD

Waiting for Consumer and Family Directed Supports

Table 5 is a summary of the list of persons waiting for Consumer and Family Directed Supports as of October 31, 2000.  Although detailed comparative data was not available from an earlier or later period, it is noted that from August 25, 2000 (see Table 2 above) to October 31, 2000 (see Table 6 below) there was a net increase of 26 people statewide waiting for Consumer and Family Directed Supports.

Table 6.  Consumer and Family Directed Supports Priority Waiting List:
As of October 31, 2000

Waiting List Data

The Department of Mental Health is in the process of designing a new information system.  As this new system is designed, DMRDD will be requesting that the new system enhance the current process for maintaining waiting lists so that comparative data and reports are more readily available.

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Department of Health - Bureau of Special Health Care Needs/Adult Head Injury Program

There is currently no waiting list.

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Department of Social Services - Division of Aging

Table 7. Social Service Block Grant Waiting  List

There is no waiting list for Medicaid funded programs.  Social Service Block Grant (SSBG) funded programs do have waiting lists, which are reviewed at least annually or as frequently as service availability warrants.  Persons are placed on the waiting list as high, medium, or low priority according to various factors such as level of care, lack of other supports, homebound status, protective service need, financial resources, and others.  This funding stream has declined in recent years due to federal budget cuts and the increased use of SSBG dollars to fund services for Medicaid spend-down consumers and presumptive eligibility for Missouri Care Options consumers during period of Medicaid ineligibility.  The Social Service Block Grant waiting list as of three dates is presented in Table 7.

[ Index | Acknowledgements | Introduction | Activity 1 | Activity 2 | Activity 3 | Activity 4 | Activity 5 | Activity 6 | Activity 7 | Activity 8 ]

[Olmstead]