This is the second of a two-part series about how inclusion and support for autistic individuals and their families fared in Olympia this past legislative session. Part 2 provides an overview of support and inclusion for adults in our state. Part 1 addressed support for children and youth.
In 2021 we were bracing for severe cuts to disability services. Thanks to federal rescue funds and a quick turnaround from a state revenue nosedive, not only were services protected, we saw modest investment in long-term supports. Going into the 2022 session, advocates were ready to push for better access, and some legislators were ready to listen.
First, a little background:
- The lingo. Some people say “disability services,” others say “community supports.” Most services designed for people with lifelong disabilities are funded through Medicaid long-term supports. If people aren’t interested in care provided in a nursing home or institutional setting, then they “waive” their right to institutional care and use what are called “home and community-based” waiver supports. Same care, different service delivery.
- Unlike regular Medicaid, most home and community-based supports aren’t entitlement. That is, you can be eligible, but still not get them. Access depends on funding. In Washington, Medicaid long-term supports are administered through two divisions of the Department of Social and Health Services (DSHS): Aging and Long-Term Services Administration (ALTSA) and the Developmental Disabilities Administration (DDA).
People may be eligible for one, or both. In general: ALTSA is geared more to support people who are aging and have physical disabilities and services focus on things like personal care and nursing support; ALTSA also licenses adult family homes. DDA, meanwhile, administers “habilitative” supports – that is services that help people with developmental disabilities learn or maintain skills needed for daily living. Two popular examples are supported employment and supported living.
This year, the interesting bills involved DDA.
First, HB 2008. This is the bill that eliminates the use of IQ scores in determining eligibility for DDA services. Requiring autistic individuals to have a co-occurring intellectual disability wasn’t a requirement of the legislature and isn’t noted in the Revised Code of Washington (that’s what the collection of state laws are called). It was administrative rule that DSHS adopted.
For people with autism, it meant that even when they had a diagnosis, and even when they met the standards for substantial limitations, they were denied access if their IQ score wasn’t low enough. Some people who really needed support didn’t qualify. And because being eligible for DDA can qualify you for other types of support (like housing vouchers, Supplemental Security Income, or certain mental health supports), they lost access to a lot.
The change won’t happen until 2025; and people still need to meet functional limitation requirements. But this is a positive step forward.
The legislature also did away with a rule that prevented people from accessing employment services AND community access/inclusion services concurrently (HB 1980). For years, the state required people to choose one or the other. The problem was some people lose their jobs, or only work a few hours a week. They needed both types of support to participate in their community. After this year they’ll be able to.
Another important bill that passed (SB 5268) gets at: If we wanted to fully fund DDA supports, what do we need to do? Advocates are most excited about courtesy caseload forecasting – that’s legislative speak for collecting information about services people are or will be eligible for but aren’t getting. Right now, the legislature only budgets based on current cost and caseload. It doesn’t even have a mechanism to consider how to expand to meet the needs of the 13,000 or so on the no-paid services list. The legislation also requires studies or work on crisis stabilization, provider rates, case manager staffing, quality metrics and cross-system collaboration. None of this sounds exciting (unless you are us), but it will position the state to build out the system of developmental supports that we all need.
This session the legislature also created or increased funding for case management at DDA in some areas (case management for clients receiving no paid services and enhanced case management for those at risk of abuse or neglect), and increased rates for community residential providers; community engagement providers; and certain respite providers. They also funded training for attorneys and other professionals in benefits planning for people with intellectual and developmental disabilities.
Behavioral health is another key area of support for adults with disabilities. HB 1773 broadens assisted outpatient treatment, or AOT. These are court-ordered outpatient psychiatric services. No money is provided to expand these services, but the state expects to spend about $36 million in court monitoring over the next two years. Advocates are split on the bill, with some in strong support who see potential to help people who don’t understand their care needs and who are a safety risk to themselves or others. Others are worried about implications for civil rights and self-determination in care. If people don’t comply with the mandated treatment plan, they can be ordered into psychiatric in-patient care. The law applies to youth ages 13 to 17 as well as adults. A petition for up to 18 months of assisted outpatient treatment can be made by an emergency room physician and other types of medical providers, as well as some non-medical professionals.
Some hoped-for bills didn’t make it this session. SB 5935 would have created a property-tax exemption for nonprofit adult family homes. Advocates are worried about lack of options for people who need supportive housing models. This issue should come back next session. Other proposed bills would have closed residential habilitation centers (RHCs), which provide institutional care for people with intellectual and developmental disabilities in our state (SB 5938), or created certified peer specialists for behavioral health support (HB 1865)
What wasn’t discussed at all? Medicaid rates; behavior specialty rates for providers of DDA services; increased parenting support for people with developmental disabilities who have children, and other support gaps families have identified.
And of course, the big conversation, the one about what a well-funded, comprehensive, equitable community-based support system for people with autism and other developmental disabilities would look like (without reliance on institutional and crisis care) remains for another year.
Public demand is what pushes public policy. Next year is the start of a new biennium. If you want more services, or different approaches, start now. Send an email or meet with your legislator this summer for 20 minutes. This is also a big election year: all the state representative positions will be on the ballot, and half of the senators.
But we’re seeing good steps. Enjoy the interim. Contact your legislators! (You can look up your legislators and their contact information here: https://app.leg.wa.gov/DistrictFinder/)
Ramona Hattendorf is the Director of Advocacy at The Arc of King County and the mother of an adult learning about their neurodiversity. Stacy Dym is the Executive Director of The Arc of Washington as well as sibling of an individual with a developmental disability.
You can learn more about individual bills and how they fared this legislative session at this link: Bills-of-Interest-3-16-22.pdf (arcwa.org)