Maryland Alphabet Soup BIP, MFP, ADRCs, MAP and TBI. Stefani O Dea Maryland Mental Hygiene Administration/ TBI Lead Agency

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1 Maryland Alphabet Soup BIP, MFP, ADRCs, MAP and TBI Stefani O Dea Maryland Mental Hygiene Administration/ TBI Lead Agency

2 Maryland LTSS Landscape Like many other states, Maryland has decided to implement a broad cross disability strategy to enhance LTSS and is implementing many of the ACA provisions. MD is combining largest two waivers- physical disability waiver and aging waiver MD is revamping and enhancing personal care program MD has a created a no wrong door approach to LTSS access through enhancement of ADRCs MD is limiting small specialty programs that focus on one particular disability group- uh oh!

3 What do we know about Maryland Medicaid beneficiaries and service utilization? Data source= the Hilltop Institute at UMBC- funded through Maryland Medicaid, largely with MFP rebalancing funds 3000 Medicaid beneficiaries with history of traumatic brain injury and/or anoxia in MD nursing facilities. This is 13% of NF population. Approximately 13% of individuals transitioning out of nurisng facilities into HCBS waivers have history of TBI or Anoxia. FY13 study found 6000 Medicaid beneficiaries with hx of TBI or Anoxia. 89% were not enrolled HCBS services.

4 Maryland s LTC Reform initiatives Money Follows the Person (MFP) Balancing Incentive Program (BIP) Community First Choice (CFC) (1915k) Health Home ADRC enhancement grant

5 What does this mean for Brain Injury Advocacy? Strategy= Targeted Infiltration Identify brain injury representatives to attend/ participate in LTC reform advisory groups and subcommittees Look for opportunities Be vocal, ask questions, offer guidance and eventually the brain injury will get incorporated into planningbefore you even have to say it Bring information back to State Advisory board and be sure that Board recommendations reflect current State strategies and priorities

6 Money Follows the Person TBI waiver is resource to Medicaid beneficiaries transitioning out of certain LTC facilities. TBI waiver has expended as a result of MFP. Rebalancing funds have been utilized to expand community BI services (approximately $250,000/ year). Funds used for several purposes including: contract with Brain injury Association of Maryland to provide application assistance and to assume role of ADRC brain injury partner Full-time statewide trainer, Anastasia Edmonston- Brain Injury, person centered planning and eventually mental health first aid training

7 Balancing Incentives Program Uniform assessment tool (InteRAI)- TBI advisory board advocated to have brain injury screening question added to interai screening tool. Positive screen leads to referral to BIAM for specific BI resources Data available on number of individuals with BI accessing ADRC for assistance. Pilot = 6% No wrong Door/ Single Point of Entry (Maryland Access Point/ ADRCs) Lead Agency contracted with BIAM to become official Brain Injury partner (MOU between MAP sites and BIAM outlines warm handoffs, training, and information sharing) BI resources to be included on MAP website- BIAM web link will be prominent Brain Injury Training for all MAP staff (ADRC staff) provided by lead agency and BIAM Recent innovative Projects RFP (BIP funds) highlighted need for proposals targeted to needs of individuals with BI

8 Aging and Disability Resource Centers 2003 first grants: Maryland was one of twelve states with two local sites Maryland now statewide with 20 sites and part of national program Maryland Access Points No Wrong Door/Partnership Development accelerated with MFP funding Required partnerships with the Brain injury Association of Maryland and Centers for Independent Living Other required partners include the Core Service Agency, Department of Social Services, and Health Department Website; statewide searchable database 8

9 Community First Choice & Health Homes Still monitoring and looking for opportunities CFC will expand personal care services and offers a support planning service that may fill case management gap for this population Also, monitoring impact of Medicaid expansion/ new adult eligibility group

10 Lessons Learned General: Targeted infiltration- make sure there are BI reps at all planning/ stakeholder meetings Expand the size and importance of the need by speaking broadly about cognitive accessibility and application to brain injury, ID, aging, chronic mental illness and substance use populations Engage by focusing on issues public is aware of- veterans and sports related concussions Specific: Aging and Disability community sees CILs as service provider and BIA as advocacy organization- need to change that perception by emphasizing I&R done by BIAs

11 Contact Info Stefani O Dea, Chief of Long Term Care Maryland Mental Hygiene Administration (BI Lead agency) Spring Grove Hospital/ Mitchell Building 55 wade Avenue Catonsville MD ; stefani.odea@maryland.gov For Training information and materials, contact Anastasia.edmonston@maryland.gov or go to