Monday, August 11, 2014

Structures and Services for Supporting Persons with Developmental Disabilities in D.C.

Although D.C. is not a state (as we know), for the purposes of what I’m discussing here the District has the same structures and responsibilities that states do, although it only recently has begun to develop “state” structures to provide oversight of city programs and actions in this area.

In D.C., the entity with primary responsibility in this arena is the Department on Disability Services ( ), headed by Laura Nuss (  DDS’ primary responsibilities pertain to persons whose disabilities are cognitive, intellectual, and/or developmental rather than physical.  In D.C. both the Developmental Disabilities Administration (DDA) and the Rehabilitation Services Administration (RSA, which also serves people with physical disabilities) both come under DDS and are overseen by two deputies reporting to her, although one of these positions is currently vacant.

Rehabilitation Services Administration
Every state has a department that deals with “vocational rehabilitation,” or VR.  This is an oddly named service but essentially is concerned with helping people with disabilities identify the type of work they’d like to do and then assisting them to get a job or to get the training or education they need.  In D.C. this department is called the Rehabilitation Services Administration, or RSA, currently headed by deputy director Andy Reese ( ).  (In Maryland the VR department is known as the Division of Rehabilitation Services, or DORS, so as you see the names can differ a lot.)  Qualifying to receive services from RSA is comparatively easy, there isn’t a high bar for qualifying.  However, once an individual has qualified, RSA is mainly focused on short-term support.  If, for example, the person loses a job into which RSA has helped place him/her, then the process starts over.  RSA has also funded some individuals to attend out-of-state vocational programs and colleges, but is doing less of this and is trying to develop more local programming instead.   RSA also is trying to develop programs such as Project Search ( ), which can help bridge the gap between school (IDEA-funded) and adulthood, an area in which D.C. has not been very strong in the past.

Developmental Disabilities Administration

The much more meaningful long-term supports for persons with disabilities are provided in all jurisdictions through a system of “Medicaid waivers,” which in essence allows federal Medicaid monies to be used for groups of people who would not normally be eligible.  (In a future post I’ll explain something about deinstitutionalization and the move toward “Home and Community Based Waivers.”)  Some jurisdictions have a fairly extensive network of Medicaid waivers for different categories of persons with disabilities, but this is not yet the case in D.C.  Here, the Medicaid waiver program for persons with developmental disabilities is administered by DDS’s Developmental Disabilities Administration, or DDA, headed until recently by deputy director Cathy Anderson (position now vacant, so Laura Nuss is the contact point).  The only waiver available for persons with developmental (i.e. non-physical) disabilities in D.C. is focused on intellectual disability ( 
With few exceptions, to qualify for this waiver it is necessary for the person to have been tested with an IQ of 69 or below before the age of 18.  Many families are unaware of this and begin trying to get services after their family member is 19 or older without having obtained such testing.  This can make it extremely difficult, if not impossible, to qualify for services.  Conditions such as autism, without this IQ qualification, are not sufficient to qualify:  D.C. does not yet have an autism waiver as do Pennsylvania, Maryland, and quite a few other states.  DDA is working to develop a new waiver that will provide flexible supports to individuals with a broader set of disabilities, but it has not yet come into effect and will only be helpful to individuals who have fewer support needs and are generally still living with their families.
For the so-called I/DD waiver described above, therefore, the primary hurdle is qualifying.  Once a person has been found eligible for services, there is no waiting list.  This differs significantly from most states, where there may be a broader set of available waivers and qualifying may not be too difficult, but the person needing services then may remain on a waiting list for years waiting to receive them.  D.C. has begun developing criteria for a potential waiting list, but at this point it has not put them into effect.

The above is just a primer, there’s more to say in future blogs.

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