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I just got this email. The following this come.

CDCAN DISABILITY RIGHTS REPORT

#223-2010 – NOVEMBER 17, 2010 – WEDNESDAY

CALIFORNIA DISABILITY COMMUNITY ACTION NETWORK: Advocacy Without Borders: One Community – Accountability With Action - California Disability Community Action Network Disability Rights News goes out to over 55,000 people with disabilities, mental health needs, seniors, traumatic brain & other injuries, veterans with disabilities and mental health needs, their families, workers, community organizations, including those in Asian/Pacific Islander, Latino, African American communities, policy makers and others across California.

To reply to this report write: MARTY OMOTO at martyomoto@rcip.com WEBSITE: www.cdcan.us TWITTER: www.twitter.com - “MartyOmoto”



State Budget Crisis:

Schwarzenegger Administration’s Final Olmstead Advisory Committee Public Meeting 11/18 – Update on Section 1115 Medicaid Waiver & Other Issues

Toll Free Line Available for People to Call In - Advisory Group Formed in 2005 by Governor’s Executive Order On State’s Compliance and Implementation of Landmark US Supreme Court Decision Regarding Rights of People With Disabilities, Mental Health Needs & Seniors – Could Continue Under Brown When He Takes Office In January



SACRAMENTO, CALIF (CDCAN) [Updated 11/17/2010 11:30 AM (Pacific Time)] - The Schwarzenegger Administration’s advisory committee on California’s implementation and compliance of the landmark 1999 US Supreme Court Olmstead Decision [photo of Elaine Wilson (seated) and Lois Curtis – the two women with disabilities who filed the lawsuit] regarding the rights of children and adults with disabilities, mental health needs, the blind and seniors to live in their homes and communities will hold its final Thursday, November 18, 2010 from 10:00 AM to 4:00 PM at the Department of Rehabilitation building in Sacramento, two blocks from the west steps of the State Capitol. A toll free line is available for any person who cannot attend the meeting (see below for details). The committee is meeting under the cloud of an enormous and on-going budget deficits for the State projected next year at over $25 billion – and under the transition of an outgoing and incoming Governor.



Public comment is taken after each agenda item throughout the committee meeting from those physically attending and from those participating via the toll free line. The full text of the committee agenda is re-produced in this report below.



NOVEMBER 18, 2010 – THURSDAY

TIME: 10:00 AM to 4:00 PM

WHAT: Olmstead Advisory Committee Meeting

WHERE: Department of Rehabilitation building in Room 242, 721 Capitol Mall (corner of Capitol Mall and 8th Streets), Sacramento, two blocks from west steps of State Capitol.

TOLL FREE LINE: 1-888-232-0362, and passcode: 785453

REASONABLE ACCOMODATIONS:

In consideration of those who will be attending and who are sensitive to environmental odors created by chemicals and perfumes, the Olmstead Advisory Committee asks that people consider restricting the use of fragrances at this meeting.

American Sign Language interpreters will be available at the meeting.

If disability-related accommodations are required or a person needs materials in alternate formats, please make the request at least five days prior to the meeting date to:

Megan Juring, Assistant Secretary of the California Health and Human Services Agency – Olmstead and Long Term Care

Phone: (916) 654-0662, TTY (916) 558-5807, or

Email: mjuring@chhs.ca.gov

MORE INFORMATION INCLUDING MEETING MATERIALS:

http://www.chhs.ca.gov/initiatives/Olmstead/Pages/FullAdvisoryCommitteeMeetingsCY2010.aspx

PRIORITY: VERY HIGH



Committee Officially Known As “Olmstead Advisory Committee”

The committee is officially known as the “Olmstead Advisory Committee” established in 2004 by executive order issued by Governor Arnold Schwarzenegger and first met officially in March 2005. The Governor later issued an executive order in 2008 that replaced his previous order (see below for text of both orders). In theory, the advisory committee continues under Governor-elect Jerry Brown, when he takes office in the first week of January, unless his Secretary of the California Health and Human Services Agency – or a new executive order by the new governor decides not to continue the committee, or to establish an entirely new committee.



The issues that the Olmstead Decision covers has sweeping impact to children and adults with disabilities, mental health needs, seniors, their families, community organizations, state hospitals and developmental centers, other health facilities – made more difficult by enormous State budget shortfalls – with more grim news earlier this month of staggering projected State budget deficits next year and in the coming years.



Update on Section 1115 Medicaid Waiver That Will Have Sweeping Impact on Medi-Cal Program

One key issue that committee members will be updated on at the meeting is the proposal – recently approved by the federal government – that will have sweeping impact on children and adults with disabilities (including developmental), mental health needs, the blind, seniors and others in the State’s Medicaid (called “Medi-Cal” in California) program. The proposal – called the “Section 1115 Medicaid Waiver” will begin to go into effect next year. The Schwarzenegger Administration was given authority to develop and submit a proposal to the federal government, as part of the 2009-2010 State Budget as revised in July 2009.



Two bills – SB 208 by Senate President pro Tem Darrell Steinberg (Democrat – Sacramento) and AB 342 by Assembly Speaker John Perez (Democrat – Los Angeles) that were passed as part of the 2010-2011 State Budget in October, made other specific requirements in how the Medicaid Section 1115 Waiver proposal is to be implemented. “Section 1115” refers to a specific part of the federal Social Security Act – the federal law that governs Medicaid – that gives the federal government authority to exempt certain Medicaid rules to allow a state to test out or demonstrate certain ideas in how their Medicaid program is delivered in their state.



For more information on this issue see previous CDCAN Reports (dating from summer 2009) on this or go to the Department of Health Care Services website page that is specifically focused on this proposal (including documents, meeting agendas and minutes from various stakeholder advisory committee meetings, workgroup meetings and reports:

http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx



Olmstead Decision Required States To Steps to Avoid Institutionalization

The federal lawsuit was filed in federal district court in the State of Georgia in 1995 by Wilson (who passed away December 5, 2004 at age 53) and Curtis - who filed a lawsuit against then Georgia state commissioner of Human Resources Tommy Olmstead. Both women had disabilities – including developmental.

[CDCAN Note: Lois Curtis appeared May 27, 2009 at the Disability Capitol Action Day at the State Capitol organized by the California Foundation for Independent Living Centers and other advocacy groups. Marty Omoto introduced and interviewed Curtis on-stage before the crowd of about 2,000 persons gathered on the West Steps of the State Capitol].



In June 1999 the US Supreme Court upheld the lower court rulings in favor of Lois Curtis and Elaine Wilson, in a landmark decision.



Since that decision, advocates across the nation and in California have criticized the slow pace of implementation and compliance by the federal government and in various states. Compliance and implementation was made more difficult due to on-going budget deficits in nearly all the states that resulted in major budget reductions to health and human services. An Olmstead Advisory Committee was created by executive order of Governor Schwarzenegger in September 2004 (that order was later revised last year)



California state officials have said that the state, given the fiscal and other budget problems since 2002, is moving as fast as it can toward compliance.



The Olmstead Advisory Committee was originally established in 2004 by executive order of Governor Arnold Schwarzenegger (which was revised in a second order issue in 2008) that underscores California’s “…commitment to provide services to people with disabilities in the most integrated setting, and to adopt and adhere to policies and practices that make it possible for persons with disabilities to remain in their communities and avoid unnecessary institutionalization.”



The California Health and Human Services Agency stated on its Olmstead Advisory Committee website that the “Governor places a high priority on providing services for people with disabilities and seniors in the most integrated setting possible and adopting policies and practices that make it feasible to remain in the community” and that the Olmstead Advisory Committee underscores this commitment by “…insuring the involvement of people with disabilities and other system stakeholders in making recommendations on actions to improve California's long term care system. “



Brenda Premo, director of the Center for Disability Issues and the Health Professions at Western University of Health Sciences and a former director of the California Department of Rehabilitation, serves as chair of the committee.



The Olmstead Advisory Committee advises Kim Belshe, Secretary of the California Health and Human Services Agency, – the state agency that oversees several departments that administer statewide a wide range of services and supports for children and adults with disabilities (including developmental), mental health needs, the blind, people with MS, Alzheimer’s disorders and diseases, people with traumatic brain and other injuries, and seniors. The committee is responsible, according to the California Health and Human Services website “…for providing input to [the California Health and Human Services] Agency on its efforts to implement the California Olmstead Plan, recommending actions to improve California's long-term care system and creating opportunities to fund expanded or new activities to support individuals with disabilities in their community. “



Committee Has Been Praised and Criticized Regarding Olmstead Compliance

Like other government related advisory committees, the Olmstead Advisory Committee has no actual decision making authority. It does receive important updates from the Secretary of the Health and Human Service Agency and the heads of the major departments and Belshe has stated several times over the years that the committee members input and concerns are taken into consideration during internal policy discussions – including those on the state budget – by the Schwarzenegger Administration.



The committee has its supporters and critics – some who say the committee has been a good vehicle to get information and updates, and to help shape some major important policy initiatives dealing with long term care, community-based services and other issues, including various major proposals that have drawn down more federal matching dollars in support of those programs. Supporters of the committee say the near constant presence and participation at virtually every committee meeting since it was established by Secretary Belshe, and also the various department heads has been important in understanding or influencing State policies regarding implementation of the Olmstead Decision.



Critics however contend the committee has not been effective in changing the Administration’s or Legislature’s approach in solving the enormous budget shortfalls over the past several years that they argue have undermined or even reversed previous progress in the State’s implementation of the Olmstead Decision. They point to sweeping cuts and even outright program eliminations that were proposed and deep cuts that were actually enacted since 2002 impacting thousands of people with disabilities, mental health needs, the blind and seniors.



Similar concerns have been raised in other states that have a similar advisory committee – and virtually all of the other 49 states have made major reductions and changes in eligibility – many permanent that impact people with disabilities, mental health needs, the blind and seniors.



NOVEMBER 18, 2010 OLMSTEAD ADVISORY COMMITTEE AGENDA

Olmstead Advisory Committee Meeting

Meeting Notice and Agenda

November 18, 2010: 10 am – 4 pm

Department of Rehabilitation, Room 242

721 Capitol Mall, Sacramento, California

Toll-Free Call-In Number: 1-888-232-0362 Passcode: 785453



AGENDA (public comment time between each item)

Please note: The order in which the agenda items are considered may be subject to change. Opportunities for public comment will be provided throughout the agenda.



1. Welcome and Introductory Remarks: Brenda Premo [Chair - Olmstead Advisory Committee]

2. Secretary’s Comments: Kim Belshe [Secretary, California Health and Human Services Agency]

An opening discussion by the Secretary, department directors and others reflecting on Olmstead-related achievements as well as policy/program objectives that were not attained or realized fully during this Administration. A brief discussion of changes in Congress and the State administration transition will help inform discussions throughout the agenda. Willis Morris will provide a D.C. [Washington, DC – federal] update.



3. Home and Community-Based Services (HCBS) Opportunities Under Health Care Reform

In addition to major tasks of improving access to healthcare for individuals with pre-existing conditions, establishing a health insurance exchange, conforming insurance rules and regulations, and implementing wellness and prevention initiatives, the Patient Protection and Affordable Care Act (PPACA) includes several initiatives for long-term care services and supports. Long-term care opportunities may include: the Community Living Assistance Services and Supports (CLASS) Program, Community First Choice Option, modifications to existing programs including the 1915(i) Medicaid State Plan Amendments, Aging and Disability Resource Centers and Money Follows the Person demonstration funding extensions, and requirements for states to extend income and asset protections for spouses of HCBS as well as for beneficiaries in nursing homes. Discussion will address California’s current implementation efforts and what may be ahead relating to implementation at a federal level.



4. Medicaid Section 1115 Waiver as a Bridge to Reform

Implementation on the 1115 Waiver as a bridge to comprehensive reform. Approved by CMS [federal Centers on Medicare and Medicaid Services] on November 2, 2010, changes under the waiver involve expanding coverage today for those who will become “newly eligible” in 2014 under health care reform, implementing models for more comprehensive and coordinated care for some of California’s most vulnerable residents, and testing various strategies to strengthen and transform the state’s public hospital health care delivery system to prepare for the additional numbers of people who will have access to health care once health care reform is fully implemented. Discussion will include implementation plans, on-going stakeholder involvement, and future steps.



5. Working Lunch



6. Human Service Transportation Coordination

The Mobility Action Plan, Strategic Implementation Plan identifies priority recommendations for action around: Strengthening Existing State Program and Funding Guidelines and Regulatory Requirements; Research and Evaluation of Coordination Concepts; Information and Education; and State Level Strategic Planning and Policy Development.



7. California Alzheimer’s Disease [State] Plan

Goals, recommendations and strategies of the California Alzheimer’s Disease Plan will be discussed in relation to Olmstead and long-term service capacity broadly.



8. Priorities of the Olmstead Advisory Committee:

Facilitated by Bobbie Wunsch, Pacific Health Consulting Group

Olmstead Advisory Committee members will identify priority recommendations to advance to the [Governor-elect Jerry] Brown Administration as part of a transition report of the Olmstead Advisory Committee.



KEYACTIONS BY FEDERAL COURTS & PARTIAL LIST OF STEPS BY THE STATE LEADING UP TO FIRST OLMSTEAD MEETING

Following is a CDCAN summary key actions of federal court actions and a partial list of some steps taken by the federal government and the State leading up to the 2004 establishment of the California Olmstead Advisory Committee. Not listed during this time period – from 2002 on – are the State budget cuts both proposed and enacted that had major impact regarding the State’s implementation of the Olmstead Decision.



It should be noted that several subsequent federal and state court rulings and decisions since 2004 have been issued referencing the Olmstead Decision and that during this same time period there were several other important proposals or initiatives (some that advocates viewed as positive – and others as negative) advanced by the State and federal government that had impact on compliance and implementation.



1995

· Lois Curtis (“L.C.”) in federal district court in Georgia, seeking placement in the community, against Georgia state officials under 42 U.S.C. Section 1983 and Title II of the federal Americans With Disabilities Act, that claimed that Georgia violated Title II in failing to place her in a community-based program once her “treating professionals” determined that such placement was appropriate. Elaine Wilson or "E. W." joined the lawsuit, making a nearly identical claim as Lois Curtis.

· Both women were originally voluntarily admitted to Georgia Regional Hospital in Atlanta, where they were confined for treatment in a psychiatric unit. Although their treatment professionals eventually concluded that each of the women could be cared for appropriately in a community-based program, the women remained confined at the Georgia Regional Hospital.

· The federal district court in Georgia granted a partial summary judgment [ruling or court order] for the women, ordering their placement in an appropriate community-based treatment program.

· The federal district court rejected the State of Georgia's claim that inadequate funding, not discrimination against Lois Curtis and Elaine Wilson“…by reason of [their] disabilit[ies],” accounted for their retention at the state institution. The federal district court concluded that under Title II of the Americans with Disabilities Act, unnecessary institutional segregation constitutes discrimination per se, which cannot be justified by a lack of funding. The federal district court also rejected Georgia's claim that requiring immediate transfers of persons (such as Lois Curtis and Elaine Wilson) in such cases would "fundamentally alter" state funded programs.

NOVEMBER 1997

· The US 11th Circuit Court of Appeals upheld (agreed with) the lower federal district court's ruling, but ordered the district court to look again at the State of Georgia's claim that community-based care would be "unreasonable" given the demands of the state's health and human services budget.

· The US 11th Circuit Court of Appeals in their decision, cited a US regulation adopted by the US Department of Justice to enforce Title II of the Americans With Disabilities Act that states "...A public entity shall administer services, programs, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities. 28 C.F.R.§ 35.130(d)." The US Department of Justice had interpreted this regulation as requiring the community placement of people in institutional settings when the state's own “treating professionals” have recommended such placement.

· The State of Georgia appealed the decision of the US 11th Circuit Court of Appeals to the US Supreme Court, asking the nation’s highest court to decide "[w]hether the public services portion of the federal Americans with Disabilities Act compels the state to provide treatment and habilitation for mentally disabled persons in a community placement, when appropriate treatment and habilitation can also be provided to them in a State mental institution."

APRIL 21, 1999

· Case was heard before the US Supreme Court – and was the first such case heard before the court involving the “integration mandate” or requirement of the Americans with Disabilities Act.

· By this point both Lois Curtis and Elaine Wilson were now living in and receiving community-based services, but the case continued because Georgia had not changed its policies.

JUNE 22, 1999

· The US Supreme Court, in a landmark decision, concluded that, under Title II of the federal Americans With Disabilities Act, the states are required to place persons with disabilities in community settings rather than in institutions when the State's treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with disabilities.

· The US Supreme Court held that "...unjustified institutional isolation of persons with disabilities is a form of discrimination" under the Americans With Disabilities Act and that "...institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life" and that "confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, and cultural enrichment."

· The US Supreme Court further held that "by definition, where, as here, the State confines an individual with a disability in an institutional setting when a community placement is appropriate, the State has violated the core principle underlying the ADA's [Americans With Disabilities Act] integration mandate."

· The US Supreme Court gave the states general guidance on how they might demonstrate compliance with the Americans With Disabilities Act if it had "a comprehensive, effectively working plan for placing qualified persons with disabilities in less restrictive settings, and a waiting list that moved at a reasonable pace not controlled by the State's desire to keep its institutions fully populated."

· Some advocates of people who reside in developmental centers and other state owned facilities, said that the Olmstead Decision – as it became widely known even though it references the name of the person sued and not the people who filed the lawsuit - offered important flexibility for the States, pointing to a concurring opinion by Justice Anthony Kennedy who held that "...It would be unreasonable, it would be a tragic event, then, were the Americans with Disabilities Act of 1990 (ADA) to be interpreted so that States had some incentive, for fear of litigation, to drive those in need of medical care and treatment out of appropriate care and into settings with too little assistance and supervision...It is careful, and quite correct, to say that it is not “the ADA’s mission to drive States to move institutionalized patients into an inappropriate setting, such as a homeless shelter . . . .”

1999

· In California, in a step that was not directly in response to the US Supreme Court decision on Olmstead v. Lois Curtis (L.C.) and Elaine Wilson (E.W.), but moved in that direction, AB 452 was passed and signed into law by then Governor Gray Davis, that created a Long-Term Care Council, chaired by secretary of the California Health and Human Services Agency. The Council (now no longer in existence) was directed by AB 452 to coordinate long-term care policy development and program operations and to develop a strategic plan for long-term care policy.

JULY 11, 2000

· Final settlement agreement was signed in federal district court, before Judge Marvin Shoob, bringing a formal close to Olmstead v. Lois Curtis (L.C.) and Elaine Wilson (E.W.) lawsuit – but was the beginning of the long road toward compliance and implementation of the decision across the country.

JANUARY 2000

· The US Department of Health and Human Services under President Clinton, issued a letter to the states advising that "...no one should have to live in an institution or a nursing home if they can live in the community with the right support. Our goal is to integrate people with disabilities into the social mainstream, promote equality of opportunity and maximize individual choice" and recommended that states develop comprehensive working plans, as described in the Olmstead opinion including steps to obtain input from people impacted by the decision, and to prevent unjustified or unnecessary institutionalization of people with disabilities, mental health needs and seniors, and to ensure appropriate community-based services and to provide quality assurances.

FEBRUARY 2001

· President George W. Bush announced the New Freedom Initiative, stating that "...though progress has been made in the last decade, too many Americans with disabilities remain trapped in bureaucracies of dependence, denied the tools they need to fully access their communities." The intent of the New Freedom Initiative includes promoting increased access into daily community life including through "swift implementation” of the Olmstead v. Lois Curtis(L.C.) and Elaine Wilson (E.W.) 1999 US Supreme Court decision.

SPRING 2002

· Assemblywoman Dion Aroner (Democrat -Berkeley) held an informational hearing on status of California's compliance with the Olmstead Decision, with many persons registering concerns or complaints about the delay in a state Olmstead Plan - three years after the original Supreme Court ruling.

SEPTEMBER 2002

· Governor Gray Davis signed into law AB 442 (Chapter 1161, Statutes of 2002 - one of the 2002 budget trailer bills), which directed the California Health and Human Services Agency to develop and submit to the Legislature by April 1, 2003, a comprehensive plan identifying the actions the state could take to improve its long-term care system and develop an array of community-based programs and services that would enable people with disabilities to avoid unnecessary institutionalization and receive the services they need in the most integrated setting appropriate, using the guidelines established by the federal Centers for Medicare and Medicaid Services for development of a state "Olmstead Plan."

FALL 2002

· California Health and Human Services Agency held series of public forums and meetings in various parts of the state for public input to develop a draft Olmstead State Plan.

MAY 2003

· The California Health and Human Services Agency, under then Governor Gray Davis, released the California Olmstead State Plan that said "...the state commits to providing services to people with disabilities in the most integrated setting. The state commits to adopting and adhering to policies and practices that will provide a full array of services and programs that make it possible for persons with disabilities to remain in their communities and avoid unnecessary institutionalization. This commitment involves making changes in current state policies and will require changes in federal policies that are biased towards institutionalization."

· The plan lays out strategies to implement the Olmstead Decision, including data collection, providing comprehensive service coordination, and reviewing community service capacity.

· The California Health and Human Services Agency announced it would be establishing an Olmstead Advisory Council - though there was no law requiring it to do so. The Council however never met in part because funding for the office of the Health and Human Services Agency was substantially reduced in the budget passed by the Legislature last year and approved by then Governor Davis - just months before the recall election.

AUGUST 2004

· The California Legislature passed SB 1365 by then State Sen. Wes Chesbro (Democrat - Arcata) that called for the creation of an Olmstead Advisory Council and made other requirements. The bill was widely supported by disability and senior organizations and advocates across the state.

SEPTEMBER 2004

· Gov. Arnold Schwarzenegger vetoed SB 1365, disappointing many advocates across the state, but signed an executive order, that called on the state to comply with the US Supreme Court decision, and also called for the creation of an Olmstead task force - though not created through state law. Some advocates still believed that the veto of SB 1365 indicated that the Schwarzenegger Administration would not seriously move to comply with Olmstead. [see text of veto message below[

NOVEMBER 2004

· Advocates push then Assembly Speaker Fabian Nunez (Democrat - Los Angeles) to authorize the continuation of the special (select) Assembly committee on Olmstead implementation through the 2005-2006 session. The Assembly Speaker declined to continue that select committee and it officially went out of existence as of November 30, 2004. [The State Senate had no specific select committee on Olmstead – but did have a select committee on people with disabilities and mental health needs that was chaired by then Sen. Wes Chesbro that covered Olmstead related issues]

JANUARY 2005

· California Health and Human Services Secretary Kim Belshe, on January 27, announces appointments to the 30 member Olmstead Advisory Committee.

MARCH 2005

· First Olmstead Advisory Committee meeting under the Schwarzenegger Administration, at the California Secretary of State’s building in Sacramento.



GOVERNOR’S 2008 ORDER REGARDING OLMSTEAD COMMITTEE

CDCAN Note: Governor Schwarzenegger issued two executive orders regarding the establishment of an Olmstead Advisory Committee – the first in September 2004 (see below for complete text), and the second (which replaces that original order) issued in September 2008.



EXECUTIVE ORDER S-10-08

09/24/2008



WHEREAS unnecessary institutional placement of individuals with disabilities adversely affects the everyday life activities, family relations, social contacts, work options, economic independence, and cultural enrichment of those institutionalized persons; and

WHEREAS the state has a responsibility to protect against the unnecessary institutionalization of individuals with disabilities; and

WHEREAS the opportunity to direct one's own affairs, live independently, and attain economic self-sufficiency is an essential component of developing self-worth and personal responsibility; and

WHEREAS direction has been provided to states under the Americans with Disabilities Act and the United States Supreme Court's decision in Olmstead v. L.C.; and

WHEREAS community-based care and services can be more cost effective than institutional care, and result in a higher quality of life that promotes the values of community participation, inclusiveness, and respect for diversity; and

WHEREAS the active involvement of people with disabilities and their representatives in the development and implementation of activities designed to move people into, or allow them to remain in, community-based settings is critical to insuring effective strategies; and

WHEREAS California has a demonstrated record of success in providing services that support the full integration of persons with disabilities in community life through such programs as In-Home Supportive Services, Medi-Cal, community mental health, and the comprehensive array of services defined under the Lanterman Act; and

WHEREAS it is possible to build upon California's previous success to improve procedures and implement new tools that will enable more people to fully access their communities.



NOW, THEREFORE, I, ARNOLD SCHWARZENEGGER, Governor of the State of California, by virtue of the power vested in me by the Constitution and Statutes of the State of California, do hereby issue this order effective immediately:

1. The state affirms its commitment to provide services to people with disabilities in the most integrated setting, and to adopt and adhere to policies and practices that make it possible for persons with disabilities to remain in their communities and avoid unnecessary institutionalization.

2. The California Health and Human Services Agency (HHSA) shall do all of the following:

A. Assess the state's ability to reasonably accommodate new and improved efforts to prevent unnecessary institutionalization of individuals with disabilities and to facilitate or expand community-based services and supports.

B. Continue to evaluate the May 2003, California Olmstead Plan and make revisions as necessary to insure that it will result in positive action toward the objectives of providing services to people with disabilities in the most integrated setting possible, and enabling persons with disabilities to remain in their communities and avoid unnecessary institutionalization.

C. Identify additional strategies to identify Californians who could be served successfully in non-institutional settings and the barriers to these individuals moving at a reasonable pace from, or avoiding admittance to, institutional long-term care facilities.

D. Research funding opportunities to support expanded or new activities to support individuals with disabilities in their communities.

E. Develop recommendations for changes in state policies that will remove programmatic and fiscal incentives for institutional placement and increase opportunities to utilize community-based services.

F. Develop recommendations for changes in federal policies that will remove programmatic and fiscal incentives for institutional placement and explore options for expanding or modifying the state Medicaid plan or Medicaid waivers.

3. In order to inform the Administration's understanding of the current system and future opportunities and insure the involvement of persons with disabilities and other system stakeholders, the Secretary of HHSA [California Health and Human Services Agency], at his or her discretion, is authorized to form an advisory group to provide input to the HHSA on its efforts to evaluate, revise, implement, and monitor the Olmstead Plan, on recommended actions to improve California's long-term care system, and on opportunities to fund expanded or new activities to support individuals with disabilities in their community. The Secretary should take into account the diversity of California's citizenry with respect to culture, language, geography, and disability in formulating the membership of his or her advisory group.

4. All state agencies and departments are hereby directed to cooperate with and assist the HHSA in carrying out its duties under this Executive Order.