As I stood before a rally crowd of advocates and people with disabilities at the NYS Most Integrated Setting Coordinating Council (MISCC)'s Syracuse public forum and led chants of "What do we want?!" "Freedom!" "When do we want it?!" "Now!", I was struck by the power and meaning of that one word: "freedom".
America's history is filled with examples of wars fought to defend or preserve our freedom as well as to champion the freedom of people all over the world. Yet we seem unable to muster the same energy or commitment to demand freedom for our own citizens, who are chained by institutionally-biased laws and regulations to segregated settings all over this great land.
The Supreme Court issued the Olmstead decision five years ago, stating that people with disabilities had the right to receive services in the most integrated setting possible, yet it took three more years for New York State to pass a law requiring a comprehensive plan to achieve this. The law, passed in 2002, created the MISCC and specified several tasks for it to carry out, culminating in a plan to ensure compliance with the principles of Olmstead by all state agencies that serve people with disabilities. That plan was to have been in place by December of 2003, but the Council had barely held its first meeting by that time, and no one but advocates and people with disabilities seemed to care. Apparently, when laws apply to people with disabilities, we can just ignore them; apparently the concept of "freedom" is less urgent when applied to us.
The current, and so far, only, chairperson of the MISCC is OMRDD Commissioner Tom Maul. One of the provisions of the MISCC law is that the chairpersonship of the Council must rotate every three months among the various Commissioners of state agencies that provide disability-related services. In violation of the law, Maul has presided over the MISCC for over a year.
When asked at the rally by a reporter from the Syracuse Post-Standard about the plan deadline, the Commissioner said, "As far as the actual law itself, I won't stand here and pretend I know it."
Am I alone in my consternation at this? I'm familiar with the law and I'm not even on the MISCC. The law contains less than 3 pages of plain language. It is easy to read and understand, and I would expect every MISCC member to have done so long ago--wouldn't you?
But this quote is from the same person who, at the last MISCC meeting, after a presentation about the efforts of Centers for Independent Living to divert and transition people from institutional placement, said that the work could probably be done by trained volunteers. When asked why the OMRDD Waiver didn't use volunteers in its similar efforts to divert or transition people with developmental disabilities, he had no answer.
The MISCC memo announcing the public forums asked people to speak on four themes: "Best Practices", "Building Community", "Improving Quality" and "Looking to the Future". While there is nothing wrong with these themes in and of themselves, there are some glaring omissions.
It is clear that the MISCC is more interested in gathering input on what is working than it is in trying to find out what isn't. None of the four themes for the forum asked about gaps in services or impediments to moving people from institutional to community settings. None of the themes focused on the crucially important concept of reversing the institutional bias in all of our long-term care services. And not once was one of the most serious barriers to community integration mentioned in the forum invitation: the lack of affordable accessible housing across the state.
The Governor has an interagency task force to study housing issues. This task force has no consumers or advocates on it, so it is unlikely to be exposed to the real issues faced by people with disabilities. Nor has any information about the task force's activities been provided to the Council. Commissioner Maul has refused to create a Housing Committee on the MISCC, which does have consumer representation.
The MISCC law requires the Council to come up with a unified assessment process for people with all disabilities of all ages to be carried out by a single point of entry in each county. As far as I've been able to determine, the MISCC has done little meaningful work on this, but the NYS Department of Health and Office for Aging are working very hard on a similar concept that seems to be related to the Governor's troubling Medicaid "Mega Waiver" proposal.
By seeking input on only half of the pie, the resulting plan is sure to be only half-baked. The word "comprehensive" comes right before "statewide plan" in the part of the law that describes what the MISCC is supposed to produce. "Comprehensive" means complete, global, thorough, all-encompassing, inclusive--taking both the bad and the good into consideration in order to develop a centralized, unified approach to this very pressing issue. Without data on service gaps and deficiencies to show where the "best practices" need to be applied, we can never hope to achieve a successful plan. It'll just be business as usual, a fragmented, disorganized approach to disability services with a not-so-hidden agenda to preserve the status quo.
Let's cut to the heart of the matter. Tom Maul is part of the problem with the MISCC, but he's not the whole ball of wax. He was appointed to do what the Governor wants because he agrees with the Governor; he has publicly opposed full integration for people with all disabilities and the very idea of a state Olmstead plan. He has been seen at Council meetings arguing with, overruling, or ignoring the members who are trying hardest to carry out the Council's legally mandated tasks. But if he were gone, the Governor would look for other ways to control the MISCC, and probably find them.
The Assembly passed a MISCC bill several years in a row and worked with advocates on bill language. While some Senators were very supportive, the Senate Majority Leader was not enthused about this law and Governor Pataki absolutely did not want it. The Senate was forced to pass it by protesters who brought to light the strength of public opinion in favor of integration for people with disabilities. The Governor then tried to add "technical" amendments to remove the requirements that the chairperson be rotated, that concrete data be collected on service gaps, and that all state agencies be bound to implement the plan once it is completed. More protests got Pataki to drop these amendments and sign the law, but he didn't give up. The next year he tried to sneak them back in with his budget proposal but was stopped by the Legislature. So, having failed to weaken the law by legal means, our Governor resorted to subterfuge: He appointed as Chair the person most likely to obstruct the MISCC's progress, and looked the other way as the chairpersonship failed to rotate. Meanwhile, the leaders of both houses delayed appointments of Council members for months, preventing the Council from conducting business.
The MISCC is an open book that by law must involve members of the disability community in achieving specific and wide-reaching reforms in disability policies and services with the goal of maximizing community integration. It should have center stage in any changes to Medicaid-funded long-term care in our state. Call me cynical, but it looks to me like most of the parties involved would much rather continue their own back-room efforts to cut Medicaid spending on services that improve the lives of people with disabilities while keeping the institutional bias in our system strong and healthy. I don't think these people ever intended for the MISCC to accomplish anything. I think they just wanted to get the public and the media off their backs.
If that's what they wanted, they made a mistake. They enacted a law that has specific provisions. It can be enforced through legal action. The only answer to Olmstead compliance, as well as to rising long-term care costs, is to consolidate disability services into a single system that maximizes low-cost community-based supports and gradually reduces use of expensive segregated services over time. We need leadership from the top down to make this happen. We need commitment from the top down to ensure success, we need courage from the top down to challenge prejudice, misplaced beliefs and an antiquated system to do what is right, to promote freedom for all New Yorkers. And, I guess, we need to either firmly grip the necks of the top leaders and force them to abide by court orders telling them to do these things, or we need new leaders.
So once again, in the words of ADAPT, we demand of the MISCC, of our state and of our nation: "Free our brothers!" "Free our sisters!" "Free our people now!"