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Disability Rights Florida Letter to Attorney General Loretta Lynch Regarding Arnaldo Rios

Friday, August 12, 2016

August 5, 2016

The Honorable Loretta Lynch
Attorney General
United States Department of Justice
950 Pennsylvania Ave., N.W.
Washington D.C. 20530-0001

Re: Support for Request for Investigation of Arnaldo Rios Case and Florida's Medicaid Waiver for Individuals with Intellectual or Developmental Disabilities

Dear Attorney General Lynch:

Disability Rights Florida (DRF), is the designated protection and advocacy system for people with disabilities, including Arnaldo Rios. 42 U.S.C. § 15043. As the protection and advocacy system, DRF is authorized to pursue legal, administrative, and other appropriate remedies to ensure the protection of, and advocacy for, the rights of individuals like Arnaldo. This letter supports the request by Arnaldo's attorney, Matthew Dietz, for an investigation into the circumstances surrounding the shooting of Arnaldo's behavioral therapist as Arnaldo played next to him with a toy truck, as well as for the continued, and unnecessary, hardships in finding appropriate behavioral services for Arnaldo in the State of Florida.

People with disabilities, including intellectual and developmental disabilities (I/DD) such as autism, deserve trained and educated law enforcement personnel to respond in a manner that does not discriminate against them for typical behaviors that are a manifestation of their disability. It is incumbent on law enforcement agencies to provide routine training to its staff on how to identify and recognize an individual with a disability and to appropriately respond to the person. Too often people with disabilities are disregarded by law enforcement personnel resulting in the escalation of innocuous situations, such as in Arnaldo's case. DRF is aware of The Arc's support for the investigation of the North Miami Police Department and further supports their efforts for a community­ based crisis management system model in order to ensure the safe inclusion of people with disabilities in their own communities.

Arnaldo is a recipient of services through Florida's Medicaid Waiver for individuals with I/DD and as such has espoused a preference for services in his community in lieu of institutional services. Florida's current waiver program inadequately provides intense behavioral services in true community settings. DRF is aware of the lack of group home providers that are designated as Intensive Behavioral group homes which forces individuals like Arnaldo to accept services in less intense settings, referred to as Behavior Focused group homes, sometimes with an increase in supports and sometimes without the increase in supports. This lack of residential, behaviorally-centered, community options also precludes the further transition of people with disabilities residing in institutional settings back to their community.

The lack of behaviorally-centered residential options in the waiver does not exist alone either. Non-residential services, that is behavior services provided to individuals that reside in their own or their family's home, are also limited by criteria set by the State in rule. However, the limits have not provided enough services to all individuals and some families have opted to place their loved ones in residential settings or seek a waiver from the State-imposed limits. Outside of the Medicaid waiver, the lack of providers is also evident. Due to a shortage in providers, Medicaid-eligible children who have been approved for Applied Behavior Analysis through the State plan wait for openings on constructive waitlists established by the existing providers. Clearly, Florida's Medicaid program as a whole lacks sufficient services for individuals with disabilities, of all ages, that require some type of behavior service, from remaining in the least restrictive setting of their choice. This is evident through the difficulty Arnaldo has experienced in locating an appropriately equipped group home near his natural supports, in this case, his own family who clearly wish to be near him and to support him.

Florida's Medicaid waiver for people with I/DD is suffering further obstacles that support an investigation. For instance, a large provider of nursing services is now opting out of the waiver because it has been unable to achieve the same rate of compensation that it receives through other Medicaid waivers. As experience with the behavior providers has shown, when the Medicaid waiver loses a well-trained and robust provider network, beneficiaries of that waiver are at risk of unnecessary institutionalization. Further, this particular waiver has limited the use of waiver-funded transportation services such that individuals who would like to work in the community are adversely impacted. Therefore, DRF supports, and is separately calling for, a thorough investigation of Florida's Medicaid waiver for people with I/DD to ensure their safe inclusion in their communities, communities that include their natural supports, and in the least restrictive setting possible.

Sincerely,

Amanda E. Heystek
Director of Litigation

Tags for this Post

developmental disabilities, medicaid, waiver,

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