David Y. Ige

HONOLULU – Hawaii residents with intellectual and developmental disabilities have come a long way toward gaining more rights to be treated like other citizens in the past 30 years.

In the past, many with substantial intellectual and developmental disabilities were isolated from the community, and were admitted to Waimano Training School and Hospital (WTSH), which opened in 1921. WTSH served as the State’s only large intermediate care facility for persons with intellectual and developmental disabilities.  However, an amendment to the state law in 1995 mandated Waimano’s closure.

With the final closure of Waimano Training School and Hospital in June 1999, Hawaii became the ninth state to completely shut down its publicly-operated institutions for individuals with intellectual and developmental disabilities. Currently, Hawaii is one of 15 states that no longer operates an institution for those with intellectual and developmental disabilities. The last state institution in the United States is projected to close within the next two decades.

The mandate came with a stipulation: all programs and services shall be provided in the community and the Hawaii State Department of Health shall maximize its funds for community services by using state-matching funds to match federal Medicaid funds through the Medicaid 1915 (c) Home and Community-Based Services Waiver.

The Medicaid Waiver makes it possible for individuals with intellectual and developmental disabilities to be integrated into the mainstream community, and allows Hawaii to leverage federal funding to better serve Hawaii’s citizens with intellectual and developmental disabilities.

Establishing the Developmental Disabilities Division within the Department of Health was the one of the positive results of the mandate. Today, the Developmental Disabilities Division provides services to people in their homes and in community-based settings that include personal assistance/habilitation, residential habilitation, emergency services, respite, employment supports, chore, training and consultation, specialized medical equipment, adult day health, skilled nursing, environmental accessibility and vehicular modifications, assistive technology, personal emergency response systems and non-medical transportation.

The statistics have been positive: Today, Hawaii ranks in the top quartile of states in supporting individuals in family homes. Currently, 99 percent of people served by the Department of Health’s Developmental Disabilities Division live in residences serving one to six people, and 61 percent in settings with one to three people.

“Hawaii has been one of the most progressive states in empowering individuals with intellectual and developmental disabilities. We have many good reasons to celebrate the strides we have made as a state over the past 30 years,” said Mary Brogan, Chief of the Department of Health’s Developmental Disabilities Division. “However, we still have much more we can do to remove stigma and ensure those with intellectual and developmental disabilities have full access to the services and supports they need to and be fully integrated into the community to enjoy, rich, full and self-determined lives.”

Despite progress in self-determination, new requirements are raising the bar to improve the quality of services for those with intellectual and developmental disabilities.

In 2014, the Centers for Medicare and Medicaid Services (CMS) finalized a new rule that dramatically shifted the emphasis to the nature and quality of the experience of beneficiaries and their desired outcomes. The new rule pertains specifically to home and community based services such as those provided through Hawaii’s waiver for intellectual and developmental disabilities.

“The expectation is that people with disabilities and older adults receiving Medicaid home and community-based services have a right to live, work, and participate in the greater community,” Brogan said.

“We’re hoping that with appropriate federal support and state-matching funds, the Department of Health’s Developmental Disabilities Division and its partners can continue to improve services and outcomes for individuals with intellectual and developmental disabilities,” she said.

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