Georgia Council on Developmental Disabilities Chairman Parker Glick interviewed Ron Wakefield, director of the Division of Intellectual and Developmental Disabilities under the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) about the state of developmental disabilities services for Georgians with disabilities, the difference between state-funded services and Medicaid waivers and how people can connect with DBHDD.
Parker Glick: I’m the new Chair of the DD Council so I’m very excited to be diving into this as a young person.
Ron Wakefield: Awesome. Trust me, you are the future and it’s always great to see young people getting involved, so thank you.
Parker Glick: Thank you. So, I’m going to jump right into it. The movement is comprised of a lot of alphabet soup, so would you mind sharing what DBHDD is and expanding that?
Ron Wakefield: Okay. So DBHDD, what a mouthful right? It’s actually the Department of Behavioral Health and Developmental Disabilities. It’s a state agency created in 2009. We provide treatment and support services for individuals with mental health, substance use disorders and intellectual and developmental disabilities (I/DD). DBHDD supports people who are uninsured, underinsured or on Medicaid.
Parker Glick: Wow. That is a lot to know, and of course that is for all of Georgia. And I know that’s not all on you, so what specifically is your role over at DBHDD?
Ron Wakefield: I’m responsible for management of the entire I/DD services and systems for the state. So I oversee policy; I oversee the entire approval process from when somebody applies for eligibility all the way until they get into services, and also the management of the provider network that would provide services. So the entire system is under my purview, and thankfully I am not the only one doing all this. I do have a tremendous team that works with me and for me.
Parker Glick: Awesome. How do you all work with the developmental disabilities community directly?
Ron Wakefield:We are actively involved and engaged. We have six regional offices across the state of Georgia, and in each region, we have staff that is actively engaged with individuals and families that are seeking services or who are in services. We have a central offices in Downtown Atlanta at 2 Peachtree Street where I am located, and a number of my directors are located. We are able to oversee services across the state. Families and individuals can interface with us directly through the central office or through field offices that are close to where they’re living. So that’s how we organize and ensure people have access to services and deliver our services and actually get involved.
Parker Glick: Awesome. Thank you. So one of the primary services that folks seek out in Georgia are the state waivers. Unfortunately, it’s not an easy task to take on. Could you provide any insight as to how the state waivers operate and what families can do to navigate that more successfully?
Ron Wakefield:When we talk about waivers, there are a few things I would like to make clear. We do have what’s called state-funded services (and I will come back to that in a second), but when we mention waivers, we’re talking about Medicaid waivers. We’re speaking specifically of two: the new option waiver, which we popularly refer to as the “NOW” waiver, and the comprehensive waiver, which we refer to as a “COMP” waiver. To be eligible for either one of those, there is a process. First there is a clinical process where people need to apply and we have psychologists who review the applications and review the person’s clinical records, primarily their psychological, just to make sure that they meet the eligibility requirement. That’s the very first step. The very first step is the application.
Once you apply, a determination is made whether you are pre-eligible for services or not. If you’re found pre-eligible, then you would get on what’s called our planning list. When waivers are available – for this upcoming year the General Assembly approved 100 waivers – so we have 100 new waivers. We will do an assessment and base our decisions on who are the most in need in terms of awarding those waivers. So that’s typically the process. State-funded services, we don’t call those “waivers,” it’s different. Let me just mention that the waivers are funded both by the federal government and by the state. There is a state match along with the money that comes for those waiver services. With state-funded services, there is no federal match so that’s all Georgia putting up money to provide state-funded services. With state-funded services, we try to mirror services that are in the waiver because we recognize that there are people who need services immediately and we have the availability to provide that. There are also services and family support that we offer using state funds for people who are on the planning list while they wait to get into the waiver services.
Parker Glick: So, you mentioned while they’re waiting, they can seek those state-funded supports while they’re waiting on the waiting list?
Ron Wakefield: Correct.
Parker Glick: Would you mind expanding a little bit further on what those state funds are and how folks can approach those?
Ron Wakefield: So what I recommend to every single person who’s interested in receiving services from DBHDD is go ahead and submit an application. As I said, once you do that and you’re determined pre-eligible for our services you land on a planning list. While on the planning list, we do assessments once you apply for services and then annually to see what your needs are and if there are any changes in the level of needs. That’s how we determine who are most in need of waiver services. While you are on the planning list, you can work with what’s called a Planning List Navigator and they will direct you based upon what your presented needs are at that time to apply for family support. That’s the way that you get into services while waiting – sorry, for waiver services.
Parker Glick: Excellent. Thank you. We mentioned earlier the state of DD services, and it’s somehow connected. Can you explain what exactly state DD services for Georgia are?
Ron Wakefield: So, we have various services that are offered. There is community access which really means that somebody receives supports to be able to go out into the community and be involved. There are community living supports where somebody is living at home or in their own apartment but they need somebody to come in and provide some level of assistance during the day or evening. There are also community and residential alternatives where somebody can no longer live with their family, but can no longer live on their own and they need 24/7 type services – so that’s out of home services, out of their residential home. It’s the type done in host homes, where somebody lives with an individual or family, and receives services that way or they live in what’s typically called a group home. But we typically call it a community living arrangement with three or less other individuals who have similar needs. So staff would come in and provide support needs in that context. I should also mention supported employment where somebody is interested in getting a job. There are supports in place to help that person receive the training they need and then transition into jobs in the community. So all the services that I just mentioned are both in waiver services and also in the state-funded services that I spoke about earlier.
Parker Glick: I personally am a person with a disability so I definitely appreciate the state waiver programs. I appreciate that I am able to choose where I want to live and then the supports come and meet me that way, and I hope that is something that reaches out to the entire community.
Ron Wakefield: I wish I could say we had unlimited resources, but we do not. That’s probably the hardest part of my job, to know that this is the amount of resources that I have and these are the number of people that we need to serve and then try to make a determination for of all these people and this limited pot of resources. How can we best stretch to serve as many people as possible? That’s probably the hardest thing that we do. That’s the challenge now and that’s the challenge going forward in the future. How can we maximize the resources we have?
And their needs vary. There are some people who absolutely need a lot of resources just to be able to make it through the day because they have complex medical needs. So that person would need more resources than somebody who just needs some assistance navigating where they live. So we try to base our decisions on clinical assessments. And, we recognize that if people were not able to access these resources from us, I’m not sure where else they would get them. So I want everybody to understand how important that is to us and how seriously we take that. So our decisions are not made lightly. That’s the context in which we plan for the future: how can we best maximize the resources that we currently manage?
Parker Glick: And reaching out for these resources is as simple as getting on your website or calling y’all? There is a number? How can folks reach out and acquire these resources?
Ron Wakefield: Absolutely. They can call the field offices, they can call the central office, and we just updated our website probably over a year ago. That is a great place to go. Go to DBHDD and once you get on our website go to I/DD and then you can navigate from there. You can call us, the field office, the central office. And something that we introduced over a year ago, for those who have access to a computer or even a cell phone, you can access our website and you can now fill out an application online.
Parker Glick: Excellent. I am personally a firm believer in interdependence and so what can we as a community do to work with DBHDD to expand the resources that are not nearly enough?
Ron Wakefield: I recognize how families and how individuals view services. What I’d like people to be more aware of is we do have limited resources and we are trying to make that stretch as much as possible. For some folks who probably, years ago, received all kinds of services and, now, we have done another clinical assessment to determine that they don’t need all of those services – it would be awesome if people who are in that situation recognize that, “You know what? I know there are others out there who need these services more than I do.” I am not saying you step off the waiver. You stay on the waiver, you use the services that you really need, but others that you don’t need, feel free to reach out to the field office support coordinator and tell us what you really don’t need anymore. That would help. When people are getting services, don’t come with the mindset that, “I’ve got to get everything that I can because I don’t know when I’ll need more or not.” What we’re trying to do is create a system and a process where as you come in, we’ll determine what you need and then we’ll offer that. As your situation or conditions change absolutely we will be flexible to try and update what is allocated to you. It’s really having people think carefully about their services and others because we’re all in this together, and of course we would like to serve as many people as we possibly can.
Parker Glick: So how about the same question for stakeholders, larger entities that are working side-by side with you towards supporting the disability community? Like us at GCDD, what are some things that we can do maybe legislatively?
Ron Wakefield: So I’ve really appreciated the partnership with GCDD and we are still going through a crisis because of the pandemic right now. So many things have needed to be adjusted during this time. Some things have changed. During times like this, our resources become even scarcer. What I’ve appreciated with partners and other stakeholders – not just GCDD, but I do want to give a shout out to GCDD – for instance, Eric Jacobson, we speak fairly frequently and Eric understands what message we want to give to people and so he’s been able to assist us with that. A few years ago, we did some work with our planning list. Some people were scared about what exactly we were trying to do. Limit resources for people? Take away resources from people? It was not that. We wanted to more accurately determine the needs of people on the waiting list. We typically call it the planning list because that’s what we use it for. We use it to know who is on the list, assess their needs and plan for the future. But I know people outside of DBHDD consider it to be a waiting list. Use the services that you really need, but others that you don’t need, feel free to reach out to the field office support coordinator and tell us what you really don’t need anymore. That would help. What’s significant about that is we try to find out exactly who is on the list and what their needs are, so we can better plan. We explained it to GCDD, and they were able to explain it to families and that is greatly appreciated. We are making sure that we are reaching all the right people who are in need of our services. So the partnership with stakeholders is absolutely critical. And the same thing goes for when things change and we need to communicate or figure some things out, Having that dialogue with our stakeholders is also critical and essential for us to be able to meet changing demands.
Parker Glick: Excellent. Well I don’t want to take too much of your day. I know that time is also limited. But I do want to thank you again for being with us and taking the time to answer our questions, clarifying DBHDD and your role, and thank you for the work you do not only in partnership with us but with our community.
Ron Wakefield: It’s been great chatting with you and it’s great to meet you. I’m looking forward to more conversations in the future. Thank you.
Parker Glick: Absolutely.