History Landmark Events and Developments WRAAA has a rich history, marked by changes in public policy, leadership and research. Check out some of the key moments from 1965 to 2014. 1965Congress passes the Older Americans Act Congress passed the Older Americans Act (OAA) as a response to policymaker concerns about the lack of community social services for older adults. It was designed to create services for older persons not adequately served by other public and private systems. Most importantly, the OAA was intended to provide institutional advocacy at the federal, state and local levels, encouraging those other systems to be more responsive to the needs of the elderly. The OAA also established a National Aging Services Network to address the social service needs of the aging population. Its mission was to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the OAA created area agencies on aging and a host of social support programs. Title XIX prompts Medicare and Medicaid In addition, Title XIX of the Social Security Act prompted the Medicare and Medicaid programs, which serve as a safety net of public health insurance for the elderly and poor. Medicare is a federal health insurance program that funds basic healthcare services for individuals who are elderly and/or have disabilities. Medicaid is a state and federal government program that pays for certain health services and nursing home care for covered families and children, as well as aged, blind and disabled individuals (ABD) with low incomes and limited assets. Both programs are crucial to financing healthcare, including long-term services and supports. The Medicare and Medicaid programs, which finance healthcare for more Americans than any other single entity, have enormous influence over the practice of medicine, shaping public policy and policy in the commercial market in the U.S. and even abroad. The OAA, Medicare and Medicaid were all part of President Johnson’s Great Society Programs. 1973OAA Establishes the Area Agencies on Aging The OAA Comprehensive Services Amendments established Area Agencies on Aging (AAAs) as the local implementing agencies for OAA programs. AAAs were also charged with advocating on behalf of older people and developing comprehensive and coordinated systems of services to address their LTSS needs. Ohio Commission on Aging Replaces Ohio Division of Administration on Aging Office Governor John J. Gilligan replaced the Ohio Division of Administration on Aging office with the Ohio Commission on Aging. The first of our 12 Area Agencies on Aging was established. 1976Cuyahoga County designates WRAAA The Ohio Commission on Aging (OCoA) designated the Cuyahoga County Office on Aging as the AAA for PSA 10A (Cuyahoga, Geauga, Lake, Lorain and Medina counties) to meet the OAA mandates. Cuyahoga County named us the designated agency, the Western Reserve Area Agency on Aging (WRAAA). 1980National Long Term Care Channeling Demonstration Tests Cost Effectiveness for Nursing Home Participants The National Long Term Care Channeling Demonstration was undertaken by the federal DHHS to test the feasibility and cost effectiveness of Home and Community Based Waiver Services for Nursing Home eligible participants. Cleveland was one of the project sites in 10 states. 1981Federal Government Establishes Home and Community Based Services Waiver Program The federal government established the Home- and Community-Based Care Service (HCBS) waiver program under Section 1915(c) of the Social Security Act. This allows States to provide community-based services by waiving certain Medicaid statutes and regulations. HCBS waiver services enable individuals at risk of being placed in long-term care facilities to be cared for in their homes, preserving their independence and ties to family and friends. 1984Ohio Commission on Aging Renamed to Ohio Department of Aging The Ohio Commission on Aging was promoted to a cabinet-level agency and renamed the Ohio Department of Aging. The agency director became the chief advisor to the governor regarding issues and concerns affecting older Ohioans and changes in national policy of the federal Administration on Aging. 1986PASSPORT Program is Launched The PASSPORT Program was launched in several Ohio counties as a new community-based, long-term care system to provide an alternative to nursing home care for Medicaid beneficiaries. 1987Conflicts Between the ODA and Cuyahoga County Commissioners The Ohio Department on Aging (ODA) placed WRAAA under suspension beginning in September 1987 and probation beginning March 1988 due to conflicts between ODA and the Cuyahoga County commissioners. In doing so, the ODA required the commissioners to restaff, relocate and reorganize the Area Agency, as well as ensure its independence of function in accordance with established mandates. With WRAAA under this provisional status, the ODA supervised all staff and approved all WRAAA decisions. 1989ODA Designates WRAAA as an Independent AAA As a result of continuing concerns with WRAAA’s operation, the ODA de-designated the Cuyahoga County Board of Commissioners as auspice for the Area Agency, and provisionally designated the Western Reserve Area Agency on Aging, Inc., as an independent Area Agency on Aging. WRAAA Incorporated as Not-For-Profit Organization In July, WRAAA was incorporated as an independent not-for-profit organization with a 19-member governing board. The board was made up of 18 trustees appointed by the Boards of County Commissioners in the five counties and one at-large trustee appointed by the governing board. WRAAA Becomes Auspice for Consortium Against Adult Abuse WRAAA became auspice for the Consortium Against Adult Abuse (CAAA), an alliance of individuals and organizations in Cuyahoga County dedicated to the prevention of elder abuse. The Consortium had been organized by the Council of Older Persons (COOP) to advocate for a state adult protective services law. It was initially sponsored by COOP, followed by St. Vincent Hospital and then Cuyahoga County before WRAAA assumed responsibility and expanded its membership to five counties. 1990ADA is Enacted by Congress The Americans with Disabilities Act of 1990 (ADA) was enacted by the U.S. Congress. It was signed into law on July 26, 1990, by President George H. W. Bush, and later amended with changes effective January 1, 2009. The ADA is a wide-ranging civil rights law that prohibits, under certain circumstances, discrimination based on disability. WRAAA Formally Designated as the Area Agency for PSA 10A On November 7, 1990, Western Reserve Area Agency on Aging, Inc., was formally designated as the Area Agency for PSA 10A by ODA and therefore given full authority and responsibility. PASSPORT Program Expands The PASSPORT program expanded to serve the remaining 88 counties including Cuyahoga, Geauga, Lake, Lorain and Medina. As a result, WRAAA underwent a major expansion. WRAAA's involvement in the PASSPORT Program gave us a major new service delivery vehicle to assist in carrying out our basic mission of helping older persons remain independent in their own homes and communities for as long as possible. It also positioned the Area Agency as the counties' sole publicly funded, community-based, long-term care developer, provider, access point and regulator. 1993Department of Aging Assumes Responsibility for Residential State Supplement Program The Department of Aging assumed responsibility for the Residential State Supplement (RSS) Program and assigned local administrative responsibility to Ohio’s 12 AAAs. The RSS Program provides a monetary supplement to low-income adults with disabilities who do not require nursing home care. The supplement, along with the consumer’s income, pays for room and board and support services at licensed foster and group homes and adult care facilities. Consumers also receive a Medicaid card. 1994PASSPORT Program Assumes Responsibilty for Preadmission Review The PASSPORT program assumed responsibility for preadmission review for all nursing home applicants, regardless of payment source. 1997ODA Establishes Care Choice Ohio ODA established Care Choice Ohio, a program that provides free assessment and consultation for long-term care to all Ohioans. The program was integrated into the PASS part of the PASSPORT Program. 1999Supreme Court Rules on Institutional Isolation of Persons with Disabilities The Landmark U.S. Supreme Court ruling in Olmstead v. L.C. recognized that unjustified institutional isolation of persons with disabilities is a form of discrimination under the ADA, affirming the rights of individuals with disabilities to live in community settings. The ruling prompted President Bush to launch the New Freedom Initiative and Congress to begin funding the Real Choice System Change (RCSC) Grants for Community Living Program. 2000OAA Creates the National Family Caregiver Support Program Reauthorization of the OAA created the National Family Caregiver Support Program, with administrative responsibility given to state units on aging and AAAs. 2001New Freedom Initiative Removes Barriers to Community Living President Bush announced the New Freedom Initiative on February 1, 2001, as part of a nationwide effort to remove barriers to community living for people with disabilities. As a part of the Initiative, the President issued Executive Order 13217, "Community-Based Alternatives for Individuals with Disabilities," on June 18, 2001. The Order called upon the federal government to assist states and localities to swiftly implement the decision of the United States Supreme Court in Olmstead v. L.C. In response to the Olmstead ruling and President Bush’s New Freedom Initiatives, Congress began funding the RCSC Grants for the Community Living Program to help states change their LTC systems to rely less on institutional services and increase access to HCBS. Ohio Access Task Force is Created Governor Bob Taft created the Ohio Access Task Force to review Ohio's services and support systems for people with disabilities. 2003Ohio Commission to Reform Medicaid is Created Governor Bob Taft and the Ohio General Assembly created the Ohio Commission to Reform Medicaid and charged it with conducting a complete review of the state Medicaid program and making recommendations for comprehensive reform and cost containment. National ADRC Initiative is Launched AoA and CMS partnered to launch the national ADRC initiative, which made grants available to states for pilot programs to streamline and strengthen access to LTSS. ADRCs were initiatively funded through the Real Choice System Change Grant program. 2006WRAAA Selected by ODA to Implement Ohio's First ADRC Project WRAAA was selected by ODA to implement Ohio’s first ADRC demonstration project, which served Cuyahoga County Additionally, ODA launched the Assisted Living Waiver Program that, for the first time, allowed Ohioans on Medicaid to access the services they needed in a residential care facility, rather than a nursing home. OAA Amendments Embedded the Principles of Consumer Access OAA Amendments embedded the principles of consumer access to information for long-term care planning, evidence-based prevention programs, and self-directed, community-based services to older individuals at risk of institutionalization. The amendments also required states to establish ADRCs. 2007Unified Long-Term Care Systems and Supports is Created Governor Ted Strickland and the Ohio General Assembly created the Unified Long-Term Care Systems and Supports Workgroup to re-engineer the state’s long-term care system into one that controls Medicaid spending and is based on consumer choice rather than funding streams. The group’s work resulted in 120 unanimous recommendations for system reform. 2010Patient Protection and Affordable Care Act is Signed into Law President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act, into law. The law contained many provisions to expand coverage, control healthcare costs and improve healthcare delivery systems. It offered many incentives and tools for states to reform their Medicaid systems and for hospitals and community-based organizations to collaborate in addressing healthcare issues such as poor care transitions and high hospital readmission rates. 2011Ohio Budget Includes Comprehensive Medicaid Reforms Governor Kasich's Jobs Budget (HB 153) included comprehensive Medicaid reforms to improve the quality of healthcare for 2.2 million Ohioans served by Medicaid, the healthcare payment program for low-income children, parents, seniors and people with disabilities. His reform plans included: (1) integrating Medicare and Medicaid benefits for dual eligibles through a Medicare-Medicaid Integrated Care System (ICDS); and (2) creating a single consolidated HCBS waiver to serve individuals with a nursing facility (NF) level of care (both requiring CMS approval). Ohio Department of Mental Health Assumes Responsibility for RSS Program The Ohio Department of Mental Health assumed responsibility for the RSS Program in July, ending ODA’s and AAA’s roles in the program. 2012Ohio Submits Integrated Care Delivery System Proposal to CMS Ohio submitted an Integrated Care Delivery System (ICDS) proposal to CMS in May. The Kasich Administration also announced that the Single HCBS Waiver initiative would be put on hold to allow priority to be given to the ICDS. Additionally, it reported that it was planning to submit an application to CMS to participate in the ACA’s Balance Incentive Program that offered a targeted increase in the FMAP for non-institutional, long-term services and supports (LTSS) to States undertaking structural reforms to increase access to non-institutional LTSS. The state reforms needed to include a “no wrong door–single entry point” (NWD/SEP) system, conflict-free case management services and a core standardized assessment instrument. Supreme Court Upholds Constitutionality of ACA The U.S. Supreme Court largely upheld the constitutionality of the Affordable Care Act of 2010 including the most critical provision of the Act, the individual mandate requiring citizens to either carry health insurance or pay a penalty. This action allowed the State of Ohio to proceed with its plans for Medicaid reform, which included expanding Medicaid eligibility, and participating in the ACA’s Integrated Care Program for Duals and Balanced Incentive Program for rebalancing the state’s Medicaid LTC system. Integrated Care Delivery System is Created for Dual Eligibles On December 12, the Centers for Medicare and Medicaid Services (CMS) approved Ohio’s ICDS proposal and entered into a Memorandum of Understanding with the Ohio Office of Medical Assistance to create an “Integrated Care Delivery System” for dual eligibles (people eligible for Medicare and Medicaid). The MOU is part of the Medicare-Medicaid Coordination Office’s Financial Alignment demonstration. Ohio became the third state to execute a MOU under the demonstration and the second state to employ a risk-based capitated model. Under the MOU, beginning in September 2013, Ohio enrolled up to 115,000 dual eligibles into Integrated Care Delivery System (ICDS) plans, or managed care plans. They were responsible for delivering all covered Medicare and Medicaid services to plan enrollees. The MOU requires the managed care plans to contract with Ohio AAAs in the participating regions for enrollees’ care coordination. 2013WRAAA Contracts with CareSource On July 1, 2013, WRAAA assumed care coordination responsibility for 967 persons of all ages with disabilities through a contract with CareSource under the Ohio Home Care and Transitions Medicaid Waiver Programs. CareSource was one of two Managed Care Organizations (MCOs) that was selected by the State to administer the Waiver programs statewide after the state reorganized the program. 2014MyCare Ohio is Launched in PSA 10A's Five Counties Ohio’s ICDS initiative named MyCare Ohio was officially launched in July 2014, in PSA 10A’s five counties. Three managed care organizations – Buckeye, Caresource and United Health Care – were selected by the state to serve dual eligibles in our PSA. WRAAA contracted with CareSource for the case management services and Buckeye and United Health Care for service coordination. WRAAA CEO Retires After 24 Years of Service In October, Ronald Hill, WRAAA’s CEO for the past 24 years, retired and his successor Dr. Douglas Beach was named. Dr. Beach is a former ODA Administrator, Orange County Florida AAA Director, State of Florida State Unit Director and Daytona Beach Florida Area Home Care Agency Director. Learn more about our current services and programs.