RSA-509 - Protection & Advocacy of Individual Rights (PAIR) Program Performance Report


General Information

Designated Agency Identification

NameMaryland Disability Law Center
Address1800 N. Charles Street
Address Line 2Suite 400
Zip Code21201
Website Address
TTY 410-727-6387
Toll-free Phone800-233-7201
Toll-free TTY800-233-7201
Name of P&A Executive DirectorVirginia Knowlton
Name of PAIR Director/CoordinatorLauren Young
Person to contact regarding reportLauren Young
Contact Person phone410-727-6352

Part I. Non-Case Services

A. Individual Information and Referral Services (I&R)

Multiple responses are not permitted.

1. Individuals receiving I&R within PAIR priority areas481
2. Individuals receiving I&R outside PAIR priority areas108
3. Total individuals receiving I&R (lines A1 + A2)589

B. Training Activities

1. Number of trainings presented by PAIR staff19
2. Number of individuals who attended training (approximate)600

PAIR staff provided outreach and training to staff and consumers of HOPE Center (Helping Other People through Empowerment), a program operated by Community Housing Associates. The purpose of the training was to inform low-income individuals with disabilities about their right to subsidized housing, how to navigate waiting lists and applications, and how to request reasonable accommodations. Method of training included a power point presentation, handouts designed by PAIR staff, an oral presentation and a question and answer session.

PAIR staff provided outreach at Health Care for the Homeless, Maryland’s largest provider of comprehensive health-related services for persons experiencing homelessness. PAIR staff provided information about MDLC’s housing work, shared information about how to apply for subsidized housing and distributed material including applications for public housing.

PAIR staff provided a fair housing training to a self-advocacy group at Health Care for the Homeless and provided a fair housing training. Methods of training included an oral presentation, hand-outs and a question and answer period followed the presentation. After the group question and answer session, two PAIR staff were available to discuss individual circumstances for persons wanting confidential time with an attorney on a housing matter. PAIR staff accepted several cases from this outreach.

PAIR staff were asked by the Maryland Department of Health and Mental Hygiene to meet with newly hired staff responsible for assisting persons transitioning out of nursing facilities under the State’s Money Follows the Person (MFP) demonstration project. PAIR staff met with MFP staff to discuss MDLC’s experience working with individuals in transition, including addressing transportation and housing barriers. As a result of this discussion, the State asked MDLC to present a separate housing training to the MFP housing specialists.

PAIR staff conducted a housing training for MFP housing specialists. The purpose of the training was to familiarize MFP housing specialist with fair housing laws. PAIR staff presented a power point and provided handouts. PAIR staff conducted an oral presentation including a question and answer session. PAIR staff also offered to provide further technical assistance and did so upon request of housing specialists on specific case matters.

PAIR staff participated on panel at a conference sponsored by Baltimore Neighborhoods, Inc. The purpose of the panel was to provide a training on fair housing laws. PAIR staff distributed written materials and made an oral presentation.

PAIR staff were requested to conduct a workshop at the National Disability Rights Network (NDRN) annual conference. The purpose of the training was to discuss advocacy tools for creating housing opportunities for person with disabilities within existing housing programs and potential opportunities created by the Frank Melville Permanent Supportive Housing Act. PAIR staff distributed handouts, provided written material for a training CD complied by NDRN and used a powerpoint presentation during this training. Oral presentation was followed by a question and answer session.

PAIR staff made a presentation to the Department of Disabilities, Advisory Commission on health care opportunities for persons with disabilities under the Affordable Care Act. PAIR staff presented orally and provided written material advocating certain actions for the State to adopt to support serving more persons with disabilities in the community.

PAIR staff had several meetings with private housing developers, real estate agents and brokers in order to provide information about financial incentives available from the Bailey Consent Decree for creating integrated rental housing opportunities for persons with disabilities. There were five separate sessions held between February 2011 and September 2011. The oral presentations focused on how mixed income developments benefit the entire community and the Notice of Funding Availability (NOFA) issued by the Housing Authority of Baltimore City offering fiscal incentives for rental housing development for persons with disabilities. (PAIR staff had provided comment and negotiation with the Housing Authority regarding the NOFA to ensure that it was usable by developers).  PAIR staff also addressed alternate ways to set up funding and ownership, such as multiple ownership methods, self-directed IRA’s and 1031 transactions. PAIR staff received a number of follow-up inquires, and there was an increase in applications for the Housing Authority NOFA issued over the course of the year.

PAIR staff were asked to address a student health law organization at the University of Maryland School of Law. PAIR staff addressed approximately 40 students with regard to working with low-income persons with disabilities and expanding opportunities to work on issues related to changes in health care and technology systems. The purpose of the meeting was to continue to build our relationship with the law school and make students aware of the importance of viewing health care from the perspective of persons with disabilities.

PAIR staff made a presentation to staff of a large private law firm about MDLC and PAIR work. The law firm sponsored a lunch for approximately twenty-five participants, which included partners and associates. A purpose of the outreach was to explain MDLC’s work and to educate members of the firm about significant issues facing people with disabilities. The presentation focused on education, health care and housing work done by PAIR and MDLC. Individuals at the firm expressed interest in taking pro bono cases referred from MDLC.

PAIR staff was recruited to provide training to 50 State officials, contractors and consumers in the Department of Health and Mental Hygiene’s Money Follows the Person Stakeholder Committee. The training focused on the rights of individuals in nursing facilities who had been labeled incompetent by the facility. The purpose of the training was to explain that such individuals have the right to information about community alternatives and to speak with peer counselors when they visit a facility. PAIR staff collaborated with the Legal Aid Bureau to develop a powerpoint, distribute handouts, and present this training.

PAIR staff was invited to present on nursing facility alternatives in a training hosted by the State Pro Bono Resource Center to train lawyers on involuntary discharge defense and negotiations with nursing facilities. PAIR staff trained the lawyers regarding: the rights of the resident to live in the most integrated setting, negotiations over involuntary discharge, and ensuring safe transitions to community services. Pair staff developed a powerpoint and handouts to compliment an oral presentation..

PAIR staff was asked to train 7 new peer-to-peer mentors hired by a Center for Independent Living to work with people who have transitioned from nursing facilities. The peers do an assessment and independent living plan with the individuals and provide peer support for up to the first twelve months after discharge from a nursing facility. PAIR staff used powerpoint, handouts, role playing, and discussion.

C. Information Disseminated to the Public

1. Radio and TV appearances by PAIR staff1
2. Newspaper/magazine/journal articles5
3. PSAs/videos aired300
4. Hits on the PAIR/P&A website17,107
5. Publications/booklets/brochures disseminated1,250
6. Other (specify separately)59,497


Other: 59,497 is the total number of MDLC website pages viewed.

PAIR staff developed and distributed a brochure about how to request reasonable accommodations in public housing from the Housing Authority of Baltimore City. The brochure was distributed at trainings and at an outreach event hosted by a non-profit organization that provides supportive housing for low-income and homeless individuals and families with disabilities. Approximately 50 brochures were distributed. The brochure is also available on MDLC’s website.

Approximately 100 copies of MDLC’s "The Sun Shines Brighter at Home" DVD were distributed to various nursing facilities, long term care ombudsmen, families and residents of nursing facilities.  "The Sun Shines Brighter at Home" is a video developed by PAIR staff and students from the Maryland Institute College of Art.  The video examines alternatives to nursing facility care and showcases former nursing facility residents who interview current residents and provide information about long term care options.  The video is available from MDLC’s website and on YouTube.  It has been viewed over 300 times this year.

PAIR staff helped coordinate distribution of approximately 400 fliers and 100 Medicaid program brochures to residents of nursing facilities.  The material addresses community service options for Medicaid recipients.

Approximately 300 copies of fair housing materials were distributed by PAIR staff at various training activities. The material distributed included information about fair housing rights for persons with disabilities. Information related to reasonable accommodations and modifications was also distributed.

Part II. Individuals Served

A. Individuals Served

Count individual once per FY. Multiple counts not permitted for lines A1 through A3.

1. Individuals still served as of October 1 (carryover from prior FY)101
2. Additional individuals served during the year56
3. Total individuals served (lines A1 + A2)157
4. Individuals w. more than 1 case opened/closed during the FY. (Do not add this number to total on line A3 above.)4

B. Individuals served as of September 30

Carryover to next FY may not exceed total on line II. A.3 above 52

C. Problem Areas/Complaints of Individuals Served

1. Architectural accessibility0
2. Employment0
3. Program access0
4. Housing91
5. Government benefits/services1
6. Transportation49
7. Education10
8. Assistive technology0
9. Voting0
10. Health care4
11. Insurance0
12. Non-government services0
13. Privacy rights0
14. Access to records0
15. Abuse0
16. Neglect0
17. Other2

D. Reasons for Closing Individual Case Files

1. Issues resolved partially or completely in individual favor85
2. Other representation found2
3. Individual withdrew complaint3
4. Appeals unsuccessful1
5. PAIR Services not needed due to individual's death, relocation etc.3
6. PAIR withdrew from case4
7. PAIR unable to take case because of lack of resources0
8. Individual case lacks legal merit12
9. Other0

Please explain

E. Intervention Strategies Used in Serving Individuals

List the highest level of intervention used by PAIR prior to closing each case file.

1. Technical assistance in self-advocacy8
2. Short-term assistance22
3. Investigation/monitoring0
4. Negotiation31
5. Mediation/alternative dispute resolution0
6. Administrative hearings5
7. Litigation (including class actions)43
8. Systemic/policy activities0

Part III. Statistical Information on Individuals Served

A. Age of Individuals Served as of October 1

Multiple responses not permitted.

1. 0 - 40
2. 5 - 2215
3. 23 - 59114
4. 60 - 649
5. 65 and over19

B. Gender of Individuals Served

Multiple responses not permitted.

1. Females93
2. Males64

C. Race/Ethnicity of Individuals Served

For individuals who are non-Hispanic/Latino only

1. Hispanic/Latino of any race2
2. American Indian or Alaskan Native0
3. Asian1
4. Black or African American105
5. Native Hawaiian or Other Pacific Islander0
6. White47
7. Two or more races0
8. Race/ethnicity unknown2

D. Living Arrangements of Individuals Served

Multiple responses not permitted.

1. Independent80
2. Parental or other family home49
3. Community residential home1
4. Foster care0
5. Nursing home6
6. Public institutional living arrangement2
7. Private institutional living arrangement6
8. Jail/prison/detention center1
9. Homeless12
10. Other living arrangements0
11. Living arrangements not known0

E. Primary Disability of Individuals Served

Identify the individual's primary disability, namely the one directly related to the issues/complaints

1. Blind/visual impairment16
2. Deaf/hard of hearing2
3. Deaf-blind0
4. Orthopedic impairment33
5. Mental illness0
6. Substance abuse0
7. Mental retardation0
8. Learning disability15
9. Neurological impairment28
10. Respiratory impairment3
11. Heart/other circulatory impairment13
12. Muscular/skeletal impairment17
13. Speech impairment0
15. Traumatic brain injury0
16. Other disability27

Part IV. Systemic Activities and Litigation

A. Systemic Activities

1. Number of policies/practices changed as a result of non-litigation systemic activities16

2. Number of individuals potentially impacted by policy changes13,200

Describe your systemic activities. Be sure to include information about the policies that were changed and how these changes benefit individuals with disabilities. Include case examples of how your systemic activities impacted individuals served.

The following describes PAIR activities to ensure access for persons with disabilities to: 1. affordable and accessible housing, with full opportunities to use and maintain such housing; 2. community based services for persons in or at risk of nursing facility placement; 3. public transportation services; and 4. youth athletic and physical fitness programs.

1. Activities to Ensure Access for Persons with Disabilities to Affordable and Accessible Housing, with Full Opportunity to Use and Maintain such Housing;

PAIR staff participated with other community partners in shaping an application from Baltimore County to the federal Department of Housing and Urban Development (HUD) that resulted in an award of housing vouchers for persons requiring housing subsidies as they leave nursing and other care facilities. PAIR staff were partners in several meetings to plan for the application to HUD. The application was successful, but the award of vouchers has not resulted in quick leasing of housing for persons wanting to leave nursing facilities, due in part to a lack of accessible housing.

PAIR staff collaborated with several legal service organizations to file an administrative complaint with the federal Department of Housing and Urban Development (HUD) regarding the lack of affordable and accessible housing in one Maryland jurisdiction. The Complaint alleges discrimination in the use of federal entitlement and voucher funds (housing and community development funds). The Complaint is also based on the failure of the jurisdiction to affirmatively further fair housing as required by the Fair Housing Act. The Complaint traces the historic segregated housing choices and policies of the jurisdiction which has resulted in low income housing being concentrated in areas of poverty and minority concentration. The failure of the jurisdiction to operate public housing, which would require at least 5% of the units to be accessible, combined with the failure to develop new opportunities for low income rental housing with federal funds, which would also require accessible housing to be developed, has had a disparate impact for persons with disabilities. About 85% of the housing in the jurisdiction was developed prior to the effective date of the Fair Housing Act and is not accessible to persons with disabilities. Persons with disabilities who receive vouchers from the jurisdiction are unable to find accessible housing, severely limiting the opportunities of the voucher program for persons with disabilities. PAIR staff is representing two of five named individuals on the Complaint as they need accessible housing but cannot locate such housing. The Complaint allegations include that the voucher program is not accessible and that the failure to identify needs and to plan for accessible rental housing violates the duty of the jurisdiction under HUD regulations to identify impediments to fair housing and to develop steps to remedy the impediments. Over 50% of the jurisdiction’s voucher holders are people with disabilities; 12.3% of persons with disabilities living in the jurisdiction live in poverty, compared to 5.4% of persons without a disability. The jurisdiction has approximately 7,500 renters with disabilities with incomes between 30-80% of area median income. The need for affordable and accessible housing is urgent. HUD has accepted the Complaint and served the Respondents.

PAIR staff had provided training and outreach to homeless individuals who are members of a self-advocacy group sponsored by Health Care for the Homeless. Subsequent to the outreach, this group asked for assistance with getting repairs made to a homeless shelter in the City. The accessible bathroom was reportedly lacking a sink, adequate lighting and a toilet seat, and these deficiencies were reported to have existed for over six months. The advocate group had met with administrators for the shelter and City of Baltimore representatives, but the repairs had not been made. PAIR staff wrote to the executive director of the program that operates the shelter, and requested that the repairs be made without delay. Within days, PAIR staff received a call from the program director thanking staff for the letter, which the program shared with the City’s Department of General Services. The program director reported that Department had previously been non-responsive to their request for repairs. Shortly thereafter, however, PAIR staff received a call from an individual from the self-advocacy group, reporting that the repairs had been completed.

PAIR staff participate in regular advocate meetings with the Commissioner of Baltimore City Housing and of the Housing Authority of Baltimore City (HABC). PAIR staff were successful in getting HABC to change its policy denying eligibility for public housing or vouchers to persons who have been terminated or evicted from transitional housing. HABC had denied eligibility to anyone who had been terminated or evicted from transitional housing in the three years prior to being eligible for public housing or a voucher. HABC agreed that terminations or evictions related to a violation of the transitional housing rules that are not otherwise related to a person’s tenancy, and would not be a substantial and material breach of a lease, should not be cause for denying that individual eligibility for public housing or a voucher.

PAIR staff partnered with a group of advocates and HABC to successfully apply to HUD for 40 vouchers for the Housing Authority to use for non- elderly persons with disabilities who are able to transition from nursing facilities into the community with rental assistance. All forty vouchers were used successfully to help individuals move into homes in their communities.

PAIR staff represent an individual who is currently in a nursing facility but who wants to live in the community. Her previous tenancy was terminated due to poor conditions in the apartment, which deteriorated when her health worsened and she was not able to physically manage her housing unit. Thereafter, she became eligible for a voucher but was denied based on her previous tenant history. While in a nursing facility she became eligible for Medicaid home services, including a live-in aide. PAIR staff successfully advocated for a reversal of the denial of eligibility based on the fact that her prior difficulties were related to her disability and would not be repeated as she now had assistance for her tasks of daily living. Without a voucher the client would not be able to rent an apartment and would remain unnecessarily in a restricted nursing facility.

PAIR staff assisted a housing client who has a respiratory disease and orthopedic disabilities for which she uses an electric wheelchair. The client originally called because she needed to postpone her annual Section 8 housing inspection. The unit had failed inspection because of peeling paint in the client’s bedroom, and the landlord needed to scrape, sand and repaint in her bedroom. The client had attempted to postpone the inspection but had been told by HABC that it wasn’t possible and she should leave the unit while her landlord made the repairs. Since she had bronchitis, which exacerbated her existing respiratory condition, the client was unable to leave her unit. PAIR staff asked for a reasonable accommodation such that the inspection was postponed until she was feeling better, which was approved. In working with the client, PAIR staff discovered that the client’s rent had increased by a substantial amount because the Housing Authority had lowered its utility allowances system wide. As a result, the client was having trouble keeping up with her utility bills. PAIR staff talked to the client and realized she was using a C-PAP machine throughout the night, an oxygen concentrator, a nebulizer, and an electric wheelchair. Because of her disability-related equipment, she was using more than the typical amount of utilities. PAIR staff asked the Housing Authority to provide her with an exception to the utility allowance, to ensure that she was equally able to participate in their housing programs. The exception was approved, and her rent has decreased by $21 each month. While negotiating with the utility company over the client’s turn-off notice, PAIR staff discovered that the utility had improperly removed the client from their Special Needs program, which gives customers with lifesaving medical equipment extra protection against turnoffs and more time to pay their bill. PAIR staff questioned the utility company and determined that it was erroneously telling customers on the Special Needs program that they needed to file a new application every six months.  PAIR staff then assisted the client in filing a complaint with the Public Service Commission, and a week later, the client was reinstated to the Special Needs Program and given an apology by the utility company. This case demonstrates how policy changes for one client can affect numerous others similarly situated.

PAIR staff were asked by a group of national housing advocates to meet with the Chief of Staff for Congressman Chris Van Hollen to discuss the need to protect federal community housing and development funds and housing subsidies. PAIR staff discussed how affordable housing is needed as an alternative to institutional and nursing facility placement and how such placements reduce federal Medicaid costs. PAIR staff were requested to provide data and studies supporting the cost benefits, which was subsequently submitted.

PAIR staff have been negotiating for changes at Orchard Ridge, a new housing development in Baltimore City. The housing is on the prior development site of Claremont Homes (formerly public housing development). The housing includes 10% accessible units (over the federally required 5% for new construction) as set forth in the Bailey Consent Decree. The accessible units were occupied, but monitoring revealed that they were not all occupied by persons needing the features of the unit. PAIR staff negotiated with the Housing Authority to correct this problem and to ensure that systems are in place to prevent this problem from occurring in other city developments. Further monitoring revealed that the units did not yet have accessible routes of travel to the community building or bus stops. PAIR staff negotiated for the developer to pay a private transportation system to take residents with disabilities who need accessible transportation to and from the community center and management office free of charge pending completion of the accessible routes. PAIR staff are in the midst of partially resolving the accessible bus stop issues at Orchard Ridge which involves negotiations with the City (sidewalk and curb cut issues), Maryland Transit Administration (re-routing issues), and the developer (internal path of travel issues). PAIR staff learned from a client that the bus stops at the new development have not been accessible for several years as part of the re-development process was delayed. PAIR staff had been provided with copies of plans and blueprints that showed an accessible route, which is required for the housing unit to serve persons with mobility impairments.

PAIR staff have raised the accessibility problems with "phased development" plans with officials from Baltimore City and the State Department of Housing and Community Development, as those entities contribute resources to many affordable housing projects. Officials have written to PAIR staff stating that in the future they will require accessibility and will require their architects to review all planned phases, not simply the construction plans for developments.  This will be helpful as future development projects involve phased development and some projects include the same developer at issue in the Orchard Ridge development.

PAIR staff represented an older gentleman with disabilities, who had been removed from HABC’s automatic rent debit program. The gentleman had been forgetting to pay his rent on time (and paying rent twice in other months), resulting in late fees and other court judgments, so the automatic debit program was a reasonable accommodation to allow him to remain stably housed. When the gentleman came to MDLC, he had been removed from the program because he had requested that the automatic debit be delayed once by a week or two so that he could help his family with funeral costs. When he asked to be reinstated in the program, his request was refused. PAIR staff educated our client about the reasonable rules of the automatic debit program and convinced HABC to reinstate him as a reasonable accommodation for his disability which caused him some memory problems.

PAIR staff assisted a man with disabilities who had been removed from the HABC waiting list for failing to respond to an eligibility letter. HABC had neglected to contact the man’s emergency contact, which is a requirement of the Bailey Consent Decree. Once reinstated, staff negotiated with HABC to extend the time period for an eligibility appointment because the man was in jail on a nuisance crime, behavior arguably related to his disability. PAIR staff then worked with his public defender and the court to educate them about the likelihood of the client being denied eligibility for public housing if he had a misdemeanor on his record. The charge was placed on the stet docket to avoid a conviction but to permit reactivation of the charge if the client picks up other charges within a year. PAIR staff next assisted the man with obtaining a birth certificate from out of state so he could present needed documents to be found eligible for housing.

MDLC was contacted by a woman living in a project based housing unit in southern Maryland. The client has a number of learning disabilities and muscular/skeletal impairments. She received an eviction notice due to conflicts with her neighbor. The County was not providing any assistance for her to relocate to an accessible unit and had threatened an eviction proceeding. After contacting the County Housing Office and then the County Attorney, PAIR staff was able to get the client additional time to find a unit. PAIR staff helped her to find an accessible housing unit, but the client was subsequently hospitalized. At the hospital, she damaged a computer while trying to leave and the hospital filed charges against her. If any of the charges had been successful, the client would have lost her voucher. PAIR staff was able to get the hospital to understand how the client’s behavior was tied to her disability, the stress of the hospitalization and lack of housing. The hospital agreed to dismiss their claim, which could have resulted in the client being found ineligible for her housing subsidy. The client called the day after she moved into her new home and said she had already met her next door neighbor, she loved the house and so did her dog.

PAIR staff assisted a single mom with a young son who has muscular sclerosis. The mom suffered a stroke and was no longer able to lift her son to take him to school or get him out of the house. She had a housing voucher and attempted to port her voucher from the County to the City to get her son into a school program that would better attend to his needs and provide him with transportation. The County had refused to allow her to port her voucher and she was forced to move without having a housing subsidy. She came to MDLC for assistance when she became unable to afford her rent. PAIR staff convinced the County to reinstate her voucher and advocated for the City to accept her voucher being ported to the city. With assistance of PAIR staff, the client found a unit with a no step entrance, although it was not fully accessible. This unit was initially usable for the client and her son. After six months, however, her son’s condition worsened, thus they needed a fully accessible unit and an additional bedroom to accommodate the needed medical equipment. PAIR staff requested a larger bedroom size voucher subsidy and also made a reasonable accommodation request to the landlord to ask that the client be allowed to move prior to her lease ending. The advocacy was successful and mom and son have moved into a new accessible home.

2. Activities to Ensure Community Based Service Options for Persons In or At Risk of Nursing Facility Placement:

PAIR staff participated in a “Long Term Services Supports and Reform Committee” required by the Maryland General Assembly. The implementing legislation specifically named Maryland Disability Law Center as a member of this Committee. PAIR staff advocated for the State to act quickly to embrace opportunities under the Affordable Care Act (ACA). PAIR staff provided written recommendations to the Committee, the new Deputy Secretary for Medicaid, and the Secretary of the Department of Health and Mental Hygiene relating to the Committee’s work. Consistent with MDLC’s recommendations, the Committee endorsed opportunities available through the Community First Choice option and the Balancing Incentive Payment Program in the ACA.

PAIR staff collaborated with representatives from the State Department on Aging, the Department of Disabilities, State Center for Independent Living, and local area agency on aging to develop “Options Counseling protocol,” a model being piloted to engage nursing facility residents regarding health care service alternatives to nursing facility care. PAIR staff worked to ensure that the communication accommodation section of the protocol was strengthened and that the protocol adopts the supported decision making model embraced in the International Convention on Persons with Disabilities as opposed to a substituted decision making model. (

PAIR staff was appointed to the Department of Health and Mental Hygiene’s “Money Follows the Person” (MFP) Stakeholder Committee. As part of their effort on this Committee, PAIR staff focused on data review and client experiences in State waiver programs which suggested that: (a) individuals in nursing facilities were not being educated that they could apply for more than one Medicaid waiver program; (b) some areas of the state demonstrated no referrals for one of the waivers, and (c) there were delays in providing both program outreach and waiver application assistance to individuals residing in nursing facilities. PAIR staff successfully advocated for the following program changes: 1. Nursing facility residents who qualify for more than one waiver program will be presented with program information about all of their options. Both the aging waiver and the disabled waiver options counselors will present program information to such individuals. 2. Waiver Application assistance must be provided the same day it is requested. 3. Specially designated housing staff will be identified in an individual’s waiver plan of service to assist the person with home hunting and to include provision of such assistance if the individual transitioned from a nursing facility to an assisted living facility.

PAIR staff reviewed outcomes for people who had transitioned to the community during the first two years of the MFP demonstration grant. This data demonstrated that individuals who transitioned to assisted living facilities (ALFs) had a significantly higher rate of return to a nursing facility within two years of discharge than did individuals who transitioned into a home setting. PAIR staff have used this data to urge more focus on independent living opportunities for persons transitioning from nursing facilities.

PAIR staff identified that some nursing facility residents were not being informed of their Medicaid options and community alternatives to nursing facility care as required by state law. The State has elected to provide education and outreach to nursing facility residents, in part by retaining peer outreach coordinators to go into nursing facilities and meet with residents. (This model is based on the SunShine Folk project developed by MDLC). At issue was the problem that the State prohibited the peer outreach coordinators from meeting with anyone the nursing facility labeled as incompetent. PAIR staff learned from peer outreach coordinators that they had concerns about certain nursing facilities using this process to impede the ability of residents to learn about alternatives to their current placements. One peer coordinator complained to PAIR staff, “We weren’t allowed to visit IC’s. The more we tried to visit, the higher the number of IC’s there were. For example, we may have had 15 visits to see in a nursing facility, but were only allowed to see 4.” PAIR staff wrote to the State about this issue as the law presumes competency. PAIR staff also made presentations on this issue and provided a workshop on the topic to generate pressure for changed policies. The State modified its instructions for peer coordinators to state: “The State currently does not have a statutory or regulatory basis for determining who can and cannot provide informed consent without a formal adjudication process. Thus, in most instances, informed consent is a process where there is agreement that the person involved is aware and is making an express choice to live in the community.” This language reflects a policy change consistent with PAIR advocacy. Peer coordinators are no longer prohibited from meeting with persons the nursing facility decides are not competent.

PAIR staff advocated for the state-funded Peer Support contracts, which provide for outreach to persons in nursing facilities, to include coordinating with the Office of the Ombudsman for intervention on behalf of individuals who (a) are labeled incompetent by a nursing facility but who have not been so adjudicated by a court, and (b) have guardians who object to individuals learning about nursing facility options.

An example of an individual case: During outreach to one facility, PAIR staff met an individual who had lived in her own apartment before she became ill and experienced a stroke when she was forty-nine years old. When PAIR staff met this individual, she had lived in the nursing facility for two years and had never been informed of her options under Medicaid for community based care. She wanted to be referred to the waiver program. During her stay in the facility, however, she developed bed sores resulting in multiple hospital admissions. The State delayed her community service planning process based on her hospitalizations. With technical assistance and advocacy, the individual and her peer mentor persisted in her request for community services until her waiver application was approved. She was ultimately discharged to her own apartment on a Medicaid waiver.

PAIR staff advocated for a change in policies so that persons in nursing facilities who had requested Medicaid waiver services prior to being admitted to such facilities could be provided with waiver application assistance immediately, without the standard procedure of waiting for a referral after receiving information about Medicaid options. PAIR staff advocated that these individuals had clearly learned about the option of Medicaid waiver services as they had requested such services prior to their admission to a nursing facility. PAIR staff requested to receive data related to this group of individuals and learned that 1,400 individuals entered nursing facilities after being on waiting lists for community services, sometimes for several years. The State agreed that individuals who had applied but not received community waiver services prior to a nursing facility admission were eligible for immediate assistance and did not need to wait to receive program outreach and education.

PAIR staff advocated that the state adopt a uniform assessment instrument as required for participation in the federal Community Choice Option program. PAIR staff also urged the State (through written and oral presentations) to review the waiting list registries to identify individuals who are at risk of institutionalization if they do not receive community services. Maryland’s 2011 Money Follows the Person Operational Protocol states that Maryland will use federal funds to “Prioritize the Waiver Registries — Assess all individuals on the Living at Home and Older Adults waiver registries using the new evidence-based standardized assessment instrument and prioritize based on need rather than date of application.”

PAIR staff sent written correspondence to the Secretary of the Department of Heath and Mental Hygiene and the Deputy Secretary for Medicaid regarding health care issues that prevent people from obtaining health care services in the community. The Secretary invited PAIR staff to meet and discuss these issues with himself and key staff. One of the issues discussed was the delay in processing long term care Medicaid applications for persons who had community Medicaid prior to entering a nursing facility. PAIR staff discussed the adverse policy and civil rights implications of such delays. Because only people on long term care Medical Assistance are eligible for the State’s outreach and case management services from the Department’s Home and Community Based waivers, a group of over one thousand individuals is missing a critical opportunity to learn about community service options at a crucial time after they have entered a nursing facility. The State’s delay in processing long term care applications also delays the individual’s ability to plan for obtaining community services available through the Medicaid waiver. This is an issue that needs continued advocacy to resolve, but was identified by the State as a priority to fix before the new year.

PAIR staff met an individual at a nursing facility who wanted to leave and return to the community, but believed he could not sign the necessary documents. The individual lacks motor function in his upper limbs and has other limitations due to a progressive neurological condition, but appeared able to communicate his wishes and needs. The nursing facility had deemed him not competent, but no court had made such a determination. PAIR staff listened to his situation and returned to visit him. On the return visit, staff brought a picture of a person with a disability signing a document while holding a pen in his mouth. PAIR staff had a law student intern, who also had limited motor function in her limbs, accompany the visit to this individual and demonstrate signing a paper by holding a pen in her mouth. When he was ready, PAIR staff placed a pen in the individual’s mouth and held a clipboard with the documents while he made his mark. The individual then decided he wanted to learn to write his initials. This individual has expressed himself more and now has a community waiver service coordinator, and has begun his path to his own home.

3. Activities to Ensure People with Disabilities have Equal Opportunity to Public Transportation Services: PAIR staff worked with other advocates to make Metro Access, a paratransit service serving Montgomery and Prince George’s Counties, revoke a restrictive policy requiring that all paratransit users, who had assistance from a third party to apply for or schedule their rides, produce a power of attorney or guardianship order to authorize the individual’s use of the public transpiration service before Metro Access would serve the individual. PAIR staff coordinated with several individuals and organizations to send a formal letter of protest regarding the policy and challenging its legality. After communications and meetings, the policy was revoked. Many individuals who use assistance from third parties would have been prevented from access to public transportation had this policy remained in force.

4. Activities to Ensure Youth with Disabilities Have Equal Opportunities in Athletic and Physical Fitness Programs:

PAIR staff was invited to attend a conference on inclusive fitness as a result of our work to expand opportunities in physical education and athletic activities for students with disabilities. At the conference, PAIR staff met the Director of Up2Us, a program that facilitates funding for coaches and leadership programs for high risk youth. The program is similar to Teach for America. PAIR staff connected this program with several Maryland non-profits, including: Safe and Sound, Play Works, Out of School Time Network, Special Olympics Maryland. These non-profits and MDLC have met several times and decided to host a ’Coaches Conference’ in Baltimore City in 2012 to bring together coaches from various recreational programs to share information, identify resources, consider working with Up2Us, and promote inclusion in all programs. PAIR staff will work on the inclusion issues. The group is interested in making sure that youth with disabilities are seen as important contributors in all activities. The group has discussed having youth athletes with disabilities present for discussions with coaches as well as coaches with experience in working with youth with disabilities.

PAIR staff have continued to monitor implementation of the Fitness and Equity Bill for Students with Disabilities. PAIR staff have reviewed compliance reports from local education agencies and observed numerous unified sport programs offered by school systems, including interviewing youth about their experiences at several events. All but one school system reported adopting policies for including youth with disabilities in school based physical education and athletic activities as required by the law.

B. Litigation/Class Actions

1. Number of individuals potentially impacted by changes as a result of PAIR litigation/class action efforts50,000
2. Number of individuals named in class actions8

Describe your litigation/class action activities. Explain how individuals with disabilities benefited from your litigation activities. Be sure to include case examples that demonstrate the impact of your litigation.

HOUSING LITIGATION: PAIR staff continues to monitor implementation of the federal court Consent Decree, Bailey et al. v. Housing Authority of Baltimore City (HABC) and a separate settlement agreement with the City of Baltimore. This case was initiated as a class action on behalf of persons with disabilities who were applicants for or residents of public housing operated by HABC and who were denied: access to affordable, accessible housing; access to subsidized housing; and/or reasonable accommodations so that they could enjoy the full benefits of the housing program. Plaintiffs include a person who was unable to use a bathroom for 19 years due to the failure of HABC to provide accessible housing in its public housing program. This Plaintiff could not go upstairs to her bedroom and the bedrooms of her children due to the inaccessibility of the unit. Her repeated requests to transfer were ignored. Another Plaintiff was a man who was homeless for years even though he should have been offered a subsidized housing unit based on his place on the HABC waiting list. HABC illegally restricted people with disabilities from leasing thousands of available housing units. The lack of stable housing and transient life style had negative consequences for his health and he had several hospitalizations related to his physical disabilities during the time he was living place to place. Another Plaintiff had requested reasonable accommodations in writing from the Housing Authority but never had a direct response to her request, which should have been granted.

As a result of the consent decree, HABC has developed reasonable accommodation policies and procedures. HABC has trained its staff in fair housing obligations (with a continued obligation for training new staff). The Consent Decree requires HABC to make between 5-7% of their approximately 10,000 public housing units accessible for persons who use wheelchairs and 2% of the units accessible for persons who have vision impairments or who are deaf or hard of hearing. The Consent Decree also provides 850 remedial tenant-based housing vouchers to be set aside exclusively for persons with disabilities. The Decree establishes an “enhanced leasing assistance program” to provide services and funds for persons with disabilities who receive a voucher subsidy so that they can be successful in leasing a housing unit. The enhanced leasing assistance program provides participants with funds for security deposits, rental applications, utility hook-ups and case management services, including transportation to look at potential apartments that accept vouchers and six month post-leasing stability services. The Consent Decree also requires that certain financial incentives be available to housing developers to stimulate development of affordable rental housing to be produced for people with disabilities on the HABC waiting list. The monitoring of the Consent Decree is a time consuming process. The following are examples of how individuals with disabilities benefited from the litigation:

PAIR staff learned that HABC was counting, as part of the 850 vouchers obligated for persons with disabilities under the under the Consent Decree, vouchers used by individuals who ported to other jurisdictions and using vouchers from the receiving jurisdiction. PAIR staff successfully argued that these 40 vouchers could not count towards the Bailey set-aside requirement. Thus, more vouchers were provided to individuals who will also receive assistance with transportation to visit potential rental units, security deposits, application fees, lease negotiation and follow up services as mandated by the Decree.

PAIR staff had several case intakes where individuals were denied a live-in-aide by HABC, despite a disability related need for such assistance. PAIR staff contacted Counsel for HABC and provided specific case examples. HABC immediately acted to correct the problem and has a policy stating that no one but the Director of the Fair Housing Enforcement Office can deny a request for a reasonable accommodation. HABC also has a process for an in-person meeting with individuals prior to denying a request to ensure proper communication and understanding by all parties.

PAIR staff learned that HABC was requiring tenants who requested live-in aides to submit a notarized statement from the live-in aide acknowledging that they have no right of tenancy if the tenant leaves the housing unit. This requirement was burdensome for clients as getting out to a notary was not an easy task. After some advocacy with HABC, that agency agreed to accept a signed statement without requiring it be notarized.

Upon review of mandatory compliance reports provided pursuant to the Bailey Consent Decree by the Housing Authority of Baltimore City, PAIR staff realized there was a problem with the number of vouchers being issued by HABC. When one of the 850 tenant based vouchers turned over due to a person leaving the voucher program, HABC was not re-issuing the voucher to a person with a disability on the voucher waiting list. After investigation and negotiation, HABC resumed issuing turn-over vouchers as required by the Consent Decree.

PAIR staff learned from a client that HABC was requiring people with disabilities on a waiting list for subsidized housing to provide a lengthy medical verification form to establish that they had a disability. Individuals were provided a short time frame to have their medical provider complete the form and to return it to HABC, or the individual could choose to certify that they did NOT have a disability. Failure to complete either form in a few weeks would result in the person being withdrawn from the waiting list. PAIR staff had multiple concerns with the letter and tried repeatedly to negotiate a halt to this new policy. PAIR staff had to draft a motion for a temporary restraining order for federal court before HABC agreed to retract their letters. A retraction letter was sent to all individuals who received the initial letter and HABC agreed not to take any adverse action regardless of what information had been submitted by an individual (for example, if someone submitted a certification that they did not have a disability in order to maintain their status on the waiting list, HABC agreed not to use the certification for purposes of establishing the person did not have a disability). One of the problems with HABC’s actions was that if people could not get to a doctor and return the 5-page form within a very short time period, they might decide to certify that they did not have a disability in order to stay on the waiting list. However, the result of such a certification would be that they would in effect be taken off the waiting list as they no longer qualified for a preference established under the Consent Decree. HABC’s letter did not inform people of this consequence. In addition, many clients who received the letter assumed the medical form and certification were only required for people who needed accessible units as most of the medical form dealt with unit modification needs for persons with physical disabilities. Other problems included that a medical verification is not required by HUD or HABC policies which permit verification from multiple non-doctor sources. HABC retracted their letter and agreed to hold harmless anyone who responded in any manner. HABC also agreed to hold personal interviews to explain options to those who may need various features of an accessible unit or other accommodations, and to accept letters or statements from case managers, social workers, and SSI or State temporary disability award letters, etc. for purposes of verification of disability.

After reviewing compliance data required by the Bailey Consent Decree, PAIR staff noticed that from October, 2010 - March 2011, 52 families were identified as having "Immediate Needs" under criteria established by the Decree. However, 22 families had delays in moving through the process established by the Consent Decree. PAIR staff identified this problem, which involved inaccurate characterization of the requests, and HABC agreed to change one of its forms that created confusion among its housing managers and the resulting delays. HABC made the appropriate changes and provided training to housing managers in the proper use of the revised form in order to respond promptly to such requests.

PAIR staff learned that HABC was requiring tenants with vision or hearing impairments to provide new medical verification forms in order to obtain vision or hearing related modifications to their housing units (e.g., a flashing door bell), which resulted in delays or inability to obtain modifications when the need was obvious or other verification was available. PAIR staff successfully advocated for a change in this policy and practice.

PAIR staff spent a significant amount of time working with independent experts and HABC and doing research on issues related to the creation of housing units for people with disabilities under the Bailey Consent Decree. HABC revised its Notice of Funding Availability (NOFA) in several ways over this past reporting period to generate more responses and be more effective with its resources. The revised NOFA more clearly specifies the process and time frames for the numerous required steps so developers can understand the process required by the City, State and Federal governments for use of available funds and voucher resources. As a result of PAIR advocacy and memorandum of law, HABC eliminated a burdensome requirement for "subsidy layering review" which had created delays of up to six months for developers to obtain funding, and made the process unworkable for incorporation into certain on-going development projects. In addition, HABC is outsourcing part of the process to a private program with particular expertise, which should provide needed efficiency to the program. (The private entity will do environmental reviews, housing quality standard inspections and some fiscal programmatic review.) HABC has also changed the operation of the NOFA to provide several specific rounds for competition and enable processing of applications in a more efficient manner. These changes are beneficial to the development process and will advance the obtaining of Consent Decree remedies.

Forty-five new units of housing were approved during the last tax credit round which will be occupied by low income persons with disabilities on the Housing Authority’s waiting list. These units will be distributed among four different housing developments and are in addition to the number of vouchers reported above.

PAIR staff learned that the funds set aside in the Decree for individuals who use tenant-based vouchers and need modifications to their unit were not being used. Generally the responsibility to pay for such modifications lies with the tenant, which is why the set-aside funds were established by the Decree. The process of informing tenants of their right to access these funds had not occurred. PAIR staff negotiated with HABC, and tenants were then sent letters informing them of their right to request modifications along with forms for the tenants to complete. Follow-up phone calls were also made in an attempt to provide information to the tenants. Fifty-seven tenants responded requesting modifications. The process of hiring contractors to provide needed modifications and obtaining permission from private landlords to make the modifications has been slow.

Case example: PAIR staff has previously assisted a client with getting repairs made to her wheelchair lift outside her public housing unit. The wheelchair lift repeatedly broke down; she had been unable to get to her college classes and as a result had to withdraw from her technical college. After much negotiation, HABC gave the client a Section 8 voucher as part of its Immediate Needs Program set up under the Bailey Consent Decree as a remedy to persons living in inaccessible housing. The Immediate Needs program establishes a process for providing assistance to families who face physical barriers using the kitchen, bathroom, entry or exit of their housing units. The Immediate Needs program reviews with the client whether structural changes can be made to accommodate the family or whether a move or transfer is needed. In this case, the client needed to move as the lift malfunctions became chronic. With the assistance of PAIR staff, the client was able to lease a unit in a tax credit development, which was not entirely accessible but had an accessible entrance and other modifications. HABC also paid for the client’s security deposit and utility hookups to allow her to move into the unit as required by the Consent Decree. The client was the first Section 8 voucher holder to rent a unit in the tax credit development, which had been open since 2003. Tax credit developments are prohibited by law from discriminating against Section 8 voucher holders, however, PAIR staff needed to instruct the housing project about the law and to advocate on behalf of the client to ensure she had a fair opportunity for housing at this newer development. Other persons with vouchers have since applied to this property. The client remained in the unit for a year and a half, until she had a baby and needed a larger unit. This past year, PAIR staff assisted the client in moving to a new tax credit development into a fully UFAS accessible two bedroom unit that better meets the needs of the client and her child. This unit was produced as a result of the Bailey Consent Decree. While some of the activity described above occurred prior to the time frame established by this Performance Report, the entire chronology is significant to recognize the systemic impact of the Bailey Consent Decree which PAIR staff litigated and continue to monitor.

PAIR staff successfully represented an individual in a court breach of lease action who was enrolled in a Medicaid waiver program which allowed her to leave a nursing facility and live in the community with her children. Her children had been placed in foster care after she entered a nursing facility. PAIR staff argued that the activities complained of were related to the client’s disability, did not rise to the level of being substantial breach of the lease, and were cured as new in-home services were being provided to the client. The court ruled in favor of the PAIR client.

TRANSPORTATION LITIGATION: PAIR staff continued to monitor provisions of the federal court settlement agreement, Smith et al v. Swaim-Staley et. al. The case was initiated as a class action on behalf of persons with disabilities who are eligible to use the Maryland Transit Administration (MTA) paratransit program. The lawsuit alleged that the State system discriminated against persons with disabilities by operating with prohibited capacity constraints in violation of federal law. The lawsuit identified problems with: on-time performance, missed trips and vehicle no-shows, people being left stranded by the transit system, accessing telephone reservationists, and arrival announcement of vehicles for persons who are visually impaired.

People use the paratransit public transportation service to attend medical appointments, including dialysis; to go to school, work, and religious activities; and for other reasons. A prior Secretary of Maryland Department of Transportation described the system as “dysfunctional” prior to the lawsuit being filed. PAIR staff continued to meet regularly with the federally sanctioned Class Representatives during this past year. PAIR staff review data reports from MTA and share the data with Class Representatives. The Class Representatives also share their experiences and analyze issues from the rider perspective. The lawsuit terminated according to the terms of the agreement in February 2011, but according to a pre-termination agreement, the parties continued meeting as the process was recognized to be beneficial to service improvement. Examples of how individuals with disabilities benefited from this litigation and negotiation process include the following:

Maryland Transit Administration officials provided Class Representatives the opportunity to review and comment on a new vehicle prototype. In the past, riders had negotiated changes to the vehicle configuration used by MTA. In particular, vehicles that required persons who use wheelchairs to be secured in the back of the vehicle produced a painful ride for many clients. After much discussion, MTA altered the vehicle purchase. Clients had also complained that the large vehicles, which would pick up several persons using wheelchairs, also resulted in lengthy trips taking passengers around town and keeping people on a vehicle much longer than warranted. The vehicle recently reviewed addressed these issues and was strongly endorsed by Class Representatives.

Class Representative had urged MTA provide better scheduling for riders using kidney dialysis as the riders are generally traveling three days a week at regular times and to fixed destinations. MTA initiated a pilot dedicated kidney dialysis service to address these issues. Some improvements appear to have been made as a result of this service, but not all dialysis centers are well-served and the program doesn’t incorporate people who use motorized scooters, which are issues for further development.

This past year MTA implemented the interactive voice response system, which Class Representatives had long advanced and which was piloted last year. The system calls riders the night before a schedule ride as a reminder and a prompt to the rider to cancel the ride if it is no longer needed, which promotes system efficiency. T he system also calls the rider when it estimates the vehicle is five minutes away from a pick up destination. There have been a few bugs in this system, which Class Representatives have shared with MTA officials, but it is a significant improvement.

Class Representatives and PAIR staff met with approximately 100 riders and MTA officials to discuss service issues this past fall. Immediately following the large forum, Class Representatives and MTA officials met to address systemic issues identified by riders. One issue addressed was telephone reservation agents and MTA agreed this was an issue for further review. MTA ultimately engaged an expert to review the phone systems and make recommendations for better service.

Class Representatives shared their experiences with a telephone late line service being "closed" on certain weekend evenings. This line is to be used for riders to contact MTA when a ride is over 30 minutes past its scheduled arrival time. It was very problematic for a stranded rider not to be able to reach an operator to get help when their ride did not appear when it is late and dark. This problem was remedied.

PAIR staff intervened on behalf of two riders who were left without transportation service and in a critical situation. A vehicle has been sent to pick up the riders, both of whom use wheelchairs. The vehicle did not have required securement devices and could not provide service to the passengers. The driver tried to contact the control center but was unable to get assistance for the two riders. One of the riders uses oxygen and her tank ran out while she was waiting. She had a nurse and back up oxygen tanks waiting at her home. The riders were able to reach PAIR staff who contacted the Director of Mobility who immediately intervened to get service to the riders, whose self-advocacy with Mobility had not resulted in an immediate response. Mobility examined the situation for corrective instructions to employees.

PAIR staff learned that a paratransit rider was sometimes being dropped off at an unsafe location and contacted officials to ensure that a notation was placed on his record indicating where he needs to be dropped off to avoid crossing a major street. His profile was updated to address this issue.

When storms caused power outages, the paratransit system did not have sufficient back up to process rides or check on the status of late rides. MTA officials contacted PAIR staff to make them aware of the problem and issued alerts providing an emergency contact number. A rider contacted PAIR staff to inform them that the contact number was incorrect. PAIR staff contacted the paratransit service who corrected the error. PAIR staff also put up notices on the MDLC website and Facebook page to inform riders of the problems and contact number.

PAIR staff have also intervened on behalf of several individuals who had problems with re-certification or eligibility determinations. On a case-by-case basis these individuals obtain services, but the systemic issues do not appear to be fixed. MTA acknowledges the need to improve the certification process.

OTHER: PAIR staff participated in filing an amicus brief in Brooks v. MHIP, in which the Court of Special Appeals found that the Maryland Health Insurance Program cannot terminate participants from the program without providing due process, including a full evidentiary hearing and an impartial arbiter. The lower court had upheld the State’s process in terminating the individual from services, which did not provide for full due process.

Part V. PAIR'S Priorities and Objectives

A. Priorities and Objectives for the Fiscal Year Covered by this Report

For each of your PAIR program priorities for the fiscal year covered by this report, please:

  1. Identify and describe priority.
  2. Identify the need, issue or barrier addressed by this priority.
  3. Identify and describe indicators PAIR used to determine successful outcome of activities pursued under this priority.
  4. Explain whether pursuing this priority involved collaborative efforts by other entities. If so, describe this collaboration.
  5. Provide the number of cases handled under the priority. Indicate how many of these, if any, were class actions.
  6. Provide at least one case summary that demonstrates the impact of the priority.

Priority in Advocacy Services: Protection of Civil Rights in Public Programs - Expanding access to: I. affordable and accessible housing, II. public transportation; III. participation in school athletic and community recreational activities, and IV. community services for persons in or at risk of nursing facility placement.

I. A.1. Priority: Expanding access to accessible and affordable housing. Targeting housing discrimination and expanding opportunities for persons with disabilities to obtain and to maintain affordable and accessible housing is a PAIR priority. Monitoring and implementation of the Consent Decree in Bailey et al. v. Housing Authority of Baltimore City (HABC) addresses this priority, as does provision of individual case representation and systemic case work.

I. A.2. Need. Studies demonstrate the crisis in housing for low-income persons with disabilities. A report issued by Technical Assistance Collaborative, “Priced Out in 2010,” documents that the Department of Housing and Urban Development (HUD) fair market monthly rent for a one bedroom rental unit in Baltimore is more than the entire monthly Supplemental Security Income (SSI) benefit check issued to a person with a disability. (The current SSI award is $674.00/month and fair market rent for a one-bedroom unit is over $900.00/month.) A person with a disability relying on SSI would have to pay 164% of his or her monthly income to rent a modest one-bedroom apartment in Maryland. (Compared with other states, only Hawaii and the District of Columbia have higher rent burdens for people on SSI.) People with disabilities who receive SSI payments continue to be the nation’s poorest citizens. In 2010, the annual income of a single individual receiving SSI payments was $8,436, equal to only 18.7% of the national median income for a one-person household and over 20% below the 2010 federal poverty level of $10,830. Since the first Priced Out study was published in 1998, the value of SSI payments compared to median income has declined precipitously — from 24.4% of median income in 1998 to 18.7% in 2010 — while national average rents have risen over 50% during the same time period. HUD has confirmed that non-elderly persons with disabilities face a worst case housing need based on the amount of income they are required to spend for housing. The economic reality is that persons with disabilities on fixed limited incomes need a subsidy to be able to rent a place to live. There is a critical lack of accessible, affordable rental housing. In Baltimore City, there is a need for accessible units and for one-bedroom rental units. There are over 31,000 people on the Housing Authority of Baltimore City’s (HABC) waiting list for subsidized housing. HABC provides subsidies through provision of vouchers and public housing units. Over 37% of the subsidized waiting list is comprised of non-elderly persons with disabilities and over 96% of these households have below 30% of the area median income. 55% of people on the HABC waiting list need one-bedroom units. At the 2008 Governor’s Annual Housing Conference, the State Department of Housing and Community Development wrote that from 2008-2015, Maryland faces a shortage of nearly 140,000 units of affordable housing of which approximately 30,000 are for individuals with disabilities. This number fails to include people with disabilities living in institutions, nursing facilities, group homes and assisted living arrangements who would be able to live independently in the community if they could afford housing. The 1,850 remedial housing opportunities required by the Bailey Consent Decree are for one-bedroom housing units for non-elderly people with disabilities. The Bailey case alleged that occupancy of approximately four thousand one-bedroom public housing units were illegally restricted such that persons with disabilities who should have had access to that housing were denied their right to occupy the units. The loss of access to these units is compounded by the huge loss of public housing units through demolition activity. A study produced by the Abell Foundation found that the number of occupied public housing units in Baltimore City decreased from 16,525 in 1992 to 9,625 in 2000. The Abell report found that over 2,400 more units were scheduled to be lost from the housing inventory. (See “The Dismantling of Baltimore’s Public Housing,” Abell Report Newsletter, September 2007; Within this loss of housing units, one-bedroom units were disproportionately affected. In six public housing projects that were demolished by the Baltimore City Housing Authority and replaced with mixed-income developments, a total of 1,329 one-bedroom public housing units were demolished and only 27 one-bedroom public housing units were replaced. The effect of the loss of subsidized housing units is devastating. The loss contributes to homelessness, instability, more restrictive living environments, and worsening of health conditions. Providing housing will increase stability, productivity and promote the human rights of persons with disabilities. The need for accessible housing is indisputable. The Baltimore City Consolidated Housing Plan and the Baltimore City Housing Authority Annual and Five Year Plan, both identify the lack of accessible housing as an issue for the region. The Mayor’s Commission on Disabilities has also identified the lack of accessible housing as a major problem for people with disabilities. The last area study of impediments to fair housing also identified the lack of accessible housing as a barrier for people with disabilities in the entire Baltimore metropolitan area. Baltimore City’s housing presents special challenges as it is home to the largest concentration of poor people in the state, including a large concentration of persons with disabilities, but is a City replete with row houses, which poses significant challenges to accessibility. The City’s public housing stock was not accessible and was one of the causes of action in the Bailey lawsuit. PAIR staff discovered that the Housing Authority had identified over 900 of public housing units as accessible in reports to the federal government, but after further analysis it was determined that only one housing unit was fully accessible out of a housing stock of over 10,000 units. The Bailey Consent Decree requires approximately 1,000 units of accessible housing to be developed. Housing discrimination and the lack of accessible and affordable housing for people with disabilities was addressed by the Bailey law suit and subsequent Consent Decree.

I. A.3. Indicators. Several indicators demonstrate successful outcomes in creating opportunities for people with disabilities to obtain affordable and accessible housing: As part of the Bailey Consent Decree, HABC set aside 1,350 vouchers for non-elderly persons with disabilities in need of a one-bedroom housing unit. Pursuant to the court order, HABC contracted with the Innovative Housing Institute (IHI) to assist persons who receive a voucher. IHI provides assistance in finding a rental unit and in leasing the unit, provides security deposit and application fees, provide funds for utility hook up, and also offers services for six months after a person leases a unit. To date, 1,121 people with disabilities have leased units though the Enhanced Leasing Assistance (ELA) Program established by the Bailey Consent Decree. During the six month follow-up period, less than .05% of tenants faced eviction action. 116 project-based subsidized rental units have been developed and are occupied by people with disabilities. Another 350 units have been identified and are in the development pipeline. For example, seven different development proposals were approved for receipt of low-income tax credits this year, which will provide approximately 60 units subsidized with project-based vouchers and reserved for persons with disabilities through the Bailey Consent Decree. Of the 755 Uniform Federal Accessibility Standards (UFAS) units required by the Consent Decree, 624 are complete and were certified as accessible under UFAS. Since the effective date of the Bailey Consent Decree, 580 households were on the resident transfer list waiting to transfer to a UFAS-compliant unit. Of these, 382 have transferred to UFAS or near-UFAS units, 39 have transferred to units with accessible features, 109 moved/died/declined offers, and 80 are still waiting for accessible units. There is a significant waiting list of people who are applicants for public housing and need accessible units. People needing accessible units also need accessible common areas. Pursuant to the Bailey Consent Decree, HABC is making sidewalks and curb ramps comply with federal accessibility guidelines. As of April, 2011, 259 of the identified 267 curb cuts to be modified have been certified as compliant with accessibility standards. HABC has also renovated or built 30 playgrounds on public housing sites to be UFAS compliant. HABC has implemented a reasonable accommodation policy for its residents and applicants, as well as a policy by which residents with immediate needs can request and obtain modifications to their units or transfers on an expedited basis. This past year, 43 public housing management staff received additional one-on-one training sessions on the HABC reasonable accommodation policy and procedures. In the past year, 41 residents of public housing requested transfers to an accessible housing unit. Of the 621 persons who are or have been on the waiting list for an accessible unit: 382 residents transferred to accessible units; 39 residents transferred to units with accessible features; 163 residents moved out of public housing, or declined three or more offers to transfer, or passed away; 37 residents are waiting to transfer. There are 483 persons on the HABC waiting list who have requested an accessible unit when they become eligible for housing. 463 people have requested reasonable accommodations or modifications to which the Housing Authority is required to respond. Requests include grab bars, raised toilet seats, hand held showers, a transfer to a different or larger unit to better accommodate the person, emergency strobe systems, a bench for a shower, lowered counter tops, lever handles on doors, and handrails. PAIR staff receives reports every six months that details the request for accommodations and the responses of the Housing Authority. The parties meet twice a year to discuss compliance on this issue. During the past year, 495 persons with disabilities moved off of the public housing waiting list into public housing units. 113 families were identified as meeting the definition of having "immediate needs", meaning they had barriers to full enjoyment of their housing unit. Since the Bailey case’s inception, there have been a total of 621 immediate needs families identified. Families with immediate needs have meetings with HABC staff within ten days to determine the need and options for the family. This year the Immediate Needs Team at HABC increased the number of home visits conducted per week to ensure that families receive a meeting within ten days. Immediate needs families receive transfers, a voucher, home modifications, or other temporary or permanent solutions. The Consent Decree also required production of new opportunities through use of project-based vouchers in new or rehabilitated developments. 55 persons with disabilities leased project-based units in 10 different private family rental developments during this grant reporting period, with 17 such units having accessible features.

I. A.4. Collaboration. PAIR staff collaborates with the U.S. Department of Justice who is co-plaintiff in the Bailey case. PAIR staff have worked closely with several housing developers to negotiate creation of affordable housing for persons with disabilities. PAIR staff collaborate with several other legal service providers that have an interest in housing (Homeless Persons Representation Project, Legal Aid Bureau, ACLU) to keep one other informed about issues related to housing services in the City and coordinate on policy reforms. The legal service advocates have monthly meetings with the Housing Commissioner to discuss common issues or concerns. PAIR staff continue to work with Technical Assistance Collaborative, Inc. a private non-profit organization that has offered housing development expertise to PAIR staff since the inception of the Bailey case. MDLC takes part in the National Low Income Housing Coalition’s Housing Justice Network, where we are able to dialogue with legal services providers across the country on local and national issues affecting our clients. PAIR staff has been appointed to serve on the State Department of Disabilities’ (DOD’s) Commission on Affordable Housing. Recently this Commission’s work has been planning to use funds that may become available under the new Frank Melville Permanent Supportive Housing funds for persons with disabilities. PAIR staff is a Commissioner for the Department of Disabilities Advisory Committee and chaired the Commission’s State Plan Subcommittee, which made recommendations related to creation of affordable, accessible and visitable housing for persons with disabilities. PAIR staff participates in the Maryland Asset Building and Community Development (ABCD) City Chapter, Subcommittee on Homelessness. PAIR staff also participates in the Baltimore City Rental Housing Coalition.

I. A.5. Cases. PAIR staff handled 95 housing cases in addition to the Bailey action.

I. A.6. Case example. PAIR staff successfully represented several individuals who needed reasonable accommodations to ensure full use and enjoyment of their housing unit. An example follows: A client informed PAIR staff that he was not receiving printed information from his property management company in an accessible format, despite his requests. PAIR staff intervened numerous times to ensure that he receives written communications in an electronic format useable for his screen reader. Various notices related to community calendars, project news and events as well as information specifically related to the client’s housing unit are distributed through the property management company. The property includes other units for persons with visual impairments who should benefit from the use of effective communications.

II. A.1. Priority - Expanding Access to Participation in School Fitness Activities. Increasing opportunities for students with disabilities to participate in school-based fitness and athletic activities is a PAIR priority. Monitoring and implementation of the 2008 Fitness and Athletic Equity Act for Students with Disabilities addresses this priority.

II. A.2. Need. Physical activity is significant to the health and emotional well-being of children with disabilities. Childhood obesity is a health epidemic. Studies demonstrate that individuals with disabilities are three times more likely to be sedentary than individuals without disabilities. Fifty percent of persons with disabilities report that they engage in no meaningful physical exercise. The Surgeon General has confirmed that physical activity reduces the risk of heart disease, high blood pressure, diabetes and other illness. In addition, studies confirm that students who participate in school based athletic programs are more likely to graduate, have increased academic success, and develop stronger self-confidence compared with students who are not participants. In addition, including students with disabilities in physical activity provides opportunities for other students to see that people with disabilities have strength and abilities. Despite federal laws requiring inclusion of students with disabilities in physical education and interscholastic activities, PAIR staff learned that formal opportunities for inclusion were lacking in Maryland’s schools. A few years ago, PAIR staff represented a young woman who was a paralympic athlete in track and field but who was denied the opportunity to participate on her high school track and field team because she uses a wheelchair. After unsuccessful attempts at negotiation with the school system, PAIR staff filed a federal lawsuit to protect the interests of the student. Her rights were vindicated in federal court and created a stir of publicity which generated public interest in this issue. PAIR staff heard from many people and co-founded the SPARK Coalition to discuss methods for including students with disabilities into school-based physical activity. Despite evidence of the importance of physical activity for youth in general and for children with disabilities in particular, a survey of Maryland’s 23 county school systems and Baltimore City schools found only 3 jurisdictions reported having policies or guidelines related to the participation of students with disabilities in athletics. A state task force (on which PAIR staff participated) found that a lack of policies and accountability for the participation of students with disabilities in Maryland’s schools is a barrier to their participation in physical education and athletic programs. A separate study surveyed 115 public high schools in Maryland, Virginia and Pennsylvania over several years and found that only 11 students with disabilities were provided accommodations in athletic programs, and only two schools reported having any written policies about including students with disabilities. In 2008, PAIR staff led a coalition of organizations who advocated for new opportunities for students with disabilities. As a result of advocacy efforts, Maryland passed a law requiring schools to provide equal opportunities for students with disabilities to participate in physical education and athletic activities and to be included with students without disabilities. Implementation of the new law to ensure that youth with disabilities have opportunities for physical exercise and to learn healthy lifestyles is a PAIR priority.

II. A.3. Indicators. The following outcomes demonstrate the success of efforts on this priority: According to a report filed with the Maryland General Assembly by the State Department of Education in August, 2011, all but one school system has adopted policies to accommodate students with disabilities in school athletic opportunities and in physical education. The law provided that such policies be adopted by 2011. All school systems submitted plans to the Maryland State Department of Education for including all students in physical education. Several school systems have developed teacher resource guides along with adapted physical education handbooks that include procedures for adapted physical education. A number of school systems have provided in-service courses and professional development to supplement inclusion of students in mainstream physical education. New course curricula have been developed and offered for teachers and adapted physical education specialists. All school systems have submitted plans to the State Department of Education demonstrating development of new sports programs in each of the three sports seasons of fall, winter and spring. These programs are required to include students with and without disabilities. Last year over 3,000 high school youth participated in such new opportunities. Slightly over half of such students were students with disabilities who have individualized (IEP) or Section 504 education plans.

II. A.4. Collaboration. PAIR staff continued a close collaboration with Special Olympics Maryland to develop successful strategies for expanding physical education and athletic opportunities for students with disabilities. PAIR staff also met several times with persons from the State Board of Education to plan for sustaining program growth and needed technical assistance.

II. A.5 Cases. PAIR staff did not handle individual cases under this priority but did provide technical assistance. For example, PAIR staff consulted with an attorney who represented a student who was prohibited from participation in a sport activity that was especially developed for students with and without disabilities. The student had been participating successfully in the activity but was informed that he could no longer participate based on his grade point average. PAIR staff discussed the new law and regulations, and why the student could request an accommodation based on his disability and progress towards the goals in his individualized education program (IEP). The student was ultimately successfully re-instated to the program after an appeal by his attorney.

II. A.6. Case example. Nearly 500 students from 33 high schools took part in a Unified Bocce Interscholastic Competition on Maryland’s Eastern Shore, where PAIR staff helped to officiate. Each team was comprised of 6-8 players and the teams included students with and without disabilities paired together in competition. PAIR staff also participated at the State Unified Tennis Championships where 200 participants from 18 high school teams met for the inaugural Special Olympics Maryland Unified Tennis Invitational held in Annapolis, MD. The event employed a team model, with the various schools winning overall honors rather than individual honors. It marked the first time throughout the nation that a team model was used in a unified tennis tournament. This activity was conducted pursuant to the Fitness and Athletic Equity law drafted by PAIR staff and passed by the Maryland General Assembly in 2008.

III. A.1. Priority. Expanding access to public transportation. Persons with disabilities must be able to rely upon accessible public transportation to meaningfully participate in community life. Persons using paratransit services in the Baltimore metro region must be provided a transit system that operates without capacity constraints and offers service that is comparable to the public bus system.

III.A.2. Need. Most of MDLC’s Smith lawsuit class members rely on public transportation as their sole means of transport. The Americans with Disabilities Act requires that Maryland Transit Administration (MTA) paratransit services be offered to persons with disabilities who cannot use MTA’s public bus system. When PAIR staff sued the Maryland Transit Administration paratransit system on behalf of riders, the system was “dysfunctional” according to the Secretary of the Maryland Department of Transportation. PAIR staff had tried to work with MTA for several years prior to filing a lawsuit. PAIR staff processed over one thousand individual complaints from riders and forwarded written complaints to MTA. After failing to resolve the issues with MTA, PAIR staff forwarded the complaints to the Federal Transit Administration and requested a compliance review of MTA’s paratransit service. After the FTA made findings of noncompliance and more time passed without major changes in the system, PAIR staff filed a lawsuit. The lawsuit detailed the need for reform. Clients were left stranded for hours when paratransit vehicles did not pick them up as scheduled. Over 600 clients a month were reported stranded when a vehicle did not come at a scheduled pick up time. Clients were left waiting outside in inclement weather resulting in illness and hospitalization. Clients reported missing dialysis and other medical appointments. Other clients reported missing school and even exams due to late rides, and losing a job due to repeated late arrivals. A client was kept on a vehicle for over five hours without a bathroom stop. Clients reported that they could not rely on the system and therefore limited their daily life activities. Many clients reported being isolated at home because of the inability to rely on the paratransit service. Many paratransit riders have fixed limited incomes and almost all have no alternative method of transportation.

III. A.3 Indicators. Since the filing of the paratransit lawsuit, there have been numerous service improvements. MTA paratransit staff has increased by over 60 persons in the call center, with ten such persons added this past year. The fleet of paratransit vehicles was expanded this past year and the service now operates approximately 410 vehicles with more ordered (there were well under 300 vehicles five years ago). The system has continued to grow, with over 105,000 trips provided in recent months, which is more than double the number of trips provided per month when the class action was filed. PAIR staff receive and review data related to on-time performance, telephone hold times, no-shows, late trips, missed trips and trip length. The on-time performance of the system fell a bit this past year but was approximately 90% on-time. MTA has acknowledged the need to enhance the performance, which PAIR staff will continue to monitor. Many paratransit riders have low incomes, are minorities and have mobility impairments. The continued growth in paratransit riders demonstrates more use and access by people with disabilities to a critical service and that the service has become more accessible and reliable.

III. A.4. Collaboration. Pursuing the transportation priority requires collaboration with class representatives, riders, and MTA. In addition, PAIR staff consult with community service providers who advocate for people with disabilities to learn more about problems in the paratransit system. PAIR staff collaborated with the Mayor’s Office for Persons with Disabilities on a paratransit forum. PAIR staff also collaborated with the League for People with Disabilities, a large provider of rehabilitation services in Baltimore City, on a paratransit forum and regarding paratransit problems.

III. A.5. Cases. MDLC handled 50 transportation cases in addition to the class action during this reporting period.

III. A.6. Case example. An individual who uses paratransit services contacted PAIR staff because she was told she could no longer use the transportation system. She was told her certification to use the system expired. PAIR staff investigated and learned that she had submitted required documentation but had not been scheduled for an eligibility appointment. PAIR staff successfully advocated for immediate reinstatement for the client pending her eligibility appointment based on the system’s delay.

IV. A.1.Priority. Nursing facility residents must be provided information about their options for living in the community and must have access to Medicaid services designed to support community integration.

IV. A.2 Need. Nationally, Medicaid (MA) is the primary payer for two-thirds of nursing facility residents, financing over 40% of nursing facility long term care costs. Serving persons with long term care needs through MA funded community services will reduce health care expenditures, is consistent with the desires of individuals with disabilities, and is consistent with civil rights laws. Maryland’s percentage of expenditures on long term care (LTC) institutional services remains well above the national averages. Despite state efforts, there has not been a significant shift from MA LTC expenditures for nursing facilities to expenditures for persons receiving Medicaid funded in-home and community based services. Maryland ranks among the ten worst states comparing the ratio of institutional with community LTC dollars spent on older adults and persons with physical disabilities. Comparing the number of home and community based service participants per 1,000 persons among the states, Maryland ranks even worse. From 2004 — 2009, most states made progress towards less reliance on nursing facility care for older adults and persons with physical disabilities, however, Maryland lost ground. Maryland must make real change so that those individuals who wish to live in the community are not forced into or remain in nursing facilities to receive health care services. Last year, 1,400 nursing facility residents were identified as having been on the Department of Health and Mental Hygiene’s (DHMH’s) registry for the Living At Home or Older Adult Medicaid Waivers. These individuals tried to get community support services but ended up in nursing facilities on MA long term care. Diversion of persons from nursing facility long term care is the most efficient and cost productive method of saving on MA LTC costs. Unfortunately, Maryland’s system of Medicaid services is not designed to keep people out of nursing facilities. For example, the 2010 and 2011 Kaiser Commission Annual Reports on Medicaid programs demonstrate the relative inadequacy of Maryland’s personal care services. Of the thirty-three states opting to provide personal care services, Maryland’s rate appears to be the lowest. With one exception, the other states listed have an hourly rate ranging from $9.39 to $63 per hour with the average Medical Assistance Personal Care (MAPC) rate being $17.60 an hour. Maryland is listed as having a $33.98 per day rate and Louisiana has a rate of $214.87 per visit. With the one exception, Maryland appears to be the only state not to base personal care on hourly rates. Maryland needs to change the current reimbursement system and establish an hourly rate sufficient to allow people with significant disabilities to remain at home or in their communities rather than a nursing facility or institution.

IV.A. 3. Indicators. Indicators of success include: increased outreach to persons in nursing facilities to ensure that they learn about their right to use MA funds for care in the community through various waiver programs; policy changes so more community services are available; more individuals move from nursing facilities to community living options. The "Sunshine Folk," peer mentors recruited and trained by PAIR staff, provided outreach to 400 individuals in nursing facilities, up from about 100 last year. The Sunshine Folk identified individuals in nursing facilities who had not received information about their community living alternatives. According to State program data, more than 4,000 individuals in nursing facilities have received either peer outreach or counseling about their alternatives for community supports, which is an increase of approximately 400%. The number of individuals transitioning from nursing facilities increased to over 1,000 individuals this past year. PAIR staff provided technical assistance to the Sunshine Folk as they assisted to transition 17 individuals from nursing facilities to their own homes in the community. PAIR staff have made inroads into two of the state’s largest nursing facilities where few residents had received information about their options. Instead of assigning one Sunshine Folk to the large nursing facilities, PAIR staff coordinated with Sunshine Folk to have six mentors and PAIR staff visit the facility together to be more visible to residents. The local long term care ombudsman had contacted PAIR staff and requested a visit to one of the large facilities. PAIR staff and the Sunshine Folk were able to share information on community alternatives with individual residents. PAIR staff also trained individuals under contract with the Independent Living Centers to provide peer outreach to nursing facility residents, a model based on the work of the Sunshine Folk. The peer outreach model was expanded to include mentorship through the first year after the resident’s transition to the community.

IV. A.4. Collaboration. PAIR staff have collaborated with the following organizations in efforts to increase community options for persons in nursing facilities: the Brain Injury Association of Maryland; the Coordinating Center (a case management provider); Eastern Shore Center for Independent Living; Friends and Family Ties-Shared Supports (non-profit service provider); The Freedom Center; The Image Center; Independence Now; LifeSpan Network (nursing facility and senior care provider association); People on the Go (statewide self-advocacy organization); Southern Maryland Center for Independent Living; State and local ombudsmen.

IV. A.5 Cases. Five individual cases were handled directly by PAIR staff. PAIR staff provided technical assistance and training to support the "Sunshine Folk" who provided direct support or outreach to several hundred individuals in nursing facilities and assisted 17 individuals to transition into the community.

IV. A.6 Case example. PAIR staff met an individual in a nursing facility in Southern Maryland. The individual speaks very little English and reads neither English nor his native Spanish. He wanted to learn how to move back into the community where he could live with other Spanish speakers and have his own apartment. PAIR staff made a referral on his behalf to the state’s Money Follows the Person program. The individual was not provided a qualified translator when his transition plan from the nursing facility was developed. He signed a service plan which called for him to transition to an assisted living facility, which was not what he wanted. PAIR staff worked with MDLC’s Latino Outreach Paralegal to ensure that the individual learned all of his options and could make an informed choice. PAIR staff are assisting him in finding his preferred setting, which is neither the nursing facility nor an assisted living facility.

B. Priorities and Objectives for the Current Fiscal Year

Please include a statement of priorities and objectives for the current fiscal year (the fiscal year succeeding that covered by this report), which should contain the following information:

  1. a statement of each prioirty;
  2. the need addressed by each priority; and;
  3. a description of the activities to be carried out under each priority.

B. 1. Maryland Disability Law Center’s areas of advocacy focus for PAIR staff include access to: affordable and accessible housing; public transportation; community based services for persons in nursing facilities, and school fitness and athletic programs and community recreational programs.

B. 2. The need addressed by each priority is stated separately in Part V. A. 2. above.

B.3. Activities to implement the priorities include the following:

a. Accessible and affordable housing: Continue to monitor implementation of the federal court Consent Decree in Bailey et al. v. Housing Authority of Baltimore City, et al. The lawsuit alleged that the housing authority discriminated against people with disabilities by refusing to allow them to live in certain housing, refusing to make public housing accessible, and refusing to provide reasonable accommodations. Current emphasis is on negotiations to obtain the Decree remedies to: create project based and long term affordable housing opportunities for non-elderly persons with disabilities; provide timely accommodations, and develop nearly 150 units of accessible public housing, including accessible common areas and routes. Individual cases relating to alleged discrimination in housing programs are accepted as resources allow. In addition, PAIR staff will negotiate through the HUD administrative process to obtain creation of accessible housing in Baltimore County, Maryland. PAIR clients who need accessible and affordable rental units in Baltimore County were unable to locate such housing in that jurisdiction. Two clients who need accessible units and have vouchers in the County are forced to live in inaccessible housing and the voucher program could not identify any accessible units to which they could apply to live.

b. Access to equal opportunity in public transportation: Continue to negotiate with the State regarding transit service improvements. Emphasis will include monitoring paratransit performance, including advocacy related to kidney dialysis service and advocating for more accessible taxi cabs. PAIR staff will be reviewing the results of these efforts along with former Class Representatives of the Smith v. Stanley paratransit lawsuit. The former Class Representatives have determined to continue to meet as a self-advocacy group and to meet quarterly with MTA officials to identify service problems and potential solutions. PAIR staff provide legal support for the self-advocacy group. Depending on the Governor’s budget for FY 2013, PAIR staff may be involved in advocacy related to fare increases or program cuts.

c. Access to physical fitness, athletic and recreational opportunities for youth with disabilities: PAIR staff will continue to collaborate with Special Olympics Maryland and the Maryland State Department of Education (MSDE) to support increased participation by students with disabilities in integrated and unified athletic programs. PAIR staff will provide outreach and education materials about opportunities, will monitor reports from local education agencies and advocate for increased opportunities as necessary through MSDE or with other appropriate entities. In addition, PAIR staff will coordinate with out of school programs that provide physical activities for youth to advocate for inclusion of students with disabilities.

d. Nursing facility residents must be provided effective information about their options for living in the community. Nursing facility residents and individuals at risk of admission to such facilities need access to appropriate Medicaid services to facilitate their option to return or remain in the community while receiving needed health care services. Advocacy services provided will enforce the right of Medicaid recipients in nursing facilities to live in the community with adequate supports, as set forth by the U.S. Supreme Court in the case of Olmstead v. L.C.; monitor implementation of the Medicaid home- and community-based waivers and the Money Follows the Person federal grant administered by the State Department of Health and Mental Hygiene (DHMH); advocate for policies to expand community options and ensure access to appropriate services for nursing facility residents, including efforts related to Community First Choice and other options under the federal Affordable Care Act; collaborate with independent living centers and ombudsmen to facilitate integration of nursing facility residents into community life.

Part VI. Narrative

At a minimum, you must include all of the information requested. You may include any other information, not otherwise collected on this reporting form that would be helpful in describing the extent of PAIR activities during the prior fiscal year. Please limit the narrative portion of this report, including attachments, to 20 pages or less.

The narrative should contain the following information. The instructions for this form outline the information that should be contained in each section.

  1. Sources of funds received and expended
  2. Budget for the fiscal year covered by this report
  3. Description of PAIR staff (duties and person-years)
  4. Involvement with advisory boards (if any)
  5. Grievances filed under the grievance procedure
  6. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency

A. Sources of funds received and expended

Source of Funding Amount Received Amount Spent

Federal (section 509) $277,711.00 $291,669.00

State 0 0

Program Income Private $ 48,861.00 $ 52,425.00

All other funds 0 0

Total (from all sources) $326,572.00 $344,094.00

B. Budget for the fiscal year covered by the report

Category Prior Fiscal Year Current Fiscal Year

Wages/Salary $147,072.00 $150,748.00

Fringe Benefits (FICA,

Unemployment, etc) $ 41,180.00 $ 42,209.00

Materials/Supplies $ 0 $ 4,250

Postage $ 608.00 $ 650.00

Telephone $ 1,525.00 $ 1,575.00

Rent $ 19,284.00 $ 19,500.00

Travel $ 2,047.00 $ 2,300.00

Copying $ 415.00 $ 500.00

Bonding/insurance $ 1,356.00 $ 1,200.00

Equipment Rental/ $ 7,994.00 $ 6,500.00


Legal Services $ ------ $ ------

Indirect Costs $ ------ $ ------

Miscellaneous $ 1,575.00 $ 2,500.00

Total Budget $ 223,056.00 $ 229,432.00

C. Description of PAIR Staff

Type of Position FTE % of year filled Person-years


Full-time 3.4 100% 3.4




Full-time 1.0 100% 1.0

Part-time Vacant

D. PAIR staff is involved with the following advisory committees: * As a Commissioner for the Commission on Disabilities, a group of persons appointed by the Governor to advise the State Department of Disabilities (DOD). The Commission meets monthly to provide advice to the Secretary of DOD. * As a member of the housing task force of the DOD. The task force meets to discuss the lack of affordable and accessible housing for persons with disabilities and to develop policy initiatives. * As Chair of the State Plan Subcommittee of the Commission for People with Disabilities. * As a member of a coalition of legal service providers and homeless housing advocates including ACLU, Homeless Persons Representation Project, Maryland Legal Aid Bureau, and University of Maryland School of Law Clinical Program. This coalition meets regularly with the Commissioner of the Housing Authority of Baltimore City. * As a member on the Living at Home Waiver Advisory Board. * As a member of the Depart of Aging Options Counseling Development Team * As a board member of the Statewide Independent Living Council.

E. Grievances filed under the grievance process: None.

F. Coordination with the Client Assistance Program (CAP) and the State long-term care program, if these programs are not part of the P&A agency: MDLC has a long-standing relationship with the Client Assistance Program and will routinely make appropriate referrals to that office. In addition, PAIR staff was appointed to the Statewide Independent Living Council (ILC) and serves with the Director of the Client Assistance Program, which enhances the relationship between the programs.

PAIR staff coordinates with both the State and local Ombudsman programs. One example of the collaboration relates to the Long Term Care Ombudsman, Stakeholder Committee. The Committee advises the Department of Aging on long term care reforms. PAIR staff provide support to a former nursing facility resident in the Stakeholders’ committee so he can be optimally involved to provide input. PAIR staff and the Statewide Ombudsman meet bi-monthly to review progress or barriers to rebalancing Maryland’ long term care institutional bias and to discuss conditions within nursing facilities.


Signed ByVirginia Knowlton
TitleExecutive Director
Signed Date12/22/2011