THE PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH MENTAL 

ILLNESS (PAIMI) PROGRAM ACTIVITIES REPORT FOR 

FISCAL YEARS 2017 AND 2018 

11/25/2020 
ii 
Table of Contents 

INTRODUCTION ........................................................................................................................................ 4 

HISTORICAL OVERVIEW ........................................................................................................................ 4 

FUNDING .................................................................................................................................................... 5 

PAIMI PROGRAM ACTIVITIES................................................................................................................ 6 

A. Demographic Information ................................................................................................................... 6 

B. Services for Individuals ....................................................................................................................... 8 

C. Class Action Litigation...................................................................................................................... 19 

D. Interventions on Behalf of Groups of PAIMI-eligible Individuals.................................................... 22 

E. Public Education, Training, and Awareness Activities ..................................................................... 24 

F. Accomplishments, Impediments, and Unmet Advocacy Needs.......................................................... 26 

GOVERNANCE......................................................................................................................................... 29 

1. The Governing Authority ................................................................................................................ 29 

2. The PAIMI Advisory Council.......................................................................................................... 30 

TRAINING AND TECHNICAL ASSISTANCE....................................................................................... 31 

CONCLUSION........................................................................................................................................... 32 

APPENDIX A............................................................................................................................................. 33 

DATA TABLES FOR FISCAL YEARS 2017 & 2018 .............................................................................. 33 

ACRONYMS............................................................................................................................................ 106 

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INTRODUCTION 

This report summarizes the annual activities for Fiscal Years (FY) 2017 and 2018 of the Protection 

and Advocacy for Individuals with Mental Illness (PAIMI) grantees, funded and administered by 

the Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental 

Health Services (CMHS). Each PAIMI grantee is required to transmit an annual report to the 

Secretary of the Department of Health and Human Services (HHS), that describes its program 

activities, accomplishments, and expenditures during the most recently completed FY.1 SAMHSA 

summarizes the grantee activity information and prepares a report, which includes aggregate data 

for the Secretary.

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HISTORICAL OVERVIEW 

The Developmental Disabilities Assistance and Bill of Rights Act of 1975, commonly known as the 

DD Act, established systems in each state, the District of Columbia, and five territories to protect 

the legal and human rights of individuals with developmental disabilities.3 These entities, the state 

Protection & Advocacy (P&A) systems, were governor-designated and approved by the 

Administration on Disabilities4 (AoD), within the Administration for Community Living (ACL). 

The DD Act authorized formula grants to each eligible state P&A system to support activities on 

behalf of individuals with intellectual and developmental disabilities through the Protection and 

Advocacy for Developmental Disabilities (PADD) Program, administered by ACL/AoD. 

ACL/AoD, which oversees the first P&A program, is the lead federal agency on matters pertaining 

to designation or re-designation of a P&A system. 

The PAIMI Act of 19865 extended the DD Act protections to individuals with significant (serious) 

mental illness (adults) and significant (severe) emotional impairments (children/youth) at risk for, or 

in danger of abuse, neglect, and rights violations, while residing in public or private residential care 

and treatment facilities. The same AoD-approved, governor-designated state P&A systems that 

received PADD Program funding were authorized to administer the PAIMI Program. 

The PAIMI Act6 mandated state P&A systems to: 

1) Protect and advocate for the rights of residents with significant (serious) mental illness 

(adults) and significant (severe) emotional impairments (children and youth),7 residing in 

public and private care and treatment facilities who are at risk for, or in danger of abuse, 

neglect, and rights violations by using administrative, legal, systemic or other appropriate 

remedies on their behalf; 

2) Investigate reports of abuse, particularly incidents involving serious injuries and deaths, 

related to the inappropriate use of seclusion and restraint; and 

1 42 U.S.C. 10805(a)(7) 

2 PAIMI Act at 42 U.S.C. 10824 

3 42 U.S.C. 6041 

4 Formerly named the Administration on Intellectual and Developmental Disabilities (AIDD) 5 42 U.S.C. 10801 et seq. 

6 42 U.S.C. 10801(b) 

7 Adults with significant mental illness denotes adults with serious mental illness. Children with significant emotional 

impairments denotes children with severe emotional impairments. 

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3) Ensure enforcement of the United States Constitution, federal laws and regulations, and state 

statutes. 

In 1986, there were 56 P&A systems located in each state, the District of Columbia, and five 

territories (American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the 

Commonwealth of Puerto Rico, and the U.S. Virgin Islands). At that time, 45 P&A systems 

operated as private, non-profit organizations (as designated by the respective state governors). The 

remaining 11 P&A systems were state or territory operated (Alabama, American Samoa, 

Connecticut, Indiana, Kentucky, New York, North Carolina, North Dakota, Ohio, the 

Commonwealths of Puerto Rico, and Virginia) and independent of any state agency that provided 

treatment or services, other than advocacy services, to individuals with mental illness.8 However, as 

of September 30, 2018, there remained five state-operated P&A systems (Alabama, American 

Samoa, Kentucky, North Dakota, and the Commonwealth of Puerto Rico). In 2000, the PAIMI Act 

was amended by the Children’s Health Act (CHA) of 2000.9 The CHA established a 57th P&A 

system for Native Americans, the American Indian Consortium (AIC). The AIC is composed of the 

Navajo Nation and Hopi tribal councils in the Four Corners region of the Southwest (Colorado, 

Utah, Arizona, and New Mexico). 

The CHA10 requires “a public or private general hospital, nursing facility, intermediate care facility, 

or other health care facility, that receives support in any form from any program supported in whole 

or in part with funds appropriated to any Federal department or agency shall protect and promote 

the rights of each resident of the facility, including the right to be free from physical or mental 

abuse, corporal punishment, and any restraints or involuntary seclusions imposed for purposes of 

discipline or convenience.”11 Per CHA, “each facility shall notify the appropriate agency, as 

determined by the Secretary, of each death that occurs at each such facility while a patient is 

restrained or in seclusion, of each death occurring within 24-hours after the patient has been 

removed from restraints and seclusion, or where it is reasonable to assume that a patient's death is a 

result of such seclusion or restraint. A notification under this section shall include the name of the 

resident and shall be provided not later than seven days after the date of the death of the individual 

involved.”12 The CHA clarified that the state P&A systems had the authority to investigate 

incidents of restraint and seclusion in these types of facilities. The CHA also allowed state P&A 

systems to serve PAIMI-eligible individuals who lived in the community, including their own 

homes; however, individuals residing in care and treatment facilities must have priority for program 

services. 

FUNDING 

Each P&A system must submit an annual application or update its annual program priorities, 

proposed budget/expenditures, the PAIMI Program assurances, and any other information requested 

by SAMHSA.

13 The annual PAIMI Program awards, subject to availability of appropriations, are 

based on a formula prescribed by the statute.14 The PAIMI formula is based equally on the 

population of each state in which there is an eligible system and on the population of each state 

8 42 U.S.C. 10801(b) 

9 42 U.S.C. 290 et seq. 10 42 U.S.C. 290ii 11 42 U.S.C. 290ii (a) 12 op. cit. at 42 U.S.C. 290ii - 1 13 42 U.S.C. 10821 14 42 U.S.C. 10822 

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weighted by its relative per capita income.

15 Relative per capita income is the quotient of the per 

capita income of the United States and the per capita income of the state. Relative per capita 

income is not used for American Samoa, Guam, the Commonwealth of the Northern Mariana 

Islands, and the U.S. Virgin Islands. Their quotient shall be considered as one.16 The Secretary 

shall use no more than two percent of the amount appropriated, commonly known as the set-aside 

under the PAIMI Act, to provide technical assistance to eligible systems.17 

The following table reflects the total annual PAIMI Program grant appropriations, the technical 

assistance set-aside, and the minimum and maximum grant allotments awarded to the states and 

territories in FY 2017 and 2018. Based on the final allocations, California, the largest state P&A 

system, received the maximum state award of $3,140,635 for FY 2017 and $3,101,059 for FY 2018. 

The minimum state allotment for P&A system grants were $428,000 for both fiscal years. Four of 

the five territories (American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, 

and the U.S. Virgin Islands) and the American Indian Consortium each received $229,300 for both 

fiscal years. 

FY 2017 FY 2018 

To State P&A Systems $35,319,775 $35,329,908 

Technical Assistance Set-aside $706,396 $706,598 

Total Annual PAIMI Appropriation $36,026,171 $36,036,506 

FY 2017 FY 2018 

Minimum State Award $428,000 $428,000 

Maximum State Award $3,140,635 $3,101,059 

Minimum Territory Award $229,300 $229,300 

 [See Appendix - Table 1] 

PAIMI PROGRAM ACTIVITIES 

A. Demographic Information 

1. Age and Sex 

The following tables summarize the number of PAIMI-eligible individuals or clients served in each 

FY by age and sex. 

Age in Years FY 2017 FY 2018 

0-4 9 7 

5-12 660 520 

13-18 1,420 1,367 

19-25 934 744 

26-64 6,738 6,206 

65 and over 689 684 

Total Served 10,450 9,528 

15 42 U.S.C. 10822 (a) (1) (A) (i) and (ii) 16 42 U.S.C. 10822 (a) (1) (B) 17 42 U.S.C. 10825 

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Sex FY 2017 FY 2018 

Male 5,508 5,254 

Female 3,833 4,243 

Unknown 1,109 31 

Total Served 10,450 9,528 

 [See Appendix - Table 2] 

2. Ethnicity and Race 

PAIMI clients served by the P&A systems self-identified their ethnicity and race18 . The following 

tables provide the ethnicity and racial identities reported by individuals served by the P&A 

systems. The information was self-reported by clients and individuals/clients served were 

permitted to select one or more races. 

Ethnicity FY 2017 FY 2018 

Hispanic/Latino 1,021 913 

Non-Hispanic/Latino 8,328 7,962 

Unknown 778 473 

Race FY 2017 FY 2018 

American Indian/Alaskan Native 247 203 

Asian 147 129 

Black/African American 2,112 1,898 

Native Hawaiian/Other Pacific Islander 108 122 

White/Caucasian 6,128 6,099 

Multiple Race 603 437 

 [See Appendix - Table 3] 

3. Living Arrangements 

P&A systems served individuals who resided in various settings. Examples of these living 

arrangements included: 

Living Arrangement Type FY 2017 FY 2018 

Independently in the community 2,163 2,182 

Adult community residential home 354 365 

Psychiatric hospitals 1,546 1,802 

Public and private institutional living 1,197 866 

Legal detention/jail 1,613 1,256 

Homeless/shelter 217 205 

Total 7,090 6,676 

 [See Appendix - Table 4] 

18 The total number of PAIMI eligible individuals reported by the P&A programs for the Age and Sex tables and for the Ethnicity and 

Race tables are not identical. There was no category to indicate an “unknown” value for the data element “race” and no “unknown” 

value for either “sex” or “age”, only the combination of these values. Hence any individual with an unknown “race” or an unknown 

“sex” or “age” would not be counted in the totals for “race”, “age” or “sex”. This lapse has been corrected for future data collection. 

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B. Services for Individuals 

Under the PAIMI Act, state P&A systems are mandated to protect and advocate for the rights of 

individuals with mental illness and authorized to investigate complaints of abuse, neglect, and rights 

violations.19 The following table shows the total number of individual PAIMI abuse, neglect, and 

rights violation cases opened, investigated, and closed. 

1. Abuse 

Number and types of individual abuse complaints investigated and closed per FY included: 

Abuse Complaints FY 2017 FY 2018 

Cases Investigated & Closed 1,733 1,390 

Inappropriate/excessive use of restraints 347 277 

Inappropriate/excessive medication 143 126 

Involuntary electroconvulsive therapy 2 3 

Failure to provide mental health treatment 907 697 

Physical assaults resulting in serious injuries 155 153 

Sexual assaults 77 59 

Staff threats/retaliation/assaults 102 75 

 [See Appendix - Tables 5] 

Case Examples from FY 2017 

Alaska 

The P&A received an anonymous complaint regarding an incarcerated 31-year-old man with 

schizophrenia who had been placed in an open population module in the prison, where he was 

physically and sexually assaulted. The P&A staff contacted the Deputy Director of Health and 

Rehabilitation at the Department of Corrections (DOC) and found that the inmate was already 

working with the Prison Rape Eliminator Act Coordinator and the Alaska State Troopers. The 

inmate was transferred to a different facility and was placed in a sub-acute mental health unit for his 

protection. 

Guam 

While detained in prison, a mental health client diagnosed with schizophrenia and bipolar disorder 

was not receiving appropriate mental health care and treatment, which included seeing a psychiatrist 

when needed and appropriate medication management. The P&A advocated for the client to be 

moved to the mental health adult inpatient unit until the client case was transferred to the mental 

health court system. Upon release from the court system, the client was able to receive the mental 

health care and treatment needed under the residential recovery program. 

Hawaii 

The P&A received a call from a 57-year-old client with mental illness living in Maui, who 

requested help with financial abuse committed against him by his daughter. The P&A advocated 

19 42 U.S.C. 10805(a)(1) 

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and investigated the complaint and found that the client’s daughter used his money, but since she 

had financial power of attorney (POA) at the time, there was no legal recourse. As a result of the 

client's complaint and the P&A’s advocacy efforts with his case manager, the POA was terminated 

and the client secured a guardian through the Office of Public Guardian. 

Case Examples from FY 2018 

Arkansas 

The P&A advocated and investigated an incident of reported abuse at a juvenile assessment and 

treatment facility, involving a 16-year old PAIMI-eligible male diagnosed with emotional 

disturbance; attention deficit hyperactivity disorder; bipolar disorder; and oppositional defiant 

disorder. The client alleged that a staff member of the facility entered the room, where he was lying 

on the top bunk of a bed, to transfer him to an isolation area. The client stated he refused to move 

off of the top bunk, whereupon the staff member pulled him off the bunk, causing him to hit his 

brow on the opposite bunk. The P&A investigated the incident, which included watching videos of 

the event and interviewing staff. The P&A determined that the technique used to remove the client 

from the top bunk caused his injury. The staff member was subsequently terminated, and remaining 

staff members in the unit underwent retraining on de-escalation techniques. 

Wyoming 

The Wyoming State Hospital (WSH) strapped a pregnant PAIMI-eligible individual to a transport 

board that the WSH started using as a long-term mechanical supine floor restraint. The patient 

contacted the P&A and authorized an investigation. The P&A’s investigation revealed that the 

patient was placed on the transport board at one time for one and a half hours. On another occasion 

when the client was placed on the transport board, it resulted in her not attending a scheduled 

ultrasound appointment. The P&A obtained and reviewed a video from WSH, which clearly 

showed that the patient was strapped to a transport board without prenatal medical assessments. 

WSH’s medical records admitted that mechanical chest and abdominal restraints were medically 

contraindicated during pregnancy. The P&A substantiated neglect for failure to have and follow an 

appropriate treatment plan and abuse for improper use of a temporary transport device as a longterm mechanical restraint; and abuse for the improper supine floor restraint without medical 

attention. The P&A reported the findings to appropriate agencies. As a direct result of the P&A’s 

investigation, the use of dangerous restraints ceased for this patient during the rest of her 

pregnancy. 

2. Neglect 

Number and types of individual neglect complaints investigated and closed per FY included: 

Neglect Complaints FY 2017 FY 2018 

Cases Investigated & Closed 1,626 1,277 

Discharge planning 945 686 

Personal care 289 242 

Mental health diagnoses 153 110 

Environmental safety 48 52 

Personal safety 191 187 

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 [See Appendix - Table 6] 

Case Examples from FY 2017 

Delaware 

The P&A received numerous complaints from a 38 year-old resident at the Delaware Psychiatric 

Center (DPC). The complaints, rising to the level of potential abuse and neglect, included: poor 

maintenance and cleaning of bathroom facilities; denial of access to telephones; lack of privacy (no 

shower curtain in communal bathroom); and retaliatory transfer to an inappropriate unit with elderly 

patients. The P&A investigated and reported neglect concerns to the facility. Regarding the 

telephones, the facility initiated a plan to install additional phones and to revise its policy. The 

P&A reported the cleanliness and shower curtain issues to the Delaware Office of Facilities 

Licensing, which inspected and cited the facility. As a result of the P&A’s investigation, the facility 

developed a correction plan. 

Illinois 

The P&A was contacted by an elderly resident of a state-operated mental health hospital. The client 

alleged that the facility was failing to respond to his complaints regarding his health needs, 

including care for his ears, which was adversely affecting his hearing. The P&A contacted the 

medical director at the facility and he agreed to have a doctor address the client’s complaints right 

away. The client met with a doctor the next day and reported that the doctor addressed all of his 

medical needs. 

Maine 

The P&A was contacted by a 61 year-old woman with mental illness, living in a group home. 

She informed the P&A that she had reported being assaulted by another resident of the group 

home, but the staff ignored her reports. The P&A went to the group home unannounced and met 

with the client and reviewed records. The P&A made a determination that the group home, as a 

mandatory reporter of abuse, had failed in its obligation by not reporting the client’s incident to 

state licensing. The P&A contacted state licensing. The state licensing did an immediate 

investigation and issued sanctions against the group home for its failure to report. The group home 

now has a system in place to always report resident allegations of abuse, including allegations 

concerning another resident. The client also wanted to move from this group home. The P&A 

assisted the client with finding another place, and the client successfully moved from the group 

home. 

Case Examples from FY 2018 

Alaska 

The P&A was contacted by the parent of a child with Post Traumatic Stress Disorder (PTSD). The 

child had been denied admittance to all residential treatment facilities enrolled in the Alaska 

Medicaid Program. The parents were concerned that they could not cover the financial cost 

associated with the child’s residential treatment, nor could they bring home their child due to the 

safety risk he posed to other children in their home. The family requested that the P&A assist them 

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with appealing the Medicaid denial to pay for their child’s treatment. The P&A advised the parents 

to request a meeting with the Division of Behavioral Health out-of-state placement team for a 

clinical review of the child’s medical records and residential facilities that were capable of 

providing the appropriate intensive behavioral supports the child needed. This meeting resulted in 

the child’s acceptance to a residential treatment facility in the State of Utah. The P&A was able to 

contest a Medicaid denial of benefits and ultimately get the child into appropriate treatment. 

District of Columbia 

The P&A represented a 36 year-old man with serious mental illness who was born in Sierra Leone 

and has lived in the United States since childhood. The client's immigration attorney contacted the 

P&A because he was connected to a mental health core service agency (CSA) but was not receiving 

any services. The P&A was initially told by CSA that the client was not receiving services because 

he did have active health insurance. When the P&A complained that he was not receiving services, 

the CSA agreed to assign a case worker and to provide some services. When the client ran out of 

medication, the P&A worked with a free-standing mental health clinic to provide the medications, 

with no assistance from his CSA. The P&A also provided information to his CSA about his 

eligibility for benefits. Since the client was granted asylum status, he was eligible for health 

insurance but his CSA was not aware of it. The P&A worked with the client and his immigration 

attorney to apply for the Assertive Community Treatment (ACT) services from a different agency, 

one which uses a housing first model. The client was accepted by the ACT team, which assisted 

him with medication management and housing search. 

Illinois 

The P&A represented a man with anxiety disorder, residing at a high security mental health center, 

who was placed in the facility after being found not guilty by reason of insanity. He was concerned 

that he missed getting his medications every time he had to go to court. The P&A viewed this issue 

as neglect and wrote a demand letter about i. The facility administrator quickly responded and 

agreed that there were failures in care relating to medication for court trips. In response, the 

administrator ensured that the facility made policy revisions and also trained staff on these policies. 

Subsequently, the client reported that he was getting his medications on the days that he was going 

to court. 

Maryland 

The P&A investigated a complaint on behalf of a youth with mental illness and Asperger's disorder, 

who was a resident at a Residential Treatment Center (RTC). The youth was 17 years old and had 

completed high school. Because he had completed his schooling, the RTC would not permit him to 

attend school classes during the day. Consequently, while other residents were at school, the client 

sat in his unit for hours at a time, with virtually no activities or structured programming. He felt 

that his rights were being violated, due to a lack of meaningful programming and activities that he 

could access. The P&A advocated for the youth (and future students who may find themselves 

similarly situated) by bringing this issue to the attention of RTC’s leadership and advocating for 

changes and increased programming. The P&A was able to substantiate that the youth was, in fact, 

spending much of his day without anything to do. Prior to the resolution of this case, the youth was 

discharged and is now doing well at a therapeutic group home. The P&A continued to advocate for 

changes surrounding this issue. As a result, RTC’s leadership informed the P&A that they would be 

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implementing a new, more robust vocational program to offer to future students who find 

themselves similarly situated. 

3. Rights Violations 

Number and types of individual rights complaints investigated and closed per FY included: 

Rights Violations FY 2017 FY 2018 

Cases Investigated & Closed 537 589 

No written treatment plan 185 233 

Guardianship/conservator problems 247 234 

Problems with advanced directives 78 86 

Failure to provide confidentiality 27 36 

 [See Appendix - Table 7] 

Case Examples from FY 2017 

Illinois 

The P&A assisted a female nursing home resident with major depressive disorder, who was 

experiencing rights violations regarding privacy rights and right to community passes. The woman 

had an upcoming care plan meeting and wanted the P&A's advice on how to advocate for herself 

with respect to those rights violations. First, with respect to the privacy concern, the nursing home 

was only allowing her to meet with visitors in the lobby. The P&A advised her of her right to meet 

with visitors in private. At the care plan meeting, the woman provided the information about her 

privacy rights, and the nursing home has now allowed her to meet with visitors in her room. In 

addition, her community pass privileges were revoked after the nursing home claimed that she 

tested positive for alcohol when she returned from a weekend visit. The woman advised the P&A 

that this couldn't be true because she had not consumed any alcohol for over a year. The P&A 

advised her that she had a right to see the test results. The woman made a request for the test results 

at the care plan meeting. Upon making that request, the facility restored her community pass 

privileges. 

Kansas 

The P&A received a call from a young woman with severe mental illness, including anxiety, 

depression, and bipolar disorder. She contacted the P&A because she was unhappy with her 

guardian and felt that she no longer needed one. In the past, the young woman had been 

institutionalized and was periodically unstable. The P&A worked with the young woman to show 

that she was able to take care of herself for several months and had been compliant with 

medications and therapy. After an evaluation, her therapist was able to report how well the young 

woman was doing and that she no longer needed a guardian. The P&A filed a petition to terminate 

the young woman’s guardianship with the court. The court granted the motion and the guardianship 

was ended. 

Rhode Island 

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The P&A represented a woman regarding a Petition for Guardianship that had been filed by a 

family member, based upon a Decision-Making Assessment Tool (DMAT) prepared by her former 

physician at the facility where she resides. The P&A prepared a Motion to Dismiss, but were able 

to successfully negotiate with the petitioner's counsel that the matter be dismissed, as the client had 

executed a Durable Power of Attorney for Healthcare, which is an alternative to guardianship. 

Rhode Island law requires that alternatives to guardianship be ruled out before a Petition for 

Guardianship is filed. In addition, due to the DMAT being prepared by her former physician at the 

facility, the P&A offered to provide training for patients and their families and staff regarding 

alternatives to guardianship. The offer was accepted and the P&A provided two trainings on 

alternatives to guardianship at the facility during FY 2017. 

Case Examples from FY 2018 

Arizona 

The P&A provided rights violation assistance in the case of a 17-year-old individual who was 

diagnosed with severe depression at the age of 12 years. The individual’s mother contacted the 

P&A for assistance after the individual had been inpatient at a behavioral health treatment facility 

for approximately four weeks. The individual’s mother alleged that the inpatient behavioral health 

facility denied the individual’s right to appropriate discharge planning, when the facility disregarded 

the family’s request for what they thought was a more appropriate placement. The individual’s 

mother also alleged that the inpatient behavioral health facility had violated the individual’s privacy 

rights. The P&A provided the individual’s mother with rights information regarding the 

individual’s right to appeal the failure of the inpatient behavioral health facility to provide adequate 

discharge planning. The P&A also provided the individual’s mother with information on how to 

file a Health Insurance Portability and Accountability Act (HIPAA) of 1996 privacy complaint. 

The individual’s mother was able to advocate for the individual after receiving this information 

from the P&A. 

Iowa 

The P&A was contacted by a 33-year-old transgender female diagnosed with bipolar disorder. The 

client’s mother was her guardian and conservator, and she contacted the P&A alleging that her 

guardian was being overly restrictive and intended to prevent her from transitioning. The client 

requested assistance terminating the guardianship and conservatorship. The P&A met with the 

client, obtained and reviewed records, and interviewed the guardian. Following discussion with the 

P&A, the guardian conceded that the guardianship and conservatorship were no longer necessary, 

and asked the court to terminate them both, which it did. As a result, the client’s rights were 

restored. 

Minnesota 

The P&A was contacted by a 61-year-old PAIMI-eligible man, indeterminately committed to the 

state’s forensic mental hospital for individuals with severe mental illness who are considered 

dangerous. The client stated that he was unable to have legal telephone calls with his court 

appointed civil commitment attorney in a private area away from hospital staff and other patients. 

The P&A contacted the hospital administration and outlined the practical necessity and legal rights 

of the patient to have private phone calls. As a result of the P&A’s advocacy, the hospital program 

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director reviewed the complaint, and agreed with the P&A’s analysis. The client was provided a 

confidential area to make calls, and confirmed that he is now able to complete his telephone calls in 

private. Although the individual’s rights violations have been resolved, during the current federal 

fiscal year, the P&A staff is following up with the hospital to ensure that this protocol is 

consistently available to other patients as well. 

4. Death Investigations 

The PAIMI Act authorized state P&A systems to investigate incidents of abuse, neglect, and deaths 

that occur in public and private care and treatment facilities on behalf of eligible individuals.

20 

Most states had no mandatory reporting statutes, central registries, or other statewide systems to 

capture incidents of restraint, seclusion, serious injuries, or fatalities. Despite state data collection 

limitations, the state P&A systems monitored and investigated the use of restraint and seclusion in 

residential care and treatment facilities, especially incidents involving serious injury or death. 

States with mandatory reporting requirements and central registries often send all state death reports 

to the P&A system, whose staff must review the information to determine incidents requiring 

investigation. Deaths reported by states and CMS, and investigated by state P&A systems and other 

sources were as follows: 

Death Reported by FY 2017 FY 2018 

States 1,087 786 

Centers for Medicare & Medicaid Services (CMS) 1 1 

Other 164 187 

Deaths Reported Total 1,252 974 

Deaths Investigated, by incident type FY 2017 FY 2018 

Seclusion (S) 6 14 

Restraints (R) 8 9 

Non S or R related 261 250 

Deaths Investigated Total 275 273 

 [See Appendix - Table 8] 

Case Examples from FY 2017 

Alaska 

The P&A received a media report alleging an inmate attempted suicide while incarcerated, and 

subsequently died. Based on the complaint, the P&A initiated a secondary investigation and found 

that the inmate's suicide was due to DOC’s negligent inaction in response to the inmate's suicidality. 

The P&A requested an expert consultant to review the records and provide recommendations on 

what should have been done in response to the inmate's suicidality, and recommended changes to 

the current DOC Suicide Prevention policy and procedure. 

Florida 

20 at 42 U.S.C. 10802 (1), (3), (4), and (5) 

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The P&A investigated the death of an adult male with psychiatric disabilities, at a state prison. The 

deceased had a history of major depressive disorder and had a long history of self-injurious 

behavior. He was being treated in the prison system’s equivalent of a crisis stabilization unit. Prior 

to his death, the deceased had several incidents of suicidal ideation and attempts. Although he 

made these attempts and wrote a suicide letter, staff at the facility were skeptical regarding the 

threat, believing that he was exaggerating and seeking attention. On the day of the deceased’s 

death, he attempted to hang himself. Staff intervened approximately forty minutes later. Staff 

applied handcuffs, leg irons, and a spit guard and placed the client in an observation cell. 

Unfortunately, he was found to be unresponsive 20 minutes later and was pronounced dead at the 

hospital. The P&A discovered this death during routine monitoring of the conditions at the various 

state prison mental health treatment facilities. The deceased was one of several deaths that were 

determined to be suspicious and warranted further investigation. The P&A’s investigation consisted 

of a review of all mental health, medical, and classification files, in addition to interviewing prison 

staff, other inmates, and reviewing the autopsy findings. This death, in addition to others, prompted 

the P&A to hire three prison mental health experts to review the findings and participate in 

monitoring visits to the prisons. Ultimately, the P&A presented these findings to DOC and are now 

in mediation to develop an agreement that will improve care and conditions throughout the prison 

systems in the State of Florida. 

Montana 

The P&A was contacted about a 15-year-old male with bipolar disorder, who was placed by his 

family at a Montana adolescent rehabilitation program, essentially an “outdoor wilderness school,” 

where he was left unsupervised long enough for him to commit suicide by hanging. The P&A is 

now establishing communication with the state regulatory board governing these facilities, to ensure 

that they are enforcing regulatory compliance, to protect youth with mental illness from abuse and 

neglect in “wilderness schools.” 

Case Examples from FY 2018 

District of Columbia 

The P&A investigated an unexpected, sudden death of a woman in her thirties, due to an 

intracranial bleed while she was a patient at St. Elizabeth’s Hospital. The P&A’s extensive review 

of the medical records and the facility’s own investigation report exposed multiple instances of 

serious nursing and medical neglect. The P&A produced a report entitled “A Patient’s Suffering 

and Death at St. Elizabeth’s Hospital.” Among the recommendations in the report, the P&A 

requested that the Department of Behavioral Health (DBH) and the Department of Health develop a 

plan to ensure that medical and nursing personnel at St. Elizabeth’s Hospital are adequately trained, 

and have the requisite skills to address the patients' needs. 

New Jersey 

The P&A reviewed the death of s a 49-year-old patient at a private general hospital, who was 

admitted for abdominal pain and received surgery for an abdominal hernia. While in the hospital, 

the patient was transferred to the psychiatric unit for psychiatric stabilization. While on the 

psychiatric unit, the patient became aggressive toward other patients. The patient was medicated by 

injection, and appeared to be calming down. When staff attempted to place the patient in a 

15 
 

 

 

 

 

 

seclusion room, she threw chairs across the room. The patient fought staff who were attempting to 

physically restrain her until mechanical restraints arrived. A towel was placed over her face to 

prevent the patient from spitting on hospital staff. The patient’s legs and one arm were placed in the 

restraints, when it was noted that she was unresponsive. Emergency life support procedures were 

initiated, but she did not respond, and was pronounced dead. As a result of the patient’s death, the 

hospital completed an intensive root cause analysis (RCA). The P&A communicated with the 

hospital's attorneys, to ensure that the RCA's many recommendations were implemented. The P&A 

reviewed the documentation, to ensure that all recommendations were appropriately implemented. 

The family hired a private attorney to file a wrongful death complaint. The P&A closed the file 

after receiving assurances that the hospital had implemented the new procedures. 

North Carolina 

The P&A, as a result of a detailed complaint filed with regulators following an investigation, 

investigated the death of a young woman with mental illness. The P&A took the case for 

investigation after it received a death report about the young woman, who died in seclusion in the 

hospital’s emergency room, following involuntary commitment. The findings were significant, 

because regulators looked at the death during an annual “recertification” survey of the hospital and 

did not find any deficiencies. After conducting a three-day investigation, based on our complaint, 

regulators determined that the hospital had violated CMS regulations related to the use of seclusion. 

The hospital’s Plan of Correction included rewriting hospital policy and retraining staff about the 

circumstances under which seclusion may be used and must be discontinued and the monitoring 

procedures during and following the seclusion that must occur. 

5. Complaints Favorably Resolved for Clients 

The case examples in section (1) Abuse, (2) Neglect, and (3) Rights violations provide information 

on the types of favorable outcomes achieved on behalf of individual P&A system clients. The 

following table shows the total number of individual PAIMI complaints investigated, closed, and 

resolved. 

Complaints Investigated and Closed, by type FY 2017 FY 2018 

Abuse 2,397 1,902 

Neglect 2,021 1,654 

Rights violations 4,597 3,976 

Total 9,015 7,532 

 [See Appendix - Table 9, 10, & 11] 

6. Intervention Strategies 

The P&A systems are authorized by the PAIMI Act21 to pursue administrative, legal, and other 

remedies, to ensure protection for individuals with mental illness. An individual’s initial complaint 

may involve multiple issues, and P&A systems often use several strategies to resolve them. The 

total strategies used often exceeded the number of complaints investigated and closed in a FY, as 

clients’ initial complaints frequently include multiple issues and various strategies are used to 

resolve them. 

21 at 42 U.S.C. 10805 (a) (1) (C) 

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Intervention Strategies, by Type FY 2017 FY 2018 

Short-term assistance 4,841 4,041 

Abuse & neglect investigations 1,294 1,028 

Technical assistance 1,222 1,030 

Administrative remedies 288 329 

Negotiation/mediation 1,146 877 

Legal remedies 288 284 

Total Intervention Strategies 9,079 7,589 

 [See Appendix - Table 12] 

Case Examples from FY 2017 

Arizona 

The P&A provided short-term assistance in the case of a 17-year-old male with mental illness. The 

individual's mother contacted the P&A for assistance because Mercy Maricopa Integrated Care 

(MMIC), the Regional Behavioral Health Authority for Maricopa County, neglected the individual, 

as a result of its failure to provide for appropriate discharge planning from the inpatient behavioral 

health facility in which the individual was residing. The individual was discharged from his 

inpatient behavioral health facility to a group home too early, which resulted in the individual 

becoming violent and ultimately incarcerated. The P&A provided the individual’s mother with 

verbal and written information on the right to file a grievance with MMIC. The P&A also provided 

the individual’s mother with referrals to additional legal resources. With the information the P&A 

provided her, the individual's mother was able to advocate on the individual's behalf. 

Colorado 

The P&A received a complaint from a 48-year-old client with mental illness, who was residing in 

public housing. The client had recently received a notice denying his request for an assistance 

animal from the local housing authority, stating that the animal barked and was a nuisance. The 

housing authority received this information from the client’s neighbors. The client was adamant 

that the neighbors were lying, and his dog was not causing any additional noise. The client has 

difficulty regulating his emotions, due to his disability, and his dog allows him to stay calm and 

conflict free in his home. The client had paperwork to support his need for the animal. The P&A 

reviewed documents provided by the client, met with him multiple times at his home, and assisted 

him in gathering evidence to support his claims. The P&A also assisted the client in following the 

housing authority appeal process. The P&A organized an informal grievance meeting with the local 

housing authority, to advocate for the client. Ultimately, the housing authority allowed the client’s 

dog as an assistance animal, as long as the client filled out some additional paperwork. The client 

was facing possible eviction due to this issue, and the P&A provided a reasonable solution for him 

to keep his housing. 

Maryland 

The P&A investigated the cases of three patients at a state psychiatric hospital, who were secluded 

in their bedrooms for nearly 24 hours a day, in a new hospital policy called "zoning," where patients 

with difficult behaviors were made to stay in their room continuously. The P&A’s investigation 

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found that at least two of the patients had been required to stay in their rooms for over two years. 

The P&A also noted that the patients’ behavior management plans were inadequate, and not aimed 

at preventing violent behavior or understanding the causes of the behavior. Further, the P&A's 

investigation revealed that at least one of the patients was diagnosed with an intellectual disability 

that made it difficult to conform to hospital rules. The P&A contacted the hospital administration, 

to request that zoning of clients be ended. When this request was unsuccessful, the P&A filed a 

complaint with the Office of Health Care Quality, who filed a Deficiency Report. The hospital was 

required to file a plan of correction, and the P&A’s clients reported that they have enjoyed being out 

of their rooms and participating in hospital groups and activities. 

 North Dakota 

A 49-year-old woman, with a diagnosis of major depression and history of overmedicating on 

prescription drugs, lived alone in an apartment in Bismarck, ND. The client worked in an 

administrative position, and had an established history of good performance. The client was 

terminated from her job while taking an approved leave of absence for mental health treatment. As 

a result of this action, the client suffered financially, had to move, and ended up reaching out to 

nonprofit agencies for financial assistance. She eventually worked two jobs to make up for what 

she was paid at her former employment. The P&A assisted the client to file a complaint with the 

North Dakota Department of Labor (NDDOL). An investigation was done and a “no cause” 

determination was made by the NDDOL investigator, despite strong evidence that disability-related 

discrimination had occurred. The P&A filed an employment discrimination complaint in court on 

the client’s behalf. The employer ultimately entered into negotiations and a very healthy settlement 

was reached on behalf of the client. 

Case Examples from FY 2018 

Connecticut 

The P&A received a call from an individual who was residing in a public mental health facility. 

The individual was experiencing gynecological issues and despite repeated requests, had not been 

taken to see a doctor. The P&A got involved, met with the client, reviewed the record, and 

approached the administration regarding lack of medical treatment. The P&A pursued the issue and 

the individual was able to see a medical professional about her issues. 

District of Columbia 

The P&A represented a 51-year-old man with serious mental illness, who was discriminated against 

by his graduate program. When the university learned that he had mental illness they suspended his 

participation in the program, and required him to get documentation from a psychiatrist that he was 

fit to be in the program. He was not then seeing a psychiatrist, so he was forced to pay $1,000 for a 

psychiatrist to evaluate him. The psychiatrist found him fit to be in the program. Then, the 

university disclosed to a prospective employer that he had a mental illness. The P&A wrote a letter 

to the university, asking that the client be reimbursed for the evaluation and compensated for the 

time he was suspended and the delay in his employment, after the illegal disclosure of his mental 

illness. The P&A also recommended training for the university on their requirements under 

Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. When the 

university failed to address his concerns the P&A assisted the client in filing a complaint with the 

18 
 

 

 

 

 

 

 

 

Office of Human Rights, alleging the university violated ADA, Section 504 of the Rehabilitation 

Act and the District of Columbia Human Rights Act. The parties were sent to mediation, and were 

able to negotiate a confidential settlement that addressed the client's concerns. 

Idaho 

The P&A filed a complaint with a state psychiatric hospital on behalf of a 32-year-old female 

diagnosed with chronic PTSD and anxiety, alleging rights violations regarding safety and mental 

health care. The client contacted the P&A because she felt that the facility doctor was not listening 

to her when she talked about emerging symptoms, to the point that an outside physician had to be 

called to order anxiety medication one night, when she had a panic attack. She also complained that 

the staff did not address safety concerns, in that a box knife was left on the unit floor by contractors 

replacing floor tile, within reach of the patients. Patients were concerned and upset, with some 

wanting to use the knife and others afraid for their safety, so the client told staff. Her concerns were 

ignored, until she threatened to go to the administration; staff then asked the contractors to pick up 

their tools, including the knife. The P&A reviewed policy and filed a grievance with the Patient 

Advocate at the facility. The Patient Advocate reviewed video of the incident, and stated that he 

would provide further training to the contractors while they are working at the facility. The Patient 

Advocate also forwarded the complaint to medical staff. The client was satisfied with the remedy, 

and was soon discharged. 

C. Class Action Litigation 

To ensure compliance with federal or state laws and regulations and when immediate action is 

needed to protect a group of individuals, state P&A systems may use class litigation.22 This type of 

litigation is a strategy of last resort. This complex strategy often takes years to resolve the 

presenting problem, and requires special staff expertise, resources, and time. These types of cases 

generally involve a range of issues that affect the lives of individuals or groups of individuals with 

mental illness and other disabilities and their families. Class action activities reported by the P&A 

systems on behalf of PAIMI-eligible individuals included: 

Class Action Litigations FY 2017 FY 2018 

Number of Events 61 81 

Individuals Impacted 2,444,669 1,612,221 

 [See Appendix – Table 13a] 

Case Examples from FY 2017 

Delaware 

The P&A and Delaware Department of Corrections (DOC) resolved a class action regarding the 

utilization of solitary confinement for inmates with serious and persistent mental illness. 

Approximately 1,000 inmates were identified as having a serious mental illness, and 200 of them 

were isolated in restrictive housing. A Federal Judge approved the settlement, which created better 

treatment options for these inmates. A prison riot in early 2017 led to disruption in implementation 

of the agreement. However, the P&A have continued to work with DOC to monitor the 

implementation and progress within DOC. The P&A randomly selects and reviews 20 inmate files 

22 42 U.S.C. 10805 (a)(1)(B) 

19 
 

on a monthly basis, to ascertain whether the inmates are receiving services as contemplated in the 

agreement. 

20 
 

 

 

 

 

 

 

 

 

 

District of Columbia 

In Brown v. District of Columbia, the P&A continued to represent class members who are District 

of Columbia Medicaid beneficiaries in nursing facilities, seeking transition assistance from the 

District of Columbia government to help them move back to the community, with the services that 

they need. The class includes adults with serious mental illness, who also have a physical disability. 

Transition assistance included essential steps such as obtaining identification documents and 

income-benefit statements, helping class members complete housing applications, assessing their 

long-term care Medicaid service needs, and linking them to provider agencies. The P&A provided 

extensive assistance in preparing the evidence presented to the Court. In September 2017, the Court 

issued its decision in favor of the District and dismissed plaintiffs’ legal claims. The Court found 

that “[t]he District has little to be proud of regarding its historic inability to comply with Olmstead’s 

integration mandate” 23 but, because the majority of class members need housing and subsidized 

housing is difficult to find, the Court found plaintiffs’ claims for transition assistance were 

essentially futile. Despite the negative decision, the District reported that 38 nursing home residents 

transitioned to the community during FY 2017, which exceeded its goal of 33. 

Illinois 

In FY 2007, the P&A and its co-counsel filed a class action lawsuit against state officials for failing 

to provide community services for people living in nursing homes in Cook County, Illinois, 

primarily people with mental illness and people with physical disabilities. Suit was brought under 

ADA, and pursuant to the U.S. Supreme Court’s Olmstead decision. It is estimated that over 16,000 

people live in nursing homes in Cook County. In FY 2008, the case was certified as a class action. 

In FY 2012, the judge granted final approval of a Consent Decree, appointed an Independent 

Monitor, and the parties worked to develop the requisite Implementation Plan. At the end of FY 

2017, over 1,800 class members had moved into the community from nursing homes. 

Case Examples from FY 2018 

California 

The P&A filed a federal class action lawsuit on behalf of five prisoners in the Santa Barbara County 

Jail, claiming conditions at the jail do not meet minimum standards under the U.S. Constitution and 

federal law, including ADA. The lead plaintiff, a 67-yearold PAIMI-eligible U.S. Army veteran, 

requested but received no meaningful treatment to help him manage his PTSD. Another class 

member was denied prescribed psychiatric medications that he had been taking prior to his arrest. 

Despite jail staff documenting his reports of an exacerbation of his mental health disability, his 

condition worsened and, a few days later, the class member attempted suicide by cutting his wrist. 

The prisoners are seeking an order from the court requiring Santa Barbara County officials to 

improve jail conditions, to comply with constitutional and statutory standards. In June 2018, the 

U.S. District Court granted the P&A’s motion for class certification. The P&A is meeting with the 

Sheriff’s office and county officials to negotiate a remedial plan. 

23 Olmstead v. LC: 1999 United States Supreme Court Decision 

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Colorado 

The P&A entered a class action lawsuit against the Federal Bureau of Prisons (BOP) for their 8th 

Amendment violations by failing to exclude inmates with serious mental illness from the 

Administrative Maximum Facility (ADX), located in Florence, Colorado, and for failing to provide 

a constitutionally appropriate level of mental health screening and treatment to inmates at the ADX. 

A settlement agreement was reached after years of discovery, policy development and settlement 

discussions. In January 2017, the settlement agreement was approved, and found to be fair, 

reasonable, and adequate for the class and subclass. The case is currently in the monitoring phase, 

where two experienced corrections psychiatrists are checking BOP’s compliance with a very 

detailed settlement agreement. The P&A is part of the monitoring process commenting on 

compliance/ noncompliance issues and receiving inmate complaints concerning implementation of 

the settlement agreement. 

Louisiana 

Early in 2017, the P&A found probable cause to believe that Defendants were exposing prisoners 

with mental illness and other disabilities at David Wade Correctional Center (DWCC) in Homer, 

Louisiana to neglect and abuse, by subjecting them to extended periods of solitary confinement and 

failing to provide adequate mental health services. As a result, the P&A initiated an investigation of 

the prison’s use of isolation and restraints and whether mental health treatment at DWCC was 

adequate and appropriate. At DWCC, hundreds of prisoners, many of whom were known to have 

serious mental illness, including history of self- harm or suicidal tendencies, were routinely placed 

on extended lockdown. A lawsuit was brought on behalf of two individuals, both of whom are 

currently in custody of the DWCC, and all persons in a similar situation. One individual, having no 

history of mental illness, now complains of auditory and visual hallucinations, as a result of his stay 

in extended lockdown and lack of mental health resources. The other individual, despite having 

been diagnosed as bipolar and being on suicide watch at the time of his evaluation, was categorized 

as having no mental problems. He has attempted suicide twice, and been on suicide watch five 

times. It is the P&A’s contention that extended lockdown is a cruel, inhumane punishment, in 

which these men are deprived of human contact, the outdoors, speaking with their families or even a 

regular shower. By subjecting prisoners to such treatment, the plaintiffs contend that Defendants 

are violating the rights of prisoners under the First and Eighth Amendments, as well as ADA and 

Section 504 of the Rehabilitation Act. 

Iowa 

The P&A filed a class action lawsuit on behalf of boys with mental illness against a State-operated 

juvenile justice facility, to eliminate the use of fixed restraints and solitary confinement for 

punishment purposes and to ensure that the boys were receiving constitutionally required mental 

health treatment. Part of the remedies requested will require that the Iowa Department of Human 

Services change their regulations concerning the use of restraint and seclusion in this facility. 

D. Interventions on Behalf of Groups of PAIMI-eligible Individuals 

The majority of P&A systems advocated on behalf of groups of PAIMI-eligible individuals. These 

types of activities were not directed toward individuals, but for resolution of a range of systemic 

issues affecting specific groups or larger populations throughout a state. Some systemic advocacy 

22 
 

 

 

activities included legal actions to protect the rights, health and safety of vulnerable facility 

residents (See C. Class Action). Sometimes individual complaints resulted in group advocacy. 

Generally, P&A non-case directed advocacy activities focused on implementing changes in 

administrative policy, procedures, or practices in state agencies, residential treatment facilities, and 

other service providers. Activities reported under the Legislative and Regulatory Advocacy section 

are limited to providing technical assistance, education, and awareness about current statutes and 

regulations regarding the rights and protection of individuals with serious mental illness (SMI) or 

serious emotional disturbance (SED) and do not include strictly prohibited activities, such as the 

inappropriate use of federal dollars to influence legislation or any actions by federal or state 

governments described in Section 503 of Title V, in Division H of the Consolidated Appropriations 

Act and specific prohibitions against lobbying in the PAIMI regulations.24 

Non-Litigation Advocacy FY 2017 FY 2018 

Number of Events 2,977 1,983 

Total number of individuals impacted 12,429,482 10,193,626 

[See Appendix – Table 13b] 

Legislative & Regulatory Advocacy FY 2017 FY 2018 

Number of Events 149 243 

Total Number of Individuals Impacted 10,212,335 8,737,697 

[See Appendix – Table 13c] 

Case Example from FY 2017 

District of Columbia 

In February 2017, the Green Door, a non-profit mental health provider, closed with very little notice 

to the 1,200 mental health consumers who relied on them for support. The P&A attended a 

consumer forum at the Green Door before it closed, and conducted outreach immediately 

afterwards, interviewing consumers regarding whether their needs were being met during the 

transition period. The P&A raised concerns to the Department of Behavioral Health (DBH) and the 

District of Columbia City Council about the lack of notice to consumers regarding the closure and 

lack of an adequate transition period, and advocated that the mental health provider that was 

acquiring Green Door’s space and clients receive special training and supervision in providing the 

evidence-based practice of Assertive Community Treatment (ACT) services. As a result of the 

P&A's advocacy, the District of Columbia City Council requested that DBH provide a plan to 

follow each client. 

Case Example for FY 2018 

Kentucky 

The P&A provided PAIMI services to a 17-year-old female who was diagnosed with several mental 

disorders. The P&A was notified because the client was bruised during a Safe Crisis Management 

(SCM) restraint at a Psychiatric Residential Treatment Facility. The allegations were investigated 

by the Child Protective Services (CPS), and reported to the Office of Inspector General (OIG). The 

24 42 CFR Part 51. Subpart A 

23 
 

 

 

 

 

P&A received and reviewed a copy of the final investigation report. The allegations were 

substantiated as “risk of harm,” due to excessive use of force during SCM. The report also 

indicated that the staff member who administered the SCM was non-compliant with required 

training. CPS recommended the facility terminate the staff’s employment. The OIG also issued a 

statement of deficiency to the facility. The P&A sent a letter to the guardian of the client, to let the 

guardian know the outcome of the investigation, and continued monitoring the treatment of the 

client and other residents. Both CPS and OIG continue to be involved in the monitoring of the 

facility for regulatory compliance and the safety of residents. 

Nevada 

The P&A provided PAIMI services to a 55-year-old male with mental illness, whose sister was his 

guardian. The client was placed on a mental health hold, and admitted to a psychiatric facility. 

Rather than filing a Petition for Involuntary Commitment, the hospital permitted the guardian to 

“voluntarily” admit the client over his objection. The P&A contacted the public defender and the 

client’s attorney appointed in the guardianship case. The P&A discovered that the guardianship 

judge specifically found that the guardian did not have the authority to voluntarily admit the client, 

and communicated this information to hospital staff. Rather than file Petition to hold, the client was 

released by the hospital. The client submitted a complaint with the Nevada’s regulatory agency 

concerning the hospital’s failure to timely file a petition as required by state law. The complaint 

was joined by the client’s attorney in the guardianship case and the public defender’s office. 

E. Public Education, Training, and Awareness Activities 

Each state P&A system received requests for information and referral services from its constituents 

via telephone, e-mail, letter, face-to-face, and walk-in visits. The systems also provided 

information by conducting public awareness, education, and training activities. Many state PAIMI 

Programs met with and provided civil rights informational training to consumers, stakeholders, and 

advocacy groups. Other P&A systems conducted mental health law classes for attorneys, graduate 

students, current and former recipients of mental health services, and mental health service 

professionals. The P&A system provided information to the public by various means, including 

newspapers, radio/television public service announcements, agency newsletters, websites, 

publications, investigative reports, and listservs. Some P&A systems within sparsely populated 

states or with large rural populations used technology to provide information through webcams, 

videoconferences, teleconferences, webinars, Facebook, and Skype. The PAIMI Program public 

education, training, and awareness activities conducted by the P&A systems included: 

Educational or Training Activities FY 2017 FY 2018 

Information and Referral Requests 24,764 23,029 

a. Number of Public Awareness Activities or Events 1,910 2,055 

b. Number of Educational/Training Activities Undertaken 2,436 2,428 

c. Number (approximate) of Person Trained in b. 80,753 72.687 

 [See Appendix, Table 14] 

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Case Examples from FY 2017 

Delaware 

The P&A assisted a client, diagnosed with depression and substance use disorder, with multiple 

concerns, including lost mail, an alleged HIPAA violation, cleanliness of the unit, and poor staff 

interactions. The P&A assisted the client in filing grievances, provided information and referral, 

attended a treatment team meeting with the client, and arranged contact with the HIPAA 

Compliance Officer at DPC. In addition, the client had a pending family law matter in New Jersey. 

The P&A facilitated telephonic attendance at an arbitration and court hearing for this client. 

Maine 

The P&A assisted a 34-year-old woman with mental illness, who was transported by police to a 

hospital emergency department for a mental health evaluation. The woman was subjected to 

restraint and involuntary medications, due to the hospital claiming that she was being “disruptive” 

to other patients. The P&A investigated the client’s treatment and determined that staff had not 

been properly trained regarding the rights of individuals with mental illness awaiting mental health 

evaluations in the emergency department. The hospital agreed to, and accepted training for, 

emergency room staff from the P&A in this area of patient rights. 

Mississippi 

The P&A collaborated with Southern Poverty Law Center's Youth Justice Project to monitor a 

juvenile detention facility in Hinds County. The P&A is working with the facility to ensure that 

eligible youths have access to advocates, receive appropriate mental health and medical treatment, 

are not subject to force and restraints, and are given educational services. The P&A has been able 

to collaborate with local mental health providers to initiate services to youth at the detention 

facility. 

Case Examples from FY 2018 

Delaware 

A client with schizoaffective disorder bipolar type at DPC asked for P&A assistance with discharge 

planning, a housing voucher issue in New York State, and other patient advocacy concerns. The 

P&A investigated her complaints, provided information and referral about her mental health patient 

rights, and involuntary commitment rights. The P&A advocated for the client to get a belongings 

inventory list and referred her to a legal services program in New York, regarding the housing 

voucher issue. Because the client is now discharged from DPC and her legal problem resolved, her 

case has been closed. 

Massachusetts 

The P&A collaborated with the Western Massachusetts and Eastern Massachusetts Peer Networks 

to share information and trends on mental health issues throughout the Commonwealth. The P&A 

provided extensive legal advice about community-based living rights and responsibilities, 

involuntary medication, and human rights laws. Representatives from the Peer Networks shared 

concerns with the P&A about specific provider abuses and a social media campaign that they were 

25 
 

 

 

 

 

 

planning. The P&A followed up with monitoring additional group homes and hospitals, based on 

this advocacy, as well as with providing legal guidance around social media campaigns, to raise 

awareness about mental health abuse/neglect. 

Texas 

The P&A conducted an education and training and focus group meeting at the Rio Grande State 

Center in February 2018. One of the issues raised by participants was their right to a safe 

environment and why they did not feel safe in the unit. The discussion led to issues regarding the 

lack of availability of the quiet room. The residents stated that the quiet room was not available. 

The P&A raised the issue of residents not being able to access the quiet room with the Director of 

Social Work, who confirmed it was not available due to construction in the unit. The P&A 

requested that an alternative location be provided. Several follow up inquiries were made with the 

staff. Due to the persistence of the P&A, and the efforts in negotiating closure on this issue, the 

quiet room was restored for use by residents. 

F. Accomplishments, Impediments, and Unmet Advocacy Needs 

1. Accomplishments 

P&A system intervention improved the quality of life for individuals with mental illness and 

resulted in systemic changes. Examples of these accomplishments included: 

MAJOR ACCOMPLISHMENTS 

Examples from FY 2017 

Maine 

The P&A continues to provide contract advocacy services to both of Maine's state psychiatric 

hospitals and one of Maine's largest private psychiatric hospitals. The P&A continues to provide 

regular outreach and monitoring visits to other private psychiatric hospitals throughout the state. In 

FY 2017, the P&A conducted this type of monitoring and outreach on 16 separate occasions to 4 

different hospitals, including another large private psychiatric hospital. 

North Dakota 

The P&A investigated and identified a number of systemic issues that resulted in denial of 

appropriate assessment and mental health services to a client. The P&A had meetings with 

personnel at the jail, the regional human service center, the States Attorney’s Office, and other 

offices, to address the identified systemic problems that contributed to the client’s situation. 

Case Examples from FY 2018 

American Samoa 

During the transition of five clients from the correctional facility to the LBJ Behavioral Health 

Center for ongoing treatment and care their rehabilitation needs were initially not being met, due to 

limited resources, including mental health care professionals and programs available for the clients. 

26 
 

 

 

 

 

 

At a Behavioral Health Planning Council meeting, the P&A suggested and a rehabilitation 

subcommittee was formed. The goal was to collaborate and share resources amongst government 

and private agencies, to enable implementation of appropriate programs that could be attended by 

clients both housed long-term at the Behavioral Health Center and in the general community. 

Programs developed included Computer Skills training with the Department of Youth & Women, 

Workforce Innovation and Opportunity Act from the Department of Human Resources for 

employment on the job training skills, Check In group with Department of Human and Social 

Services (focusing on communication and social skills), a Drop-in group (now on hold), which gave 

ukulele lessons, art and meditation sessions, and Self-advocacy and Rights for clients training for 

clients and their family members by the P&A and peer mentor staff. Several cases were able to be 

closed, due to collaboration among a collective group of agencies on the island willing to come 

together for rehabilitation goal setting and achievement. This collaboration was an accomplishment 

not only for the five clients in transition, but also for the mental health system in general. 

Illinois 

An individual with schizophrenia who was in the maximum security mental health center, with a 

status of not guilty by reason of insanity, contacted the P&A seeking assistance to avoid being 

transported to court in shackles. After the P&A engaged in extensive negotiations, the facility 

relented and allowed the client to go to court accompanied by staff, but without shackles. This 

advocacy also had a systemic effect, by educating the facility and Division of Mental Health that the 

statewide policy does not require shackles where other security measures are sufficient, based on an 

individualized assessment of the person. 

2. Impediments & Unmet Needs 

Examples from FY 2017 

Alabama 

While the P&A’s PAIMI Act access authority has been repeatedly reaffirmed in jurisdictions across 

the United States, facilities in Alabama continue to challenge the P&A’s access to monitor and 

investigate any abuse, neglect or rights violations. During FY 2017, the P&A was denied access by 

county jails, requiring the P&A to engage in protracted negotiations with the jails over its access 

authority. Even though the P&A has successfully met access challenges to date, it has done so with 

a considerable amount of expenditures, time, and resources, which could have been used to provide 

direct client services. 

Alaska 

For the P&A, the major impediment to the implementation of mandated PAIMI activities is the lack 

of a comprehensive, statewide plan to fill service delivery gaps for individuals with severe mental 

illness. The absence of community-based services for individuals exiting institutional 

environments, such as prisons or psychiatric facilities, results in unacceptable recidivism and 

readmission rates. This “revolving door” consequence places a tremendous strain on the system, 

making it difficult for other individuals to access needed stabilization services. The dearth of stepup or step-down services challenges the individual advocacy conducted by the P&A. 

27 
 

 

 

 

 

 

 

 

 

California 

The P&A did not receive any notification from CMS regarding reports of behavioral restraintrelated deaths in California hospitals. The P&A renewed its data use agreement to receive 

notification of restraint-related hospital deaths, as required by 42 CFR 482.13(e); nevertheless, it is 

of grave concern that deaths related to the use of behavioral restraint or seclusion are not being 

reported to either CMS or the P&A, as required. 

Vermont 

The P&A’s impediment is the lack of a requirement in Vermont that Emergency Departments report 

to the State Department of Mental Health (DMH) episodes of seclusion and restraint of psychiatric 

patients or of voluntary patients in the inpatient units. This lack of reporting represents an obstacle, 

in that unlike seclusions and restraints of involuntary patients in psychiatric units, which are all 

reported to the P&A in one, easy to review and analyze dataset by the DMH, the other reports above 

are fragmented and hard to obtain, thus not allowing for a systematic review for systemic concerns. 

Examples from FY 2018 

Delaware 

The P&A’s greatest external impediment to progress is a staffing shortage that the state seems 

unable to address. The understaffing has led directly to deficiencies in a number of categories, 

including lack of peer oversight, inconsistent programming, a non-functioning investigations unit, 

and other issues. The lack of an effective and efficient investigations system at the Delaware 

Psychiatric Center has negatively impacted the P&A’s ability to obtain timely investigative reports 

and other materials. There is unacceptably long delays between incidents and investigations and 

investigations and production of documents. 

Louisiana 

The P&A did not regularly receive reports of seclusion, restraint, death, or serious injury from 

licensed facilities, the State Medicaid office, or the CMS regional office. The P&A regularly 

visited many of the facilities outlined in the Children’s Health Act of 2000, as well as other 

facilities on monitoring visits, and spoke with residents regarding conditions and incidents. In 

addition, the P&A monitored the media for reports of death or serious injury. 

Maryland 

The P&A received complaints of alleged sexual abuse or harassment from patients at state 

psychiatric hospitals, yet they failed to comply with the mandatory reporting requirements. 

Moreover, the reports of sexual abuse that P&A does receive are delayed, impeding its ability to 

investigate and address the allegations in a timely manner. Furthermore, some state hospitals fail to 

use the proper reporting forms, which upon investigation, the P&A noted, is often because the 

hospital staff were not aware of the reporting procedures. The P&A works with the Assistant 

Attorney General for the Maryland Department of Health to ensure that staff receive appropriate 

training on their obligations for responding to sexual assault reports and implementing the proper 

reporting forms and procedures required by the Doe v. Department of Health and Mental Hygiene 

28 
 

 

 

 

 

 

 

 

 

settlement agreement. The P&A continues to provide “Know Your Rights” presentations to both 

patients and staff on their rights related to sexual abuse allegations. 

Tennessee 

For the P&A, the external impediments remain unchanged. In Tennessee, there continues to be a 

shortage of resources for mental health services, especially for clients with the most serious 

behaviors related to their mental illness and those with secondary disabilities, such as deafness or 

other physical disabilities. In addition, there continues to be a move toward shorter duration 

inpatient treatment, with limited community support options. The most significantly impacted are 

some of the most vulnerable Tennesseans, those with limited access to medical insurance, as well as 

those with secondary disabilities and the aging population. This move limits the advocacy options, 

culturally and linguistically appropriate service options, and the safe community living resources. 

GOVERNANCE 

1. The Governing Authority 

The DD Act of 1975,25 which created the state P&A systems, and the PAIMI Act26 mandated that 

private, non-profit entities have a multimember governing authority (the Board) to oversee the 

system.

27 Each Board is responsible for the planning, design, implementation, and functioning of 

the system.

28 The Board must work jointly with its PAIMI Advisory Council (PAC)29 and establish 

policies and procedures for the selection of its members.30 The DD Act included provisions for 

Board terms of appointment, size, and composition. The DD Act required that: 

• Board members be selected according to policies and procedures of the system; 

• The Board include individuals who broadly represent or are knowledgeable about the needs 

of the clients served by the system; 

• The Board must make continuing efforts to ensure that its members represent racial and 

ethnic minorities.

31 

• The majority of Board members include individuals with disabilities who are current or 

former recipients of disability services, their family members, guardians, authorized 

representatives and advocates; 

• The system set term limits to ensure rotating membership on the board; and 

• Board vacancies be filled within 60-days.

32 

As of September 30, 2018, there were 52 private, non-profit P&A systems. Unlike private, nonprofit P&A systems, state-operated P&A systems may have a governing authority, but are not 

required to do so. 

25 42 U.S.C. 15043 (a), amended in 2000 26 42 U.S.C. 10805(c) 27 42 U.S.C. 15044 28 42 U.S.C. 10805(c) (2) (A) 

29 42 U.S.C. 10805(c) (2) (B) 30 42 U.S.C. 10805(c) (1) (B) 31 respectively at, 42 U.S.C. 10805(a) (6) (C) and 42 CFR 51.22(b) and (c) 32 respectively, at 42 U.S.C. 15044 (a) (1) (A), (B) (i), (ii) and (C) (3) and (4) 

29 
 

 

 

 

 

 

 

 

 

 

 

The PAIMI Act and Rules also require the PAC Chair, who must be a current or former recipient of 

mental health services or a family member of such an individual, sit on the governing Board of 

private, non-profit P&A systems. 

2. The PAIMI Advisory Council 

Each state P&A system is mandated to establish a PAC33 to advise the system on policies and 

priorities to be carried out in protecting and advocating for the rights of individuals with mental 

illness.

34 The composition of the PAC is also mandated.35 The PAC Chair must be a current or 

former mental health recipient or a family member of such an individual.36 

Each PAC is required to provide independent advice and recommendations to its state P&A system; 

to work jointly with the governing authority in the development of policies and priorities; and 

submit a section of the system’s annual report.37 Council terms of appointment must be staggered 

and of reasonable duration. The size of the PAC varies by state, but at least 60 percent of Council 

members must be current or former recipients of mental health services or their family members. 

The Council must meet at least three times each calendar year, include ethnic and racial minorities, 

and receive information related to its corresponding P&A system’s budget, staff, current program 

policies, priorities and performance outcomes.38 

The PAC is mandated to provide the governing board with advice and recommendations on the 

annual PAIMI programmatic activities and priorities to be funded in a FY. The PAIMI Act requires 

that the PAC Chair sit on the governing board of private, non-profit state P&A systems;

39 however, 

any PAC member may serve on the governing board.40 

By January 1 of each year, each P&A system is required to submit an annual Program Performance 

Report (PPR) to the HHS Secretary.

41 The PAC is also required to submit a section of that annual 

PPR, as mandated by the PAIMI Act42 and the PAIMI Rules.43 

The Council’s report must: 

• Describe its membership and its PAIMI Program activities; 

• Explain its relationship to the P&A governing board of the previous calendar year; 

• Independently assess the P&A system’s PAIMI Program; and 

• Include whether the program accomplished its priorities, goals, and objectives for the 

previous FY. 

33 PAIMI Act at 42 U.S.C. 10805(a) (6) (C) 34 at 42 U.S.C. 10805 (a) (6) (A) 35 PAIMI Act at 42 U.S.C. 10805(a) (6) (B) 36 42 U.S.C. 10805(a) (6) (C) and the PAIMI Rules at 42 CFR at 51.23(b) (2) 37 PAIMI Rules at 42 CFR 51.23 (a) (1) - (3) 38 PAIMI Rules at 42 CFR 51.23(b) (2), (3) and (c) 

39 42 U.S.C. 10805 (a) (6) (A), 42 CFR at 51.22 (b) (3) 40 42 CFR at 51.22(d) 41 42 U.S.C. 10805 (a) (7) 42 42 U.S.C. 10824 43 42 CFR 51.8 

30 
 

 

 

 

 

 

 

 

 

 

 

 

In addition to attending meetings, PAC members participated in numerous activities sponsored or 

endorsed by the PAIMI Program (e.g., attending in- and out-of-state trainings, serving on P&A 

governing board committees, engaging in systemic advocacy; and participating in special projects). 

TRAINING AND TECHNICAL ASSISTANCE 

SAMHSA provided training and technical assistance (T/TA) to the state P&A systems through an 

interagency agreement (IAA) administered by the AoD. AoD, which oversees the PADD Program, 

is the first federal protection and advocacy program, and is the lead on the federal P&A system for 

issues pertaining to designation, re-designation, and regulations. SAMHSA supports the IAA with 

funds specifically set-aside for T/TA, but limited to a maximum of two percent of the annual PAIMI 

Program appropriation. The Rehabilitation Services Administration (RSA), within the Office of 

Special Education and Rehabilitation Services, U.S. Department of Education, administers the 

Protection and Advocacy for the Individual Rights Program, the Client Assistance Program, and the 

Protection and Advocacy for Assistive Technology Program. RSA has a separate IAA with AoD. 

This consolidation of federal P&A program set-aside funds maximizes each agency’s limited 

resources, and contributes to a federal partnership among the three agencies that fosters cooperation, 

information sharing, strategic planning, coordination, and integration of P&A system activities. 

The Training Advocacy and Support Center (TASC) of the National Disability Rights Network was 

the contractor selected by the AoD to serve the P&A systems. Under the contract, TASC is 

responsible for various T/TA tasks including both general and agency-specific tasks (for example, 

the annual PAC training). TASC activities under FYs 2017 and 2018 contract included the 

following: 

• Investigation protocols for incidents of abuse and neglect cases involving deaths; 

• Seclusion and restraint; 

• Community integration (Olmstead); 

• Medicaid funding; 

• Consumer self-advocacy; 

• Role of PACs; 

• Access to jails, prisons, and juvenile detention facilities; 

• Housing; and 

• Outreach strategies for unserved and underserved populations, including members of ethnic 

and racial minorities and individuals in urban or rural settings, prisons, jails, and detention 

centers. 

TASC also assisted P&A systems prepare legal briefs when their PAIMI Act investigative and 

access authority was challenged. 

Under the IAA, TASC prepared three publications: the TASC Update (monthly), LegalEase 

(monthly), and the P&A News (quarterly). Each publication was reviewed and edited by the federal 

P&A TA partners (SAMHSA, AoD, and RSA) before AoD approved their distribution to the state 

P&A systems. 

Under the IAA, TASC staff: 

31 
 

 

• Maintained a website accessible to the public and a webpage accessible only to the federal 

partners and state P&A systems; 

• Developed model guidelines, training manuals, and legal advocacy materials, including 

LegalEase (monthly) and Case Dockets; 

• Analyzed public policy; 

• Established relationships with state P&A system staff; 

• Served as liaison to the state P&A system staff; 

• Facilitated information exchanges and requests for assistance from the P&A system staff; 

• Subcontracted with national legal organizations, including the Bazelon Center for Mental 

Health Law, the Center for Public Representation, and other legal experts for P&A system 

consultation services; 

• Promoted the use of the Protection and Advocacy Standards, which were developed in 

2009; 

• Identified and disseminated samples of model P&A system policies and procedures; 

• Developed P&A system self-assessment procedures, a project started in 2009; and 

• Planned and conducted training on current disability, legal, and advocacy issues, including 

the Annual Conference, training the P&A executive director, and fiscal management 

training. 

Through the IAA, SAMHSA assists P&As to improve performance (for example, legal advocacy 

services to include individual and systems advocacy), operations, and outcomes; maintain statutory 

compliance; support P&A’s as leaders and catalysts of systems change, capacity building, and 

advocacy at the national, state/territory, and local levels. 

CONCLUSION 

This report offers examples of successful implementation of statutorily mandated activities related 

to the PAIMI program. PAIMI grantees worked tirelessly to protect and advocate for the rights of 

individuals with significant (serious) mental illness (adults) and significant (severe) emotional 

impairments (children and youth), residing in public and private care and treatment facilities who 

are at risk for, or in danger of abuse, neglect, and rights violations, by using administrative, legal, 

systemic, or other appropriate remedies on their behalf. PAIMI grantees successfully investigated 

reports of abuse, particularly incidents involving serious injuries and deaths related to the 

inappropriate use of seclusion and restraint, and ensured enforcement of the United States 

Constitution, federal laws and regulations, and state statutes. 

Through the PAIMI program systemic changes were implemented in a variety of settings, which 

ultimately improved treatment, support, and services for those with SMI and SED. The PAIMI 

grantees assisted states/territories make systemic changes, change or improve practices, and 

implement best practices. Through these and other efforts, the PAIMI program assisted individuals 

and families obtain better treatment, decreased abuse or neglect, protected rights of individuals, 

expanded employment and educational opportunities, and promoted access to community living. 

32 
 

 

 

 

APPENDIX A 

DATA TABLES FOR FISCAL YEARS 2017 & 2018 

Table 1 – State PAIMI Appropriations 

Table 2 – PAIMI Eligible Individuals Served by Age Group and Sex 

Table 3 – PAIMI Eligible Individuals Served by Race and Ethnicity 

Table 4 – Living Arrangements of PAIMI Eligible Individuals 

Table 5 – Complaints Involving Alleged Abuse of PAIMI Eligible Individuals 

Table 6 – Complaints Involving Alleged Neglect of PAIMI Eligible Individuals 

Table 7 – Complaints Involving Alleged Rights Violations of PAIMI Eligible Individuals 

Table 8 – Death Investigations 

Table 9 – Analysis of Alleged Abuse 

Table 10 – Analysis of Alleged Neglect 

Table 11 – Analysis of Alleged Rights Violations 

Table 12 – Intervention Strategies 

Table 13 – Non-Case Directed Services 

Table 14 – Information and Referral/Public Education/Awareness & Training Activities 

33 
 

 

 

Table 1 – State PAIMI Appropriations 

State/Jurisdiction FY 2017 

Final Appropriations 

FY 2018 

Final Appropriations 

Alabama $453,952 $458,554 

Alaska $428,000 $428,000 

Arizona $626,682 $634,205 

Arkansas $428,000 $428,000 

California $3,140,635 $3,101,059 

Colorado $438,159 $443,445 

Connecticut $428,000 $428,000 

Delaware $428,000 $428,000 

District of Columbia (DC) $428,000 $428,000 

Florida $1,738,714 $1,761,727 

Georgia $925,906 $934,106 

Hawaii $428,000 $428,000 

Idaho $428,000 $428,000 

Illinois $1,066,670 $1,051,088 

Indiana $600,047 $592,729 

Iowa $428,000 $428,000 

Kansas $428,000 $428,000 

Kentucky $428,000 $428,000 

Louisiana $428,000 $428,000 

Maine $428,000 $428,000 

Maryland $466,105 $467,047 

Massachusetts $507,663 $502,978 

Michigan $887,795 $878,974 

Minnesota $445,887 $446,246 

Mississippi $428,000 $428,000 

Missouri $537,097 $542,302 

Montana $428,000 $428,000 

Nebraska $428,000 $428,000 

Nevada $428,000 $428,000 

New Hampshire $428,000 $428,000 

New Jersey $678,311 $675,631 

New Mexico $428,000 $428,000 

New York $1,522,109 $1,507,227 

North Carolina $909,472 $912,914 

North Dakota $428,000 $428,000 

Ohio $1,019,483 $1,019,501 

Oklahoma $428,000 $428,000 

Oregon $428,000 $428,000 

Pennsylvania $1,058,552 $1,051,937 

Rhode Island $428,000 $428,000 

34 
 

States FY 2017 

Final Appropriations 

FY 2018 

Final Appropriations 

South Carolina $457,957 $460,260 

South Dakota $428,000 $428,000 

Tennessee $588,878 $589,859 

Texas $2,278,953 $2,321,910 

Utah $428,000 $428,000 

Vermont $428,000 $428,000 

Virginia $671,652 $674,079 

Washington $573,587 $577,376 

West Virginia $428,000 $428,000 

Wisconsin $494,807 $493,292 

Wyoming $428,000 $428,000 

American Indian Consortium (AIC) $229,300 $229,300 

American Samoa (Am. Samoa) $229,300 $229,300 

Guam $229,300 $229,300 

Northern Marianas (N. Marianas) $229,300 $229,300 

Puerto Rico $528,202 $528,962 

Virgin Islands $229,300 $229,300 

Total State P&A Systems $35,319,775 $35,329,908 

Technical Assistance Set-aside (2%) $706,396 $706,598 

Total Annual PAIMI Appropriations $36,026,171 $36,036,506 

35 
 

 

 

Table 2 – PAIMI Eligible Individuals Served by Age Group and Sex – FY2017 

State/Jurisdiction HHS Age Sex 

Region 0-4 5-12 13-18 19-25 26-64 65+ Total Male Female Unk. Total 

Alabama 4 0 25 46 13 110 21 215 169 46 0 215 

Alaska 10 0 1 4 8 47 1 61 30 31 0 61 

AIC 11 0 4 14 1 9 0 28 21 7 0 28 

Am. Samoa 9 0 1 3 33 17 0 54 49 5 0 54 

Arizona 9 0 2 10 25 277 22 336 141 195 0 336 

Arkansas 6 0 31 38 4 45 6 124 83 41 0 124 

California 9 0 35 58 69 614 71 847 0 0 847 847 

Colorado 8 0 3 9 13 65 2 92 77 15 0 92 

Connecticut 1 0 0 0 0 7 2 9 3 6 0 9 

Delaware 3 0 2 8 21 148 8 187 92 95 0 187 

DC 3 0 0 11 16 94 19 140 77 63 0 140 

Florida 4 0 6 6 14 195 13 234 172 62 0 234 

Georgia 4 0 1 9 11 99 3 123 62 61 0 123 

Guam 9 0 2 4 2 20 0 28 15 13 0 28 

Hawaii 9 0 49 50 6 96 11 212 125 87 0 212 

Idaho 10 0 7 5 8 69 11 100 38 61 1 100 

Illinois 5 1 53 96 32 278 31 491 259 232 0 491 

Indiana 5 0 14 18 13 50 5 100 64 36 0 100 

Iowa 7 0 8 10 7 16 0 41 26 14 1 41 

Kansas 7 0 20 18 25 334 31 428 214 214 0 428 

Kentucky 4 0 12 17 20 84 12 145 106 39 0 145 

Louisiana 6 0 20 26 16 57 5 124 92 32 0 124 

Maine 1 0 28 86 16 81 8 219 128 91 0 219 

Maryland 3 0 0 12 13 113 5 143 99 44 0 143 

Massachusetts 1 0 2 8 21 113 10 154 76 78 0 154 

Michigan 5 0 23 18 12 49 17 119 76 43 0 119 

Minnesota 5 0 14 24 7 144 6 195 90 105 0 195 

Mississippi 4 0 13 41 4 11 0 69 46 23 0 69 

Missouri 7 0 1 7 10 171 21 210 139 71 0 210 

Montana 8 0 7 50 24 131 13 225 0 0 225 225 

Nebraska 7 0 0 0 2 19 1 22 10 12 0 22 

Nevada 9 0 0 2 2 39 6 49 22 27 0 49 

New Hampshire 1 1 5 13 36 167 12 234 106 128 0 234 

New Jersey 2 0 15 32 25 194 27 293 108 154 31 293 

36 
 

 

 

State/Jurisdiction HHS Age Sex 10 4 123 14 158 105 53 0 158 

Region 0-4 5-12 13-18 19-25 26-64 65+ Total Male Female Unk. Total 

North Carolina 4 0 6 15 23 87 7 138 97 41 0 138 

North Dakota 8 0 46 86 20 89 12 253 176 77 0 253 

N. Marianas 9 0 0 0 1 11 0 12 8 4 0 12 

Ohio 5 3 57 59 49 413 29 610 351 258 1 610 

Oklahoma 6 0 15 11 7 45 1 79 57 22 0 79 

Oregon 10 0 0 3 9 38 5 55 40 15 0 55 

Pennsylvania 3 1 25 46 26 139 8 245 155 90 0 245 

Puerto Rico 2 0 7 8 8 94 6 123 58 65 0 123 

Rhode Island 1 1 14 21 34 115 27 212 82 130 0 212 

South Carolina 4 0 7 161 5 28 7 208 129 79 0 208 

South Dakota 8 0 13 21 4 21 0 59 34 25 0 59 

Tennessee 4 0 8 18 7 54 2 89 56 33 0 89 

Texas 6 1 27 104 92 444 35 703 423 280 0 703 

Utah 8 0 5 14 21 97 4 141 79 62 0 141 

Vermont 1 0 0 2 11 76 8 97 51 46 0 97 

Virgin Islands 2 0 1 3 0 13 0 17 12 5 0 17 

Virginia 3 0 1 11 21 77 22 132 67 64 1 132 

Washington 10 1 2 10 31 481 76 601 438 161 2 601 

West Virginia 3 0 5 9 7 62 7 90 55 35 0 90 

Wisconsin 5 0 7 36 11 71 3 128 83 45 0 128 

Wyoming 8 0 0 0 2 33 3 38 19 19 0 38 

Totals 9 660 1,420 934 6,738 689 10,450 5,508 3,833 1,109 10,450 

Percentages 0.09 6.32 13.59 8.94 64.48 6.59 100.00 52.71 36.68 10.61 100.00 

37 
 

 

 

 

Table 2 – PAIMI Eligible Individuals Served by Age Group and Sex – FY2018 

State/Jurisdiction HHS Age Sex 

Region 0-4 5-12 13-18 19-25 26-64 65+ Total Male Female Unk. Total 

Alabama 4 0 27 66 15 73 14 195 145 50 0 195 

Alaska 10 0 2 3 3 41 0 49 27 22 0 49 

AIC 11 0 4 13 2 2 0 21 14 7 0 21 

Am. Samoa 9 0 0 0 9 57 0 66 52 14 0 66 

Arizona 9 0 4 13 31 292 18 358 147 211 0 358 

Arkansas 6 0 21 30 2 37 3 93 59 34 0 93 

California 9 2 28 53 48 576 73 780 367 407 6 780 

Colorado 8 0 1 6 25 89 2 123 97 24 2 123 

Connecticut 1 0 1 2 2 10 3 18 8 10 0 18 

Delaware 3 0 4 11 16 145 7 183 86 97 0 183 

DC 3 0 0 12 8 75 18 113 71 42 0 113 

Florida 4 0 0 6 14 166 16 202 140 62 0 202 

Georgia 4 0 2 5 13 74 2 96 53 43 0 96 

Guam 9 0 0 7 2 5 2 16 8 8 0 16 

Hawaii 9 0 23 34 1 61 7 126 77 49 0 126 

Idaho 10 0 7 7 9 76 3 102 51 51 0 102 

Illinois 5 1 52 98 35 259 27 472 273 199 0 472 

Indiana 5 0 14 9 3 67 3 96 65 30 1 96 

Iowa 7 0 7 15 1 14 3 40 20 19 1 40 

Kansas 7 1 10 20 23 343 34 431 182 249 0 431 

Kentucky 4 0 5 20 10 70 6 111 78 33 0 111 

Louisiana 6 0 9 16 5 28 4 62 49 13 0 62 

Maine 1 0 20 54 12 93 10 189 107 82 0 189 

Maryland 3 0 2 28 9 112 9 160 76 84 0 160 

Massachusetts 1 0 2 1 4 23 3 33 16 16 1 33 

Michigan 5 0 21 26 17 67 28 159 98 61 0 159 

Minnesota 5 0 11 26 11 159 12 219 105 114 0 219 

Mississippi 4 0 2 19 3 6 0 30 14 16 0 30 

Missouri 7 0 0 3 9 143 11 166 114 52 0 166 

Montana 8 0 6 73 12 109 2 202 65 137 0 202 

Nebraska 7 0 0 0 1 11 2 14 5 9 0 14 

Nevada 9 0 0 1 6 25 5 37 17 20 0 37 

New Hampshire 1 0 15 40 29 197 15 296 119 177 0 296 

New Jersey 2 0 5 33 33 179 33 283 151 132 0 283 

38 
 

 

 

 

State/Jurisdiction HHS Age Sex 

Region 0-4 5-12 13-18 19-25 26-64 65+ Total Male Female Unk. Total 

New Mexico 6 0 4 15 3 75 22 119 71 48 0 119 

New York 2 0 3 6 12 112 9 142 65 76 1 142 

North Carolina 4 0 4 16 13 67 4 104 60 44 0 104 

North Dakota 8 0 64 88 20 81 15 268 176 92 0 268 

N. Marianas 9 0 0 1 3 15 1 20 16 4 0 20 

Ohio 5 2 36 66 46 320 27 497 259 237 1 497 

Oklahoma 6 0 1 0 4 54 7 66 44 22 0 66 

Oregon 10 0 0 1 3 28 4 36 19 17 0 36 

Pennsylvania 3 1 20 43 25 172 16 277 126 135 16 277 

Puerto Rico 2 0 1 1 4 63 9 78 34 44 0 78 

Rhode Island 1 0 8 21 18 155 27 229 113 116 0 229 

South Carolina 4 0 7 166 11 23 4 211 131 80 0 211 

South Dakota 8 0 5 6 4 13 2 30 17 13 0 30 

Tennessee 4 0 9 17 4 48 2 80 54 26 0 80 

Texas 6 0 32 89 72 511 37 741 461 280 0 741 

Utah 8 0 7 11 24 121 5 168 71 97 0 168 

Vermont 1 0 0 9 6 71 10 96 48 48 0 96 

Virgin Islands 2 0 1 3 0 5 0 9 4 5 0 9 

Virginia 3 0 2 17 13 85 25 142 78 64 0 142 

Washington 10 0 0 5 20 330 73 428 303 123 2 428 

West Virginia 3 0 4 7 3 53 7 74 47 27 0 74 

Wisconsin 5 0 7 29 13 92 2 143 89 54 0 143 

Wyoming 8 0 0 0 0 28 1 29 12 17 0 29 

Totals 7 520 1,367 744 6,206 684 9,528 5,254 4,243 31 9,528 

Percentages 0.07 5.46 14.35 7.81 65.13 7.18 100.00 55.14 44.53 0.33 100.00 

39 
 

 

 

 

 

 

 

 

 

Table 3 – PAIMI Eligible Individuals Served by Race and Ethnicity – FY2017 

Race Ethnicity 

State/ 

Jurisdiction 

HHS 

Region 

American 

Indian / 

Alaska 

Native 

Asian 

Black or 

African 

American 

Multiple 

Races 

Native 

Hawaiian 

/ Other 

Pacific 

Islander 

White Total 

Hispanic 

or 

Latino 

Not 

Hispanic 

or 

Latino 

Unk. Total 

Alabama 4 0 1 97 1 0 116 215 2 213 0 215 

Alaska 10 11 0 4 3 0 39 57 3 0 1 4 

AIC 11 28 0 0 0 0 0 28 0 28 0 28 

Am. Samoa 9 0 0 0 5 49 0 54 0 54 0 54 

Arizona 9 13 1 27 11 0 233 285 51 285 0 336 

Arkansas 6 0 2 41 4 1 73 121 3 121 0 124 

California 9 13 40 104 47 5 392 601 161 601 85 847 

Colorado 8 1 1 25 1 0 64 92 10 82 0 92 

Connecticut 1 0 0 1 0 0 8 9 2 7 0 9 

Delaware 3 0 2 54 3 0 115 174 12 174 1 187 

DC 3 1 1 116 3 0 17 138 2 138 0 140 

Florida 4 2 0 88 5 0 117 212 14 167 53 234 

Georgia 4 0 1 65 1 0 51 118 5 87 31 123 

Guam 9 0 5 2 0 17 4 28 0 28 0 28 

Hawaii 9 1 35 7 93 17 59 212 11 201 0 212 

Idaho 10 3 0 2 6 1 88 100 6 91 3 100 

Illinois 5 4 3 143 29 1 277 457 74 403 14 491 

Indiana 5 0 0 21 0 0 79 100 0 100 0 100 

Iowa 7 0 0 8 2 0 31 41 1 36 4 41 

Kansas 7 9 2 50 21 1 318 401 24 377 27 428 

Kentucky 4 0 0 25 13 0 107 145 3 142 0 145 

Louisiana 6 0 0 62 4 0 51 117 7 117 0 124 

Maine 1 5 0 5 5 0 204 219 0 93 126 219 

Maryland 3 2 3 87 1 0 50 143 4 139 0 143 

Massachusetts 1 1 4 15 1 0 132 153 10 144 0 154 

Michigan 5 2 2 30 5 0 73 112 2 112 5 119 

Minnesota 5 6 5 41 11 3 129 195 2 163 30 195 

Mississippi 4 0 0 33 1 0 35 69 0 69 0 69 

Missouri 7 1 1 62 0 0 146 210 3 207 0 210 

Montana 8 16 0 2 1 0 201 220 3 220 2 225 

Nebraska 7 1 0 2 1 0 16 20 1 20 1 22 

40 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race Ethnicity 

State/ 

Jurisdiction 

HHS 

Region 

American 

Indian / 

Alaska 

Native 

Asian 

Black or 

African 

American 

Multiple 

Races 

Native 

Hawaiian 

/ Other 

Pacific 

Islander 

White Total 

Hispanic 

or 

Latino 

Not 

Hispanic 

or 

Latino 

Unk. Total 

Nevada 9 1 2 15 2 0 20 40 8 40 1 49 

New 

Hampshire 1 1 1 3 4 0 217 226 2 226 6 234 

New Jersey 2 0 4 75 12 1 201 293 30 245 18 293 

New Mexico 6 7 1 7 0 0 143 158 67 91 0 158 

New York 2 0 3 53 12 2 107 177 28 177 6 211 

North Carolina 4 2 1 42 4 0 71 120 4 134 0 138 

North Dakota 8 44 3 10 8 1 187 253 13 233 7 253 

N. Marianas 9 0 1 0 2 5 4 12 0 12 0 12 

Ohio 5 5 1 75 8 0 183 272 9 75 259 343 

Oklahoma 6 10 0 17 1 0 51 79 8 71 0 79 

Oregon 10 0 0 4 0 0 51 55 2 0 53 55 

Pennsylvania 3 0 1 61 4 0 148 214 12 213 20 245 

Puerto Rico 2 0 0 0 123 0 0 123 123 0 0 123 

Rhode Island 1 1 2 15 9 0 185 212 17 195 0 212 

South Carolina 4 0 0 97 7 1 103 208 7 194 7 208 

South Dakota 8 11 0 0 4 1 43 59 3 56 0 59 

Tennessee 4 0 1 27 3 0 57 88 1 88 0 89 

Texas 6 5 5 166 11 0 318 505 185 518 0 703 

Utah 8 1 0 4 1 0 107 113 27 98 17 142 

Vermont 1 1 0 5 4 0 87 97 0 97 0 97 

Virgin Islands 2 0 0 15 1 0 1 17 0 16 1 17 

Virginia 3 1 3 41 3 0 84 132 2 130 0 132 

Washington 10 24 8 113 91 2 363 601 40 561 0 601 

West Virginia 3 4 0 14 2 0 68 88 2 88 0 90 

Wisconsin 5 3 1 34 9 0 72 119 9 119 0 128 

Wyoming 8 6 0 0 0 0 32 38 6 32 0 38 

Totals 247 147 2,112 603 108 6,128 9,345 1,021 8,328 778 10,127 

Percentages 2.64 1.57 22.60 6.45 1.16 65.58 100 10.08 82.24 7.68 100.00 

41 
 

 

 

 

 

 

 

 

 

Table 3 – PAIMI Eligible Individuals Served by Race and Ethnicity – FY2018 

Race Ethnicity 

State/ 

Jurisdiction 

HHS 

Region 

American 

Indian / 

Alaska 

Native 

Asian 

Black or 

African 

American 

Multiple 

Races 

Native 

Hawaiian 

/ Other 

Pacific 

Islander 

White Total 

Hispanic 

or 

Latino 

Not 

Hispanic 

or 

Latino 

Unk. Total 

Alabama 4 0 1 88 1 0 105 195 6 189 0 195 

Alaska 10 10 0 6 2 0 28 46 3 46 0 49 

AIC 11 21 0 0 0 0 0 21 0 21 0 21 

Am. Samoa 9 0 0 0 5 61 0 66 0 0 0 0 

Arizona 9 9 4 33 9 1 254 310 48 310 0 358 

Arkansas 6 0 0 25 5 1 61 92 1 91 1 93 

California 9 8 30 104 28 4 537 711 174 539 67 780 

Colorado 8 0 3 30 4 2 43 82 14 68 37 119 

Connecticut 1 0 0 1 1 0 10 12 4 12 2 18 

Delaware 3 0 2 52 5 0 108 167 12 167 4 183 

DC 3 0 2 94 2 0 12 110 3 110 0 113 

Florida 4 1 0 64 4 0 101 170 15 169 18 202 

Georgia 4 1 0 45 3 0 46 95 3 92 1 96 

Guam 9 0 1 1 0 12 2 16 0 16 0 16 

Hawaii 9 0 21 2 48 11 44 126 8 70 0 78 

Idaho 10 1 0 0 5 1 81 88 8 88 6 102 

Illinois 5 6 7 148 30 0 255 446 53 393 26 472 

Indiana 5 0 0 25 1 0 67 93 1 94 1 96 

Iowa 7 0 0 7 0 0 33 40 0 39 1 40 

Kansas 7 11 4 43 10 3 321 392 18 392 21 431 

Kentucky 4 0 1 11 7 0 88 107 4 101 6 111 

Louisiana 6 0 0 30 1 0 26 57 5 57 0 62 

Maine 1 1 0 9 6 0 173 189 1 89 99 189 

Maryland 3 2 4 88 3 1 55 153 4 150 1 155 

Massachusetts 1 0 2 7 1 2 18 30 3 30 0 33 

Michigan 5 1 1 48 7 0 95 152 2 157 5 164 

Minnesota 5 4 4 50 15 0 146 219 9 210 0 219 

Mississippi 4 0 0 13 0 0 16 29 1 29 0 30 

Missouri 7 1 1 65 0 0 97 164 2 164 0 166 

Montana 8 25 1 0 4 1 171 202 4 198 0 202 

Nebraska 7 0 0 0 0 0 13 13 1 13 0 14 

42
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race Ethnicity 

State/ 

Jurisdiction 

HHS 

Region 

American 

Indian / 

Alaska 

Native 

Asian 

Black or 

African 

American 

Multiple 

Races 

Native 

Hawaiian 

/ Other 

Pacific 

Islander 

White Total 

Hispanic 

or 

Latino 

Not 

Hispanic 

or 

Latino 

Unk. Total 

Nevada 9 0 2 10 2 0 21 35 2 35 0 37 

New 

Hampshire 1 3 4 4 8 0 267 286 9 286 1 296 

New Jersey 2 0 9 61 10 0 203 283 30 251 2 283 

New Mexico 6 5 0 4 2 0 108 119 36 83 0 119 

New York 2 1 0 36 7 0 86 130 17 113 12 142 

North Carolina 4 1 0 24 3 1 51 80 3 80 21 104 

North Dakota 8 45 1 8 14 0 200 268 16 251 1 268 

N. Marianas 9 1 3 0 4 9 3 20 0 20 0 20 

Ohio 5 2 1 105 8 0 300 416 6 410 81 497 

Oklahoma 6 6 0 17 2 0 41 66 1 65 0 66 

Oregon 10 0 0 1 0 0 35 36 2 27 7 36 

Pennsylvania 3 0 4 58 15 0 164 241 15 263 0 278 

Puerto Rico 2 0 0 0 78 0 0 78 78 0 0 78 

Rhode Island 1 1 1 14 6 0 191 213 16 213 0 229 

South Carolina 4 3 0 105 8 3 92 211 6 197 8 211 

South Dakota 8 3 0 1 1 0 22 27 1 29 0 30 

Tennessee 4 0 1 19 6 0 53 79 1 79 0 80 

Texas 6 3 4 173 18 1 542 741 198 541 2 741 

Utah 8 3 0 6 1 0 142 152 16 152 0 168 

Vermont 1 2 2 7 3 2 79 95 1 95 0 96 

Virgin Islands 2 0 0 8 0 0 1 9 0 9 0 9 

Virginia 3 0 2 34 4 1 88 129 5 124 13 142 

Washington 10 16 5 65 16 4 230 336 29 336 0 365 

West Virginia 3 2 0 5 1 0 65 73 1 73 0 74 

Wisconsin 5 2 1 44 8 1 87 143 12 102 29 143 

Wyoming 8 2 0 0 5 0 22 29 5 24 0 29 

Totals 203 129 1,898 437 122 6,099 8,888 913 7,962 473 9,348 

Percentages 2.28 1.45 21.35 4.92 1.37 68.62 100 9.77 85.17 5.06 100.00 

43
 

 

 

 

 

Table 4 - Living Arrangements of PAIMI Eligible Individuals – FY2017 

State/ 

Jurisdiction 

HHS 

Region 

Community Residential Home

for Children/ Youth up to age

18 Yrs.

Community Residential

Home for Adults

Non-Medical Community

-Based Residential Facility

for Children/ Youth

Foster Care

Nursing Homes, Including

Skilled Nursing Facilities (SNF)

Intermediate Care Facilities

(ICF)

Public and Private General

Hospital 

Public and Private Institutions

Psychiatric Hospitals

(Public or Private)

Legal/Jail/ Detention

Veterans Administration 

Hospital

Other Federal Facility

Homeless

Independent (in the community

&

PAIMI-eligible)

Parental or Other Family Home

Unk.

Total 

Alabama 4 0 11 0 9 4 0 0 112 3 43 0 0 0 0 0 75 257 

Alaska 10 0 7 1 0 0 0 0 1 0 7 0 0 3 28 11 3 61 

AIC 11 1 0 0 3 0 0 0 1 0 4 0 0 0 5 14 0 28 

Am. Samoa 9 0 0 0 0 0 0 0 0 12 18 0 0 0 11 13 0 54 

Arizona 9 2 16 0 0 0 0 0 1 27 2 1 0 18 0 0 269 336 

Arkansas 6 1 6 0 1 2 0 0 2 15 17 0 0 0 22 58 0 124 

California 9 5 14 0 2 7 1 4 92 10 111 0 0 30 446 124 1 847 

Colorado 8 0 2 0 0 2 0 4 1 2 69 0 0 1 8 3 0 92 

Connecticut 1 0 1 0 0 5 0 0 0 0 1 0 0 0 1 0 1 9 

Delaware 3 0 15 0 0 2 0 0 0 70 5 0 0 3 63 29 0 187 

DC 3 0 9 0 0 3 0 2 38 15 5 0 0 22 9 13 24 140 

Florida 4 1 11 0 0 1 0 1 120 15 72 0 0 3 8 9 0 241 

Georgia 4 1 7 0 0 0 0 1 3 78 2 0 0 2 14 12 3 123 

Guam 9 3 3 0 1 1 0 0 0 0 0 0 0 1 3 16 0 28 

Hawaii 9 0 11 0 1 0 0 0 0 36 2 0 0 4 0 158 0 212 

Idaho 10 1 9 0 2 5 0 0 47 6 5 0 0 1 13 11 0 100 

Illinois 5 4 5 0 1 52 1 5 54 35 5 0 0 12 161 155 1 491 

Indiana 5 2 0 0 0 3 0 0 0 22 24 0 0 4 14 26 5 100 

Iowa 7 0 2 0 0 1 0 0 1 2 8 0 0 1 7 4 15 41 

Kansas 7 0 13 0 0 58 1 1 32 29 0 0 0 10 227 57 0 428 

Kentucky 4 14 0 0 4 5 0 0 45 3 36 0 0 0 14 22 2 145 

Louisiana 6 0 1 1 0 4 0 1 34 5 15 0 0 1 5 9 48 124 

Maine 1 23 20 0 1 2 0 20 0 37 35 0 0 3 4 4 70 219 

Maryland 3 1 4 0 0 1 2 2 0 57 18 0 0 3 53 4 0 145 

Massachusetts 1 0 7 0 1 3 0 11 57 0 2 0 0 3 43 27 0 154 

Michigan 5 1 13 0 0 17 0 0 2 21 7 0 0 1 14 43 0 119 

Minnesota 5 5 24 0 10 9 0 0 11 15 15 0 1 4 66 35 0 195 

Mississippi 4 1 1 0 0 0 0 0 20 0 7 0 0 0 2 38 0 69 

44
 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Community Residential Home

for Children/ Youth up to age

18 Yrs.

Community Residential

Home for Adults

Non-Medical Community

-Based Residential Facility

for Children/ Youth

Foster Care

Nursing Homes, Including

Skilled Nursing Facilities (SNF)

Intermediate Care Facilities

(ICF)

Public and Private General

Hospital 

Public and Private Institutions

Psychiatric Hospitals

(Public or Private)

Legal/Jail/ Detention

Veterans Administration 

Hospital

Other Federal Facility

Homeless

Independent (in the community

&

PAIMI-eligible)

Parental or Other Family Home

Unk.

Total 

Missouri 7 0 15 0 1 37 2 0 64 0 32 0 0 0 41 18 0 210 

Montana 8 0 4 50 0 2 0 3 43 0 56 1 0 4 47 11 4 225 

Nebraska 7 0 1 0 0 1 0 0 15 0 0 0 0 0 2 0 3 22 

Nevada 9 0 3 0 0 0 0 1 11 1 11 0 0 2 20 0 0 49 

New 

Hampshire 1 3 12 0 1 2 0 7 0 45 22 0 0 6 0 0 142 240 

New Jersey 2 0 2 0 0 2 0 13 0 181 3 0 0 0 36 56 0 293 

New Mexico 6 1 7 0 1 1 0 3 0 113 6 0 0 0 14 12 0 158 

New York 2 3 4 0 0 10 0 0 0 0 30 0 0 4 0 0 0 51 

North 

Carolina 4 1 7 0 0 1 0 0 37 3 48 0 0 2 19 20 0 138 

North Dakota 8 0 6 3 0 1 0 0 0 43 8 0 0 9 47 136 0 253 

N. Marianas 9 0 0 0 0 0 0 0 0 1 4 0 0 1 6 0 0 12 

Ohio 5 11 18 1 1 32 0 0 0 0 60 0 0 9 162 0 13 307 

Oklahoma 6 0 2 0 0 0 0 1 0 30 31 0 0 0 8 7 0 79 

Oregon 10 2 0 2 0 0 0 6 3 20 15 0 0 0 3 1 3 55 

Pennsylvania 3 4 3 9 1 3 0 4 4 47 49 0 0 1 54 64 2 245 

Puerto Rico 2 1 5 0 0 0 0 0 43 7 3 0 0 1 35 28 0 123 

Rhode Island 1 1 9 0 0 12 0 3 9 76 5 0 0 4 55 73 9 256 

South 

Carolina 4 1 2 0 1 0 0 0 12 11 148 0 0 0 10 21 2 208 

South Dakota 8 1 2 1 0 1 0 0 4 8 3 0 0 0 9 30 0 59 

Tennessee 4 3 6 0 0 0 0 0 2 21 28 0 0 4 2 0 23 89 

Texas 6 27 14 3 21 12 0 5 18 321 68 0 2 17 114 80 1 703 

Utah 8 2 0 0 1 0 0 0 8 1 23 0 0 1 85 21 0 142 

Vermont 1 0 7 0 0 0 2 3 22 16 21 0 0 2 23 1 0 97 

Virgin Islands 2 1 0 0 0 0 0 0 3 1 0 0 0 2 7 3 0 17 

Virginia 3 0 1 0 0 1 0 0 115 3 9 0 0 0 0 3 0 132 

Washington 10 0 3 0 0 0 0 0 102 1 351 0 0 11 81 12 40 601 

West Virginia 3 0 3 0 1 2 0 0 0 39 6 0 0 7 18 14 0 90 

45
 

 

 

State/ HHS 

Community Residential Home

for Children/ Youth up to age

18 Yrs.

Community Residential

Home for Adults

Non-Medical Community

-Based Residential Facility

for Children/ Youth

Foster Care

Nursing Homes, Including

Sk Nursing Facilities (SNF) illed

Intermediate Care Facilities

(ICF)

Public and Private General

Hospital 

ublic and Private Institutions

Psychiatric Hospitals

(Public or Private)

Legal/Jail/ Detention

Veterans Administration 

Hospital

Other Federal Facility

Homeless

dependent (in the community

&

PAIMI-eligible)

Parental or Other Family Home

Unk.

Total 

Jurisdiction Region P

In

Wisconsin 5 0 5 0 0 2 0 0 7 17 38 0 0 0 17 42 0 128 

Wyoming 8 0 1 0 0 1 0 0 1 25 0 0 0 0 7 3 0 38 

Totals 128 354 71 65 310 9 101 1,1 

97 1,546 1,613 2 3 21 

7 2,163 1,551 759 10,089 

Percentages 1.27 3.51 0.70 0.64 3.07 0.09 1.00 11. 

86 15.32 15.99 0.02 0.0 

3 

2. 

15 21.44 15.37 7.52 100.00 

46
 

 

 

 

 

 

 

 

 

 

Table 4 - Living Arrangements of PAIMI Eligible Individuals – FY2018 

State/ 

Jurisdiction 

HHS 

Region 

Community Residential Home

for Children/ Youth up to age

Community Residential

Home for Adults

Non-Medical Community

-Based Residential Facility

for Children/ Youth

Foster Care

Nursing Homes, Including

Skilled Nursing Facilities (SNF)

Intermediate Care Facilities

(ICF)

Public and Private General

Hospital 

Public and Private Institutions

Psychiatric Hospitals

(Public or Private)

Legal/Jail/ Detention

Veterans Administration 

Hospital

Other Federal Facility

Homeless

Independent (in the community

&

PAIMI-eligible)

Parental or Other Family Home

Unk.

Total 

Alabama 4 3 6 0 28 2 0 0 50 1 29 0 0 0 5 6 65 195 

Alaska 10 0 5 0 0 0 0 0 0 1 0 0 0 7 26 10 0 49 

AIC 11 1 0 0 2 0 0 0 2 0 1 0 0 0 1 14 0 21 

Am. Samoa 9 0 0 0 0 0 0 0 0 42 4 0 0 0 20 0 0 66 

Arizona 9 3 16 0 1 2 0 3 11 14 2 0 0 15 9 3 279 358 

Arkansas 6 0 5 5 0 2 0 0 3 3 11 0 0 1 5 5 53 93 

California 9 2 17 0 3 9 1 5 67 38 80 0 0 31 400 127 0 780 

Colorado 8 0 0 0 0 1 0 16 2 12 68 0 0 1 21 1 10 132 

Connecticut 1 0 0 0 0 6 0 1 1 3 1 0 0 0 4 2 0 18 

Delaware 3 0 16 0 0 1 0 0 0 80 8 0 0 4 47 27 0 183 

DC 3 0 6 0 0 1 0 0 43 9 6 0 0 17 10 8 13 113 

Florida 4 0 5 0 0 3 4 0 101 24 49 0 0 0 8 5 3 202 

Georgia 4 1 9 0 0 0 0 0 0 72 1 0 0 2 7 4 0 96 

Guam 9 1 3 1 0 0 2 0 0 1 0 0 0 1 1 6 0 16 

Hawaii 9 0 11 0 5 0 0 19 0 0 3 0 0 0 0 3 85 126 

Idaho 10 0 10 2 0 1 2 1 3 57 2 0 0 4 8 12 0 102 

Illinois 5 0 6 2 1 34 1 6 39 70 10 0 0 10 133 160 0 472 

Indiana 5 0 2 1 0 0 0 0 14 1 30 0 0 0 21 17 10 96 

Iowa 7 1 2 0 0 3 0 0 0 0 7 0 0 0 5 7 15 40 

Kansas 7 0 14 0 0 63 0 2 22 21 8 0 0 6 248 47 0 431 

Kentucky 4 11 0 0 2 4 1 0 34 5 22 0 0 2 12 17 1 111 

Louisiana 6 1 4 1 1 2 1 0 4 12 3 0 0 0 10 23 0 62 

Maine 1 14 21 7 2 1 0 25 0 47 21 1 0 4 22 11 13 189 

Maryland 3 1 3 0 0 0 0 0 16 45 18 0 0 1 60 8 0 152 

Massachusetts 1 0 3 0 0 1 0 5 12 0 1 0 0 1 5 5 0 33 

Michigan 5 1 12 0 0 27 0 5 6 41 6 0 0 1 15 45 0 159 

Minnesota 5 3 20 0 8 0 7 1 14 13 21 0 0 5 89 38 0 219 

Mississippi 4 0 0 0 0 0 0 0 0 16 4 0 0 0 5 5 0 30 

49 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Community Residential Home

for Children/ Youth up to age

Community Residential

Home for Adults

Non-Medical Community

-Based Residential Facility

for Children/ Youth

Foster Care

Nursing Homes, Including

Skilled Nursing Facilities (SNF)

Intermediate Care Facilities

(ICF)

Public and Private General

Hospital 

Public and Private Institutions

Psychiatric Hospitals

(Public or Private)

Legal/Jail/ Detention

Veterans Administration 

Hospital

Other Federal Facility

Homeless

Independent (in the community

&

PAIMI-eligible)

Parental or Other Family Home

Unk.

Total 

Missouri 7 0 16 1 1 23 4 0 43 12 28 0 0 2 31 5 0 166 

Montana 8 1 6 0 1 1 0 2 102 2 53 0 0 4 22 7 1 202 

Nebraska 7 0 0 0 0 2 0 0 8 0 0 0 0 0 4 0 0 14 

Nevada 9 0 4 0 0 0 0 1 4 5 5 0 0 1 16 1 0 37 

New 

Hampshire 1 0 9 0 0 3 0 5 24 33 11 0 0 7 78 1 125 296 

New Jersey 2 3 1 0 1 2 0 5 3 178 0 0 0 0 41 49 0 283 

New York 2 0 7 0 0 6 0 1 3 4 24 0 0 6 26 2 63 142 

North 

Carolina 4 2 6 0 0 1 0 0 37 4 29 0 0 2 8 15 0 104 

North Dakota 8 0 7 1 5 1 0 1 7 41 4 0 0 7 40 154 0 268 

N. Marianas 9 0 0 0 0 0 0 0 0 1 6 0 0 1 7 5 0 20 

Ohio 5 6 31 1 0 23 2 5 20 91 51 0 0 12 166 105 1 514 

Oklahoma 6 0 0 0 0 1 0 0 0 11 50 0 0 0 2 1 0 65 

Oregon 10 0 3 0 0 1 0 1 3 15 6 0 0 0 3 2 2 36 

Pennsylvania 3 3 6 3 0 3 0 2 10 59 25 0 0 5 99 63 0 278 

Puerto Rico 2 0 1 0 0 0 0 0 42 12 3 0 0 0 14 6 0 78 

Rhode Island 1 1 8 2 0 11 0 7 11 44 6 0 0 5 74 52 8 229 

South 

Carolina 4 2 1 1 0 0 0 1 20 6 140 0 0 0 7 31 2 211 

South Dakota 8 0 1 2 0 2 1 0 1 7 1 0 0 0 7 8 0 30 

Tennessee 4 0 7 4 0 0 0 0 0 14 23 0 0 1 5 0 26 80 

Texas 6 11 9 9 1 13 0 3 13 398 90 0 0 10 122 50 12 741 

Utah 8 2 0 0 0 2 0 0 9 3 11 0 0 6 114 21 0 168 

Vermont 1 1 5 0 0 2 0 1 12 15 15 0 0 2 38 5 0 96 

Virgin Islands 2 1 0 0 0 0 0 0 2 0 0 0 0 0 3 3 0 9 

Virginia 3 0 14 1 0 3 0 0 13 98 7 0 0 0 2 4 0 142 

Washington 10 1 13 1 0 2 2 1 33 50 200 0 0 17 4 1 103 428 

West Virginia 3 0 3 1 1 0 0 0 0 30 5 0 0 3 20 11 0 74 

Wisconsin 5 0 11 1 1 3 0 0 2 18 47 0 0 1 26 33 0 143 

48
 

 

 

State/ HHS 

Community Residential Home

for Children/ Youth up to age

Community Residential

Home for Adults

Non-Medical Community

-Based Residential Facility

for Children/ Youth

Foster Care

Nursing Homes, Including

Sk Nursing Facilities (SNF) illed

Intermediate Care Facilities

(ICF)

Public and Private General

Hospital 

ublic and Private Institutions

Psychiatric Hospitals

(Public or Private)

Legal/Jail/ Detention

Veterans Administration 

Hospital

Other Federal Facility

Homeless

dependent (in the community

&

PAIMI-eligible)

Parental or Other Family Home

Unk.

Total 

Jurisdiction Region P

In

Wyoming 8 0 0 0 0 0 0 0 0 23 0 0 0 0 6 0 0 29 

Totals 77 365 47 64 268 28 125 866 1,802 1,25 

6 

1 0 20 

5 2,182 1,251 890 9,427 

Percentages 0.82 3.87 0.50 0.6 

8 2.84 0.30 1.33 9.19 19.12 13.3 

2 0.01 0.00 2.1 

7 23.15 13.27 9.44 100.00 

49
 

 

 

Table 5 – Complaints Involving Alleged Abuse of PAIMI Eligible Individuals – FY2017 

Inappropriate/Excessive Involuntary Complaints Concerning 

State/ 

Jurisdiction 

HHS 

Region 

Number of Abuse

Complaints Closed 

Medication

Physical Restraint

Chemical Restraint

Mechanical Restraint

Seclusion

Medication

Electric Convulsive 

Therapy (ECT)

Aversive Behavioral

Therapy

Sterilization

Failure to provide 

appropriate

Failure to provide

Medical Treatment

Physical Assault

Sexual Assault

Staff Threats

/Retaliation/Assaults

Coercion

Financial Exploitation

Suspicious Death

Other 

Alabama 4 33 1 10 1 0 0 0 0 0 0 13 2 1 0 2 0 2 1 0 

Alaska 10 9 0 0 0 2 1 1 0 0 0 3 0 0 2 0 0 0 0 0 

AIC 11 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 

Am. Samoa 9 19 5 0 0 0 3 2 0 0 0 3 3 0 0 0 2 1 0 0 

Arizona 9 8 0 1 0 0 0 0 0 0 0 1 1 1 3 0 0 1 0 0 

Arkansas 6 19 1 1 0 0 2 0 0 0 0 7 2 2 1 2 0 1 0 0 

California 9 66 3 4 1 0 2 3 0 0 0 14 2 14 7 3 1 2 10 0 

Colorado 8 35 0 2 0 3 14 0 0 0 0 15 0 1 0 0 0 0 0 0 

Connecticut 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 

Delaware 3 4 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 

DC 3 32 1 5 1 0 0 4 0 0 0 6 3 6 3 2 0 1 0 0 

Florida 4 71 5 2 0 0 1 1 0 0 0 34 22 1 0 1 0 3 1 0 

Georgia 4 38 0 0 0 0 1 16 0 0 0 3 3 0 0 3 0 0 12 0 

Guam 9 3 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 2 0 

Hawaii 9 15 3 2 1 0 0 0 0 0 0 3 0 2 1 3 0 0 0 0 

Idaho 10 12 3 1 0 0 0 0 0 0 0 5 0 1 0 1 0 0 1 0 

Illinois 5 47 4 3 4 1 2 6 0 0 0 9 7 2 2 3 0 4 0 0 

Indiana 5 8 0 1 0 0 0 0 0 0 0 4 0 1 0 2 0 0 0 0 

Iowa 7 47 2 9 1 5 8 0 0 0 0 9 3 2 1 1 1 1 4 0 

Kansas 7 28 4 1 0 1 1 2 0 0 0 7 0 5 2 0 1 4 0 0 

Kentucky 4 13 1 3 1 1 2 1 0 0 0 2 0 1 0 0 0 0 1 0 

Louisiana 6 17 0 1 0 0 0 1 0 0 0 7 4 3 0 1 0 0 0 0 

Maine 1 49 0 8 1 0 0 0 0 0 0 38 0 0 0 0 0 2 0 0 

Maryland 3 44 0 2 1 0 13 4 0 0 0 5 3 8 4 2 0 1 1 0 

Massachusetts 1 45 1 3 2 0 0 0 0 0 0 27 6 4 1 1 0 0 0 0 

Michigan 5 21 0 4 1 0 1 0 0 0 0 6 1 3 0 2 0 0 0 3 

Minnesota 5 25 0 1 0 0 0 1 0 1 0 13 7 1 0 1 0 0 0 0 

Mississippi 4 8 1 0 1 0 0 0 0 0 0 3 2 0 0 1 0 0 0 0 

50
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inappropriate/Excessive Involuntary Complaints Concerning 

State/ 

Jurisdiction 

HHS 

Region 

Number of Abuse

Complaints Closed 

Medication

Physical Restraint

Chemical Restraint

Mechanical Restraint

Seclusion

Medication

Electric Convulsive 

Therapy (ECT)

Aversive Behavioral

Therapy

Sterilization

Failure to provide 

appropriate

Failure to provide

Medical Treatment

Physical Assault

Sexual Assault

Staff Threats

/Retaliation/Assaults

Coercion

Financial Exploitation

Suspicious Death

Other 

Missouri 7 86 17 4 0 0 0 3 1 0 0 28 28 2 1 1 0 0 1 0 

Montana 8 82 1 13 0 0 8 0 0 0 0 22 5 6 7 3 1 1 1 14 

Nebraska 7 9 0 1 0 0 1 0 0 0 0 1 3 1 0 1 0 1 0 0 

Nevada 9 7 0 0 0 0 0 1 0 0 0 5 1 0 0 0 0 0 0 0 

New Hampshire 1 46 3 4 1 0 3 2 0 0 0 28 1 2 2 0 0 0 0 0 

New Jersey 2 79 17 2 0 0 0 0 0 0 0 10 6 14 2 8 0 0 20 0 

New Mexico 6 99 21 4 1 0 5 22 0 0 0 13 7 10 10 2 0 2 2 0 

New York 2 46 0 0 1 0 1 1 0 0 0 30 2 3 2 6 0 0 0 0 

North Carolina 4 8 1 1 0 0 2 0 0 0 0 2 0 1 1 0 0 0 0 0 

North Dakota 8 36 0 5 5 0 2 2 0 0 0 5 2 2 2 3 0 7 0 1 

N. Marianas 9 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

Ohio 5 141 11 3 1 1 13 1 0 0 0 36 31 17 4 14 3 3 0 3 

Oklahoma 6 15 2 0 0 0 2 0 0 0 0 6 0 3 0 1 1 0 0 0 

Oregon 10 17 0 1 0 0 5 0 0 0 0 3 0 1 1 0 6 0 0 0 

Pennsylvania 3 21 1 2 0 0 1 0 0 1 0 7 2 6 0 1 0 0 0 0 

Puerto Rico 2 5 1 1 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 

Rhode Island 1 3 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 

South Carolina 4 127 0 0 0 0 0 0 0 0 0 124 0 1 0 0 0 0 0 2 

South Dakota 8 13 0 0 0 0 1 1 0 0 0 8 1 0 0 2 0 0 0 0 

Tennessee 4 32 5 2 1 0 1 0 0 0 0 12 2 8 1 0 0 0 0 0 

Texas 6 180 10 11 2 0 2 5 1 0 0 88 42 7 5 3 0 4 0 0 

Utah 8 7 0 0 0 0 0 0 0 0 0 5 2 0 0 0 0 0 0 0 

Vermont 1 47 2 7 2 4 4 0 0 0 0 17 2 3 2 1 2 0 0 1 

Virgin Islands 2 4 1 0 0 0 0 0 0 0 0 2 0 0 1 0 0 0 0 0 

Virginia 3 55 1 7 0 6 0 1 0 0 0 15 1 6 5 3 7 0 3 0 

Washington 10 301 9 10 3 1 33 9 0 1 0 173 35 1 0 17 0 5 0 4 

West Virginia 3 18 3 2 0 0 2 0 0 0 0 2 0 1 2 5 0 1 0 0 

Wisconsin 5 16 0 0 0 2 1 0 0 0 0 12 1 0 0 0 0 0 0 0 

Wyoming 8 26 0 1 0 2 0 0 0 0 0 13 7 0 2 0 0 0 1 0 

51
 

 

 

Inappropriate/Excessive Involuntary Complaints Concerning 

State/ 

Jurisdiction 

HHS 

Region 

Number of Abuse

Complaints Closed 

Medication

Physical Restraint

Chemical Restraint

Mechanical Restraint

Seclusion

Medication

Electric Convulsive 

Therapy (ECT)

Aversive Behavioral

Therapy

Sterilization

Failure to provide 

appropriate

Failure to provide

Medical Treatment

Physical Assault

Sexual Assault

Staff Threats

/Retaliation/Assaults

Coercion

Financial Exploitation

Suspicious Death

Other 

Totals 2,245 143 145 34 29 139 90 2 3 0 907 254 155 77 102 25 49 63 28 

Percentages 100.00 6.37 6.46 1.51 1.29 6.19 4.01 0.09 0.13 0. 

00 40.40 11.31 6.90 3.43 4.54 1.11 2.18 2.81 1.25 

52
 

 

 

 

Table 5 – Complaints Involving Alleged Abuse of PAIMI Eligible Individuals – FY2018 

Inappropriate/Excessive Involuntary Complaints Concerning 

State/ 

Jurisdiction 

HHS 

Region 

Number of Abuse

Complaints Closed 

Medication

Physical Restraint

Chemical Restraint

Mechanical Restraint

Seclusion

Medication

Electric Convulsive 

Therapy (ECT)

Aversive Behavioral

Therapy

Sterilization

Failure to provide 

appropriate

Failure to provide

Medical Treatment

Physical Assault

Sexual Assault

Staff Threats

/Retaliation/Assaults

Coercion

Financial Exploitation

Suspicious Death

Other 

Alabama 4 22 2 5 2 0 1 0 0 0 0 3 0 8 1 0 0 0 0 0 

Alaska 10 2 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 

AIC 11 3 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 

Am. Samoa 9 5 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 2 0 0 

Arizona 9 28 8 3 0 0 2 1 1 1 0 5 2 2 2 1 0 0 0 0 

Arkansas 6 16 0 1 0 0 0 0 0 0 0 9 3 3 0 0 0 0 0 0 

California 9 57 5 7 0 0 4 0 0 0 0 6 0 5 4 3 0 3 20 0 

Colorado 8 17 0 0 0 0 0 0 0 0 0 16 1 0 0 0 0 0 0 0 

Connecticut 1 3 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 

Delaware 3 15 0 2 0 0 0 0 0 0 0 6 1 2 2 1 0 1 0 0 

DC 3 37 0 3 2 1 3 2 0 0 0 16 2 1 3 0 0 2 2 0 

Florida 4 98 4 1 0 0 2 0 0 0 0 33 17 27 2 2 0 2 7 1 

Georgia 4 30 0 1 4 0 0 7 0 0 0 1 1 2 0 1 0 0 10 3 

Guam 9 2 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 

Hawaii 9 5 0 0 0 1 0 0 0 0 0 1 0 3 0 0 0 0 0 0 

Idaho 10 31 3 9 2 0 3 3 0 0 0 6 2 1 0 1 0 1 0 0 

Illinois 5 55 5 10 1 1 7 5 0 2 0 6 6 5 0 2 0 3 0 2 

Indiana 5 16 1 2 0 0 0 0 0 0 0 7 3 0 0 3 0 0 0 0 

Iowa 7 33 0 5 0 0 7 0 0 0 0 9 1 2 1 3 0 1 4 0 

Kansas 7 21 2 2 1 0 0 0 0 0 0 2 5 2 1 1 4 0 1 0 

Kentucky 4 4 0 3 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 

Louisiana 6 5 0 0 0 0 0 2 0 0 0 1 1 1 0 0 0 0 0 0 

Maine 1 50 0 6 1 0 1 0 1 0 0 36 3 2 0 0 0 0 0 0 

Maryland 3 36 1 5 0 1 2 3 0 0 0 3 5 0 10 1 0 1 1 3 

Massachusetts 1 9 0 1 0 0 0 1 0 0 0 0 6 0 0 0 0 1 0 0 

Michigan 5 14 1 5 0 0 3 1 0 0 0 1 0 0 0 0 0 2 0 1 

Minnesota 5 33 1 1 0 0 0 0 0 0 0 18 3 3 0 0 0 1 0 6 

Mississippi 4 8 0 1 0 0 0 0 0 0 0 3 1 0 0 3 0 0 0 0 

53
 

 

 

 

 

 

 

 

 

 

 

 

 

Inappropriate/Excessive Involuntary Complaints Concerning 

State/ 

Jurisdiction 

HHS 

Region 

Number of Abuse

Complaints Closed 

Medication

Physical Restraint

Chemical Restraint

Mechanical Restraint

Seclusion

Medication

Electric Convulsive 

Therapy (ECT)

Aversive Behavioral

Therapy

Sterilization

Failure to provide 

appropriate

Failure to provide

Medical Treatment

Physical Assault

Sexual Assault

Staff Threats

/Retaliation/Assaults

Coercion

Financial Exploitation

Suspicious Death

Other 

Missouri 7 83 9 2 2 0 2 0 1 0 0 29 29 0 1 2 0 0 6 0 

Montana 8 59 5 3 1 0 6 0 0 1 0 28 3 2 7 0 1 1 0 1 

Nebraska 7 2 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 

Nevada 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

New Hampshire 1 51 4 4 1 4 3 2 0 0 0 27 2 2 0 1 1 0 0 0 

New Jersey 2 103 24 0 0 1 0 1 0 0 0 8 10 37 1 7 0 1 13 0 

New Mexico 6 63 10 4 0 1 5 1 0 0 0 13 12 1 7 9 0 0 0 0 

New York 2 11 0 0 0 0 2 0 0 0 0 7 2 0 0 0 0 0 0 0 

North Carolina 4 17 2 0 0 0 2 0 0 0 0 7 1 2 0 3 0 0 0 0 

North Dakota 8 28 2 5 0 2 0 0 0 0 0 2 0 3 2 2 1 8 0 1 

N. Marianas 9 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 

Ohio 5 57 7 3 1 0 2 1 0 0 0 16 7 5 0 6 5 2 2 0 

Oklahoma 6 16 0 1 0 0 0 0 0 0 0 4 9 2 0 0 0 0 0 0 

Oregon 10 11 0 1 0 0 0 0 0 0 0 3 0 0 0 0 6 1 0 0 

Pennsylvania 3 17 1 0 0 1 0 3 0 0 0 3 2 4 0 0 0 3 0 0 

Puerto Rico 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

Rhode Island 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 

South Carolina 4 129 0 0 0 0 0 0 0 0 0 125 0 1 1 1 0 0 0 1 

South Dakota 8 11 2 1 0 0 1 0 0 0 0 4 2 0 0 1 0 0 0 0 

Tennessee 4 30 2 6 0 0 1 0 0 0 0 15 1 2 2 1 0 0 0 0 

Texas 6 99 8 5 0 2 1 2 0 0 0 57 9 8 1 4 1 1 0 0 

Utah 8 8 1 0 1 0 0 0 0 0 0 5 1 0 0 0 0 0 0 0 

Vermont 1 33 0 5 2 1 3 0 0 0 0 7 3 3 0 4 1 1 0 3 

Virgin Islands 2 10 1 0 0 0 1 0 0 0 0 2 1 2 2 0 0 0 1 0 

Virginia 3 30 1 5 0 3 1 0 0 0 0 7 0 3 2 0 0 0 8 0 

Washington 10 193 11 4 1 3 26 9 0 0 0 109 12 2 2 8 0 3 0 3 

West Virginia 3 14 0 2 0 0 1 0 0 0 0 3 2 0 1 2 0 3 0 0 

Wisconsin 5 32 0 2 0 0 6 0 0 0 0 16 4 2 2 0 0 0 0 0 

Wyoming 8 21 1 3 0 1 2 0 0 0 0 6 5 1 1 1 0 0 0 0 

54
 

 

 

Inappropriate/Excessive Involuntary Complaints Concerning 

State/ 

Jurisdiction 

HHS 

Region 

Number of Abuse

Complaints Closed 

Medication

Physical Restraint

Chemical Restraint

Mechanical Restraint

Seclusion

Medication

Electric Convulsive 

Therapy (ECT)

Aversive Behavioral

Therapy

Sterilization

Failure to provide 

appropriate

Failure to provide

Medical Treatment

Physical Assault

Sexual Assault

Staff Threats

/Retaliation/Assaults

Coercion

Financial Exploitation

Suspicious Death

Other 

Totals 1,785 126 132 22 23 100 44 3 4 0 697 182 153 59 75 20 44 76 25 

Percentages 

100.0 

0 7.06 7.39 1.23 1.29 5.60 2.46 0.17 0.22 0.0 

0 39.05 10.20 8.57 3.31 4.20 1.12 2.46 4.26 1.40 

55
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 6 – Complaints Involving Alleged Neglect of PAIMI Eligible Individuals – FY2017 

Failure to Provide for Appropriate 

State/ 

Jurisdiction 

HHS 

Region 

Number of Neglect

Complaints Closed

Admission to Residential

Care or Treatment Facility

Transportation to/from

Residential Care or 

Treatment Facility

Discharge Planning or Release 

from Residential Care or 

Treatment Facility

Mental Health Diagnostic or

Other Evaluation (does not

include treatment)

Medical (non-mental health 

related) diagnostic physical

examination

Inadequate Care (e.g.,

personal hygiene, clothing,

food, shelter)

Physical Plant or

Environmental Safety

Personal Safety Issues 

(unsecured access to facility,

resident rooms, patient to

patient abuse)

Other 

Alabama 4 74 8 0 29 1 5 3 1 26 1 

Alaska 10 2 0 0 1 1 0 0 0 0 0 

AIC 11 1 0 0 0 0 0 1 0 0 0 

Am. Samoa 9 9 1 1 2 1 1 1 1 0 1 

Arizona 9 8 2 0 3 1 0 0 0 2 0 

Arkansas 6 18 1 0 12 0 0 3 0 2 0 

California 9 21 2 0 4 11 1 2 0 1 0 

Colorado 8 2 0 0 1 0 1 0 0 0 0 

Connecticut 1 0 0 0 0 0 0 0 0 0 0 

Delaware 3 12 0 0 9 0 0 2 0 1 0 

DC 3 43 0 0 18 3 0 20 0 2 0 

Florida 4 32 1 0 10 1 5 11 2 2 0 

Georgia 4 92 0 0 56 1 5 4 0 0 26 

Guam 9 3 2 0 1 0 0 0 0 0 0 

Hawaii 9 10 0 0 5 1 0 2 0 2 0 

Idaho 10 59 2 0 42 2 5 6 0 2 0 

Illinois 5 151 29 2 66 23 6 10 10 5 0 

Indiana 5 17 1 0 8 0 0 4 1 3 0 

Iowa 7 13 2 0 0 0 0 2 5 4 0 

Kansas 7 40 2 0 27 0 4 4 1 2 0 

Kentucky 4 16 0 0 11 3 1 0 0 1 0 

Louisiana 6 17 1 0 12 0 0 1 0 3 0 

Maine 1 37 4 0 32 0 0 1 0 0 0 

Maryland 3 20 1 0 8 3 1 5 0 1 1 

Massachusetts 1 35 3 0 20 3 2 4 0 3 0 

Michigan 5 29 0 0 5 2 1 0 0 20 1 

Minnesota 5 19 2 0 6 1 0 10 0 0 0 

Mississippi 4 9 0 0 3 0 0 3 0 2 1 

56
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Failure to Provide for Appropriate 

State/ 

Jurisdiction 

HHS 

Region 

Number of Neglect

Complaints Closed

Admission to Residential

Care or Treatment Facility

Transportation to/from

Residential Care or 

Treatment Facility

Discharge Planning or Release 

from Residential Care or 

Treatment Facility

Mental Health Diagnostic or

Other Evaluation (does not

include treatment)

Medical (non-mental health 

related) diagnostic physical

examination

Inadequate Care (e.g.,

personal hygiene, clothing,

food, shelter)

Physical Plant or

Environmental Safety

Personal Safety Issues 

(unsecured access to facility,

resident rooms, patient to

patient abuse)

Other 

Missouri 7 95 1 0 30 10 30 22 1 1 0 

Montana 8 51 1 0 6 13 14 5 6 2 4 

Nebraska 7 3 0 0 0 0 1 0 2 0 0 

Nevada 9 11 0 0 4 0 1 1 0 0 5 

New Hampshire 1 30 11 0 16 0 1 1 0 1 0 

New Jersey 2 31 0 0 23 0 2 1 2 2 1 

New Mexico 6 199 22 0 63 6 12 72 0 24 0 

New York 2 32 2 0 22 3 2 1 0 2 0 

North Carolina 4 28 4 0 10 6 3 1 1 3 0 

North Dakota 8 30 0 0 10 6 4 5 0 5 0 

N. Marianas 9 1 0 0 0 0 0 1 0 0 0 

Ohio 5 130 5 4 52 11 17 15 2 21 3 

Oklahoma 6 10 0 0 10 0 0 0 0 0 0 

Oregon 10 14 1 0 9 1 2 1 0 0 0 

Pennsylvania 3 47 9 0 32 2 2 0 1 0 1 

Puerto Rico 2 22 13 0 0 2 0 4 3 0 0 

Rhode Island 1 19 3 0 11 1 1 0 0 1 2 

South Carolina 4 6 1 0 2 0 0 0 1 0 2 

South Dakota 8 9 0 0 6 2 0 1 0 0 0 

Tennessee 4 11 4 0 0 1 1 2 0 3 0 

Texas 6 136 5 0 74 5 0 30 3 19 0 

Utah 8 2 1 0 0 0 0 0 0 0 1 

Vermont 1 27 7 1 13 0 2 1 0 0 3 

Virgin Islands 2 1 1 0 0 0 0 0 0 0 0 

Virginia 3 61 3 0 34 2 6 3 1 12 0 

Washington 10 164 6 2 93 20 16 16 1 6 4 

West Virginia 3 32 0 0 21 1 5 3 0 2 0 

Wisconsin 5 18 0 2 10 3 0 1 1 1 0 

57
 

 

 

 

Failure to Provide for Appropriate 

State/ 

Jurisdiction 

HHS 

Region 

Number of Neglect

Complaints Closed

Admission to Residential

Care or Treatment Facility

Transportation to/from

Residential Care or 

Treatment Facility

Discharge Planning or Release 

from Residential Care or 

Treatment Facility

Mental Health Diagnostic or

Other Evaluation (does not

include treatment)

Medical (non-mental health 

related) diagnostic physical

examination

Inadequate Care (e.g.,

personal hygiene, clothing,

food, shelter)

Physical Plant or

Environmental Safety

Personal Safety Issues 

(unsecured access to facility,

resident rooms, patient to

patient abuse)

Other 

Wyoming 8 12 1 0 3 0 1 3 2 2 0 

Totals 2,021 165 12 945 153 161 289 48 191 57 

Percentages 100.00 8.16 0.59 46.76 7.57 7.97 14.30 2.38 9.45 2.82 

58
 

 

 

 

Table 6 – Complaints Involving Alleged Neglect of PAIMI Eligible Individuals – FY2018 

Failure to Provide for Appropriate 

State/ 

Jurisdiction 

HHS 

Region 

Number of Neglect Complaints

Closed

Admission to Residential

Care or Treatment Facility

Transportation to/from

Residential Care or Treatment

Facility

Discharge Planning or Release 

from Residential Care or 

Treatment Facility

Mental Health Diagnostic or Other 

Evaluation (does not include

treatment) 

Medical (non-mental health 

related) diagnostic physical

examination

Inadequate Care (e.g., personal

hygiene, clothing, food, shelter)

Physical Plant or Environmental

Safety

Personal Safety Issues (unsecured

access to facility, resident rooms,

patient to patient abuse)

Other 

Alabama 4 59 3 0 25 3 1 1 0 3 23 

Alaska 10 2 1 0 1 0 0 0 0 0 0 

AIC 11 1 0 0 0 0 0 1 0 0 0 

Am. Samoa 9 31 5 4 7 3 3 4 4 1 0 

Arizona 9 35 5 1 7 13 1 4 0 3 1 

Arkansas 6 5 3 0 1 0 0 0 1 0 0 

California 9 23 1 1 6 2 9 2 1 1 0 

Colorado 8 20 0 0 0 17 3 0 0 0 0 

Connecticut 1 1 0 0 0 0 1 0 0 0 0 

Delaware 3 34 0 0 23 0 0 8 1 2 0 

DC 3 26 1 0 14 0 0 11 0 0 0 

Florida 4 39 1 0 15 1 3 15 1 3 0 

Georgia 4 105 0 1 58 1 5 6 0 2 32 

Guam 9 4 4 0 0 0 0 0 0 0 0 

Hawaii 9 7 0 0 3 1 1 0 0 2 0 

Idaho 10 33 1 0 25 1 1 0 1 4 0 

Illinois 5 59 9 0 36 6 1 4 2 1 0 

Indiana 5 12 0 0 4 0 1 3 3 1 0 

Iowa 7 15 2 1 2 1 0 7 1 1 0 

Kansas 7 31 0 0 12 7 6 6 0 0 0 

Kentucky 4 7 0 0 2 0 1 1 1 2 0 

Louisiana 6 5 3 0 1 0 1 0 0 0 0 

Maine 1 43 8 0 34 0 1 0 0 0 0 

Maryland 3 19 5 0 11 1 0 0 1 0 1 

Massachusetts 1 19 4 0 5 0 0 0 0 10 0 

Michigan 5 22 1 0 5 1 2 7 0 6 0 

59
Failure to Provide for Appropriate 

State/ 

Jurisdiction 

HHS 

Region 

Number of Neglect Complaints

Closed

Admission to Residential

Care or Treatment Facility

Transportation to/from

Residential Care or Treatment

Facility

Discharge Planning or Release 

from Residential Care or 

Treatment Facility

Mental Health Diagnostic or Other 

Evaluation (does not include

treatment) 

Medical (non-mental health 

related) diagnostic physical

examination

Inadequate Care (e.g., personal

hygiene, clothing, food, shelter)

Physical Plant or Environmental

Safety

Personal Safety Issues (unsecured

access to facility, resident rooms,

patient to patient abuse)

Other 

Minnesota 5 34 14 2 11 1 0 5 0 0 1 

Mississippi 4 8 1 0 1 0 0 6 0 0 0 

Missouri 7 52 1 0 9 1 19 14 3 5 0 

Montana 8 91 0 0 6 2 2 0 9 70 2 

Nebraska 7 0 0 0 0 0 0 0 0 0 0 

Nevada 9 8 0 0 2 0 1 3 0 0 2 

New Hampshire 1 47 16 1 17 3 5 5 0 0 0 

New Jersey 2 25 1 0 16 0 2 3 2 1 0 

New Mexico 6 139 5 0 51 7 8 47 0 21 0 

New York 2 28 2 0 21 1 0 4 0 0 0 

North Carolina 4 7 0 0 4 1 2 0 0 0 0 

North Dakota 8 40 3 0 3 1 6 14 3 10 0 

N. Marianas 9 5 2 0 0 1 0 1 1 0 0 

Ohio 5 68 11 3 18 6 8 12 3 6 1 

Oklahoma 6 7 3 0 1 0 1 1 1 0 0 

Oregon 10 4 0 0 3 1 0 0 0 0 0 

Pennsylvania 3 26 1 0 13 3 6 0 0 2 1 

Puerto Rico 2 2 2 0 0 0 0 0 0 0 0 

Rhode Island 1 6 0 0 5 1 0 0 0 0 0 

South Carolina 4 12 2 0 7 0 1 0 0 0 2 

South Dakota 8 5 0 0 4 0 0 0 1 0 0 

Tennessee 4 20 0 0 6 1 6 6 0 1 0 

Texas 6 135 7 1 50 8 21 24 1 19 4 

Utah 8 0 0 0 0 0 0 0 0 0 0 

Vermont 1 25 5 0 12 1 0 3 1 2 1 

Virgin Islands 2 9 2 0 0 2 1 1 2 1 0 

Virginia 3 70 0 0 57 0 4 2 2 5 0 

60 
Failure to Provide for Appropriate 

State/ 

Jurisdiction 

HHS 

Region 

Number of Neglect Complaints

Closed

Admission to Residential

Care or Treatment Facility

Transportation to/from

Residential Care or Treatment

Facility

Discharge Planning or Release 

from Residential Care or 

Treatment Facility

Mental Health Diagnostic or Other 

Evaluation (does not include

treatment) 

Medical (non-mental health 

related) diagnostic physical

examination

Inadequate Care (e.g., personal

hygiene, clothing, food, shelter)

Physical Plant or Environmental

Safety

Personal Safety Issues (unsecured

access to facility, resident rooms,

patient to patient abuse)

Other 

Washington 10 72 1 0 41 6 9 6 4 2 3 

West Virginia 3 23 1 0 16 0 2 3 1 0 0 

Wisconsin 5 21 0 2 11 5 2 1 0 0 0 

Wyoming 8 8 0 0 4 0 2 1 1 0 0 

Totals 1,654 137 17 686 110 149 242 52 187 74 

Percentages 100.00 8.28 1.03 41.48 6.65 9.01 14.63 3.14 11.31 4.47 

61 
 

 

 

Table 7 – Complaints Involving Alleged Rights Violations of PAIMI Eligible Individuals – FY2017 

Denial of Failure to Provide 

State/ 

Jurisdiction 

HHS 

Region 

Number of Rights

Complaints Closed 

Financial Benefits and 

Entitlements

Guardianship

/Conservative Problems

Rights Protection/Legal

Assistance

Privacy Rights

Recreational Opportunities

Visitors

Access to Records

Individual Treatment Plan

Written Discharge Plan

Mental Health Services

Planning

Confidentiality

Informed Consent

Problem with Advance

Directives

Denial of Parental

/Family Rights

Other 

Alabama 4 65 3 4 6 1 3 0 1 1 0 0 0 1 2 0 43 

Alaska 10 29 16 0 0 0 0 0 1 0 0 0 0 0 0 0 12 

AIC 11 13 2 0 0 0 0 0 0 0 0 0 0 0 1 0 10 

Am. Samoa 9 25 0 0 4 2 2 2 0 4 3 0 0 0 0 3 5 

Arizona 9 8 1 0 5 1 0 0 0 0 0 0 0 0 0 1 0 

Arkansas 6 69 2 2 3 0 0 0 0 0 0 0 0 0 1 0 61 

California 9 668 67 2 68 4 0 1 10 0 0 151 4 6 0 4 351 

Colorado 8 14 0 0 8 3 3 0 0 0 0 0 0 0 0 0 0 

Connecticut 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 

Delaware 3 58 31 1 1 1 1 1 0 0 0 0 0 0 1 1 20 

DC 3 32 1 5 2 0 1 0 0 9 1 3 1 2 6 0 1 

Florida 4 47 2 1 25 2 6 0 1 0 0 0 1 1 0 0 8 

Georgia 4 13 1 2 3 0 0 0 0 0 0 0 0 2 0 0 5 

Guam 9 19 1 7 6 0 0 0 0 0 0 0 0 0 4 1 0 

Hawaii 9 174 14 14 0 0 0 0 0 0 0 91 0 0 38 0 17 

Idaho 10 46 2 6 18 3 2 0 1 2 1 0 4 1 0 0 6 

Illinois 5 323 9 31 1 6 2 0 7 0 0 0 0 1 3 1 262 

Indiana 5 37 1 3 0 0 1 0 0 0 0 0 0 0 0 0 32 

Iowa 7 32 3 3 0 0 1 0 0 0 0 1 0 0 0 0 24 

Kansas 7 325 5 15 13 2 1 0 2 0 0 0 2 2 0 6 277 

Kentucky 4 45 2 3 20 0 1 0 1 0 0 10 0 0 0 0 8 

Louisiana 6 48 0 1 5 0 1 0 1 0 0 0 0 2 1 0 37 

Maine 1 85 8 8 2 2 7 1 0 0 0 4 0 0 0 0 53 

Maryland 3 74 3 0 4 2 3 0 0 1 0 0 0 2 0 0 59 

Massachusetts 1 76 1 0 16 1 2 0 1 0 0 0 0 0 0 1 54 

Michigan 5 27 4 0 1 0 0 0 1 1 4 1 0 0 0 0 15 

Minnesota 5 102 7 8 2 13 2 3 3 15 2 25 0 0 0 2 20 

Mississippi 4 11 1 0 2 0 2 0 0 0 0 0 0 0 0 0 6 

62
Denial of Failure to Provide 

State/ 

Jurisdiction 

HHS 

Region 

Number of Rights

Complaints Closed 

Financial Benefits and 

Entitlements

Guardianship

/Conservative Problems

Rights Protection/Legal

Assistance

Privacy Rights

Recreational Opportunities

Visitors

Access to Records

Individual Treatment Plan

Written Discharge Plan

Mental Health Services

Planning

Confidentiality

Informed Consent

Problem with Advance

Directives

Denial of Parental

/Family Rights

Other 

Missouri 7 130 30 33 2 22 8 2 3 21 0 0 3 0 1 0 5 

Montana 8 59 4 0 1 2 1 0 0 0 0 0 0 1 0 2 48 

Nebraska 7 3 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 

Nevada 9 21 0 0 4 1 0 1 0 0 0 0 0 0 0 0 15 

New Hampshire 1 119 12 8 4 0 5 1 0 2 1 0 0 0 0 3 83 

New Jersey 2 70 0 0 1 2 4 1 0 0 0 0 0 0 0 0 62 

New Mexico 6 44 1 5 20 7 0 0 0 0 0 0 0 2 1 5 3 

New York 2 121 5 4 2 1 0 0 1 0 0 0 0 0 0 4 104 

North Carolina 4 46 1 9 9 1 6 1 0 0 0 0 0 0 0 1 18 

North Dakota 8 72 1 0 3 0 1 0 0 63 1 0 0 0 0 0 3 

N. Marianas 9 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 

Ohio 5 354 22 22 13 18 24 3 7 9 1 4 3 24 2 4 198 

Oklahoma 6 11 0 0 2 0 0 0 0 0 0 0 0 1 0 0 8 

Oregon 10 11 0 3 0 0 0 0 0 0 4 2 0 0 0 0 2 

Pennsylvania 3 163 4 5 16 0 0 2 0 49 0 0 0 0 5 2 80 

Puerto Rico 2 38 7 0 12 0 0 0 1 0 0 0 0 0 0 0 18 

Rhode Island 1 62 2 4 0 0 0 0 0 0 0 0 0 0 0 0 56 

South Carolina 4 15 0 1 0 0 0 0 1 0 0 0 0 0 0 0 13 

South Dakota 8 29 4 0 1 2 0 0 0 0 0 0 0 0 0 0 22 

Tennessee 4 24 0 0 1 0 0 2 0 0 0 0 0 0 0 0 21 

Texas 6 213 10 23 28 27 26 2 5 0 0 0 4 7 2 7 72 

Utah 8 111 2 1 47 0 3 0 1 0 0 0 0 0 0 2 55 

Vermont 1 31 0 0 4 1 1 0 2 0 0 0 0 0 9 0 14 

Virgin Islands 2 6 2 2 1 0 0 0 1 0 0 0 0 0 0 0 0 

Virginia 3 12 3 3 1 0 2 0 1 0 0 0 0 1 1 0 0 

Washington 10 289 43 3 30 14 7 0 4 8 20 36 5 0 0 14 105 

West Virginia 3 29 2 2 5 3 2 0 0 0 0 0 0 0 0 0 15 

Wisconsin 5 36 0 1 1 1 0 0 0 0 0 0 0 0 0 0 33 

Wyoming 8 10 2 1 5 1 1 0 0 0 0 0 0 0 0 0 0 

63 
Denial of Failure to Provide 

State/ 

Jurisdiction 

HHS 

Region 

Number of Rights

Complaints Closed 

Financial Benefits and 

Entitlements

Guardianship

/Conservative Problems

Rights Protection/Legal

Assistance

Privacy Rights

Recreational Opportunities

Visitors

Access to Records

Individual Treatment Plan

Written Discharge Plan

Mental Health Services

Planning

Confidentiality

Informed Consent

Problem with Advance

Directives

Denial of Parental

/Family Rights

Other 

Totals 4,597 344 247 428 147 132 23 57 185 38 328 27 57 78 64 2,442 

Percentages 100.00 7.48 5.37 9.31 3.20 2.87 0.50 1.24 4.02 0.83 7.14 0.59 1.24 1.70 1.39 53.12 

64 
 

 

Table 7 – Complaints Involving Alleged Rights Violations of PAIMI Eligible Individuals – FY2018 

Denial of Failure to Provide 

State/ 

Jurisdiction 

HHS 

Region 

Number of Rights

Complaints Closed 

Financial Benefits and 

Entitlements

Guardianship

/Conservative Problems

Rights Protection/Legal

Assistance

Privacy Rights

Recreational Opportunities

Visitors

Access to Records

Individual Treatment Plan

Written Discharge Plan

Mental Health Services

Planning

Confidentiality

Informed Consent

Problem with Advance

Directives

Denial of Parental

/Family Rights

Other 

Alabama 4 42 1 2 4 0 1 0 1 1 1 1 0 0 0 0 30 

Alaska 10 23 14 0 1 0 0 0 0 0 0 0 0 0 0 0 8 

AIC 11 11 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 

Am. Samoa 9 24 0 0 1 3 2 0 0 4 7 4 0 0 0 3 0 

Arizona 9 27 1 0 4 0 0 3 0 15 1 0 1 0 1 1 0 

Arkansas 6 57 0 5 0 0 0 0 1 0 0 0 0 2 0 0 49 

California 9 570 76 8 31 2 1 0 8 5 4 5 1 4 2 3 420 

Colorado 8 34 0 0 10 2 7 0 0 0 10 5 0 0 0 0 0 

Connecticut 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 

Delaware 3 49 29 3 0 0 0 0 1 0 0 0 1 0 0 2 13 

DC 3 28 0 3 0 1 1 0 0 0 3 1 0 1 14 0 4 

Florida 4 50 2 6 21 5 4 0 2 0 0 0 0 0 0 0 10 

Georgia 4 5 0 0 1 0 0 0 0 0 0 0 0 0 0 0 4 

Guam 9 10 0 2 0 0 0 0 0 1 1 0 0 0 5 1 0 

Hawaii 9 99 5 5 0 0 0 0 0 53 0 3 0 0 33 0 0 

Idaho 10 26 1 3 7 2 1 0 3 4 0 1 1 0 0 0 3 

Illinois 5 234 5 24 2 5 6 1 5 2 0 3 1 0 0 5 175 

Indiana 5 12 0 0 0 4 1 0 0 0 0 2 0 1 0 0 4 

Iowa 7 21 2 2 0 0 1 0 0 0 0 2 0 0 0 0 14 

Kansas 7 323 91 19 5 0 2 0 1 0 0 0 4 6 1 2 192 

Kentucky 4 33 0 3 1 4 5 1 0 0 8 1 0 3 0 0 7 

Louisiana 6 10 2 2 1 0 1 0 0 0 2 0 0 1 0 0 1 

Maine 1 73 4 6 8 5 1 0 0 0 3 15 1 0 1 1 28 

Maryland 3 19 1 0 5 2 0 0 0 0 0 1 1 0 0 1 8 

Massachusetts 1 11 0 0 5 0 1 0 0 0 0 0 0 0 0 0 5 

Michigan 5 51 0 3 5 1 1 1 0 6 10 23 0 1 0 0 0 

Minnesota 5 51 4 4 0 2 2 1 1 3 2 0 1 1 1 0 29 

Mississippi 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 

65
 

 

Denial of Failure to Provide 

State/ 

Jurisdiction 

HHS 

Region 

Number of Rights

Complaints Closed 

Financial Benefits and 

Entitlements

Guardianship

/Conservative Problems

Rights Protection/Legal

Assistance

Privacy Rights

Recreational Opportunities

Visitors

Access to Records

Individual Treatment Plan

Written Discharge Plan

Mental Health Services

Planning

Confidentiality

Informed Consent

Problem with Advance

Directives

Denial of Parental

/Family Rights

Other 

Missouri 7 69 20 27 1 7 4 0 0 3 4 0 0 0 1 0 2 

Montana 8 30 1 0 1 1 0 0 0 1 5 0 0 1 0 4 16 

Nebraska 7 5 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 

Nevada 9 22 1 0 5 0 0 0 0 0 0 0 0 0 0 0 16 

New Hampshire 1 162 19 9 8 3 13 1 0 3 0 0 8 3 0 4 91 

New Jersey 2 57 0 1 1 1 2 0 1 0 0 3 0 0 1 1 46 

New Mexico 6 32 0 5 19 0 0 0 3 0 0 0 0 4 0 1 0 

New York 2 81 0 4 2 0 0 0 0 0 1 8 2 0 1 3 60 

North Carolina 4 40 1 7 1 4 0 0 0 0 15 2 0 0 0 1 9 

North Dakota 8 113 2 5 0 0 0 0 0 84 13 5 0 0 0 0 4 

N. Marianas 9 4 3 0 0 0 0 0 0 0 0 0 0 0 1 0 0 

Ohio 5 351 9 33 32 12 12 2 6 1 20 0 2 10 2 3 207 

Oklahoma 6 7 0 1 2 0 0 0 0 0 2 1 0 0 0 0 1 

Oregon 10 8 0 6 0 0 0 0 0 1 0 1 0 0 0 0 0 

Pennsylvania 3 229 22 1 35 3 3 0 2 14 8 0 1 2 4 9 125 

Puerto Rico 2 3 1 0 2 0 0 0 0 0 0 0 0 0 0 0 0 

Rhode Island 1 17 0 3 0 0 0 0 0 0 0 0 0 0 0 0 14 

South Carolina 4 19 0 0 0 1 0 0 0 0 3 0 0 0 0 0 15 

South Dakota 8 12 1 0 0 0 1 0 2 0 0 0 0 0 0 0 8 

Tennessee 4 20 1 0 7 0 0 1 0 0 0 0 0 0 0 0 11 

Texas 6 250 6 8 69 28 27 1 3 0 35 0 4 15 11 4 39 

Utah 8 134 5 6 121 0 0 0 0 0 1 1 0 0 0 0 0 

Vermont 1 26 4 1 1 2 0 1 2 0 0 0 1 0 6 0 8 

Virgin Islands 2 8 0 1 2 0 0 0 0 1 2 2 0 0 0 0 0 

Virginia 3 25 2 3 3 0 5 0 3 0 2 3 0 3 1 0 0 

Washington 10 261 31 7 15 9 9 1 10 18 34 67 5 1 0 4 50 

West Virginia 3 36 3 0 12 1 0 0 0 1 3 0 1 0 0 0 15 

Wisconsin 5 49 1 1 0 4 3 0 0 1 0 0 0 2 0 0 37 

Wyoming 8 5 0 0 2 1 2 0 0 0 0 0 0 0 0 0 0 

66
 

 

 

Denial of Failure to Provide 

State/ 

Jurisdiction 

HHS 

Region 

Number of Rights

Complaints Closed 

Financial Benefits and 

Entitlements

Guardianship

/Conservative Problems

Rights Protection/Legal

Assistance

Privacy Rights

Recreational Opportunities

Visitors

Access to Records

Individual Treatment Plan

Written Discharge Plan

Mental Health Services

Planning

Confidentiality

Informed Consent

Problem with Advance

Directives

Denial of Parental

/Family Rights

Other 

Totals 3,976 371 234 454 116 119 14 55 233 200 160 36 61 86 54 1,783 

Percentages 100.00 9.33 5.89 11.42 2.92 2.99 0.35 1.38 5.86 5.03 4.02 0.91 1.53 2.16 1.36 44.84 

67
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 8 – Death Investigations – FY2017 

The number of deaths of 

individuals reported to the P&A 

for investigation 

All Death investigations conducted involving PAIMIeligible individuals related 

State/ 

Jurisdiction 

HHS 

Region Total 

Number 

of Deaths 

Reported 

State 

The 

Center 

for 

Medicaid 

& 

Medicare 

Services 

Other 

Sources 

Total 

Number of 

Death 

Investigations 

Number of 

deaths 

investigated 

involving 

incidents of 

seclusion 

(S). 

Number of 

deaths 

investigated 

involving 

incidents of 

restraint 

(R). 

Number of 

deaths 

investigated 

NOT related to 

incidents of 

S&R, (e. g., 

suicides.) 

Alabama 4 2 0 0 2 2 0 0 2 

Alaska 10 8 0 0 8 8 0 0 8 

AIC 11 0 0 0 0 0 0 0 0 

Am. Samoa 9 0 0 0 0 0 0 0 0 

Arizona 9 0 0 0 0 1 0 0 1 

Arkansas 6 0 0 0 0 0 0 0 0 

California 9 20 19 0 1 20 0 1 19 

Colorado 8 1 0 0 1 1 0 0 1 

Connecticut 1 0 0 0 0 0 0 0 0 

Delaware 3 19 17 0 2 19 0 0 19 

DC 3 4 4 0 0 1 0 0 1 

Florida 4 12 1 0 11 12 0 3 9 

Georgia 4 12 0 0 12 12 0 0 12 

Guam 9 2 2 0 0 2 0 0 2 

Hawaii 9 0 0 0 0 0 0 0 0 

Idaho 10 1 0 0 1 1 0 0 1 

Illinois 5 0 0 0 0 5 0 0 5 

Indiana 5 1 1 0 0 0 0 0 0 

Iowa 7 6 0 0 6 6 0 0 6 

Kansas 7 1 0 0 1 1 0 0 1 

Kentucky 4 10 8 0 2 10 0 0 10 

Louisiana 6 0 0 0 0 0 0 0 0 

Maine 1 0 0 0 0 0 0 0 0 

Maryland 3 71 12 0 59 2 1 0 1 

Massachusetts 1 255 254 0 1 2 1 0 1 

Michigan 5 10 5 0 5 10 0 0 10 

Minnesota 5 0 0 0 0 0 0 0 0 

Mississippi 4 0 0 0 0 0 0 0 0 

68
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The number of deaths of 

individuals reported to the P&A 

for investigation 

All Death investigations conducted involving PAIMIeligible individuals related 

State/ 

Jurisdiction 

HHS 

Region Total 

Number 

of Deaths 

Reported 

State 

The 

Center 

for 

Medicaid 

& 

Medicare 

Services 

Other 

Sources 

Total 

Number of 

Death 

Investigations 

Number of 

deaths 

investigated 

involving 

incidents of 

seclusion 

(S). 

Number of 

deaths 

investigated 

involving 

incidents of 

restraint 

(R). 

Number of 

deaths 

investigated 

NOT related to 

incidents of 

S&R, (e. g., 

suicides.) 

Missouri 7 595 595 0 0 4 0 0 4 

Montana 8 2 0 0 2 1 0 0 1 

Nebraska 7 0 0 0 0 0 0 0 0 

Nevada 9 2 0 0 2 1 0 0 1 

New Hampshire 1 0 0 0 0 0 0 0 0 

New Jersey 2 39 36 0 3 39 0 1 38 

New Mexico 6 1 1 0 0 1 0 0 1 

New York 2 12 0 0 12 12 0 1 11 

North Carolina 4 21 21 0 0 1 0 0 1 

North Dakota 8 4 3 0 1 4 0 0 4 

N. Marianas 9 0 0 0 0 0 0 0 0 

Ohio 5 2 2 0 0 2 0 0 2 

Oklahoma 6 1 0 1 0 0 0 0 0 

Oregon 10 0 0 0 0 0 0 0 0 

Pennsylvania 3 41 41 0 0 0 0 0 0 

Puerto Rico 2 2 1 0 1 2 0 0 2 

Rhode Island 1 1 0 0 1 0 0 0 0 

South Carolina 4 1 0 0 1 1 0 0 1 

South Dakota 8 0 0 0 0 0 0 0 0 

Tennessee 4 0 0 0 0 0 0 0 0 

Texas 6 4 0 0 4 4 0 0 4 

Utah 8 5 0 0 5 5 2 0 3 

Vermont 1 4 0 0 4 3 0 0 3 

Virgin Islands 2 0 0 0 0 0 0 0 0 

Virginia 3 65 55 0 10 65 0 2 63 

Washington 10 6 0 0 6 6 2 0 4 

West Virginia 3 0 0 0 0 0 0 0 0 

Wisconsin 5 7 7 0 0 7 0 0 7 

Wyoming 8 2 2 0 0 2 0 0 2 

69
 

 

 

The number of deaths of 

individuals reported to the P&A 

for investigation 

All Death investigations conducted involving PAIMIeligible individuals related 

State/ 

Jurisdiction 

HHS 

Region Total 

Number 

of Deaths 

Reported 

State 

The 

Center 

for 

Medicaid 

& 

Medicare 

Services 

Other 

Sources 

Total 

Number of 

Death 

Investigations 

Number of 

deaths 

investigated 

involving 

incidents of 

seclusion 

(S). 

Number of 

deaths 

investigated 

involving 

incidents of 

restraint 

(R). 

Number of 

deaths 

investigated 

NOT related to 

incidents of 

S&R, (e. g., 

suicides.) 

Totals 1,252 1,087 1 164 275 6 8 261 

70
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 8 – Death Investigations – FY2018 

The number of deaths of 

individuals reported to the P&A 

for investigation 

All Death investigations conducted involving PAIMIeligible individuals related 

State/ 

Jurisdiction 

HHS 

Region Total 

Number 

of Deaths 

Reported 

State 

The 

Center 

for 

Medicaid 

& 

Medicare 

Services 

Other 

Sources 

Total 

Number of 

Death 

Investigations 

Number of 

deaths 

investigated 

involving 

incidents of 

seclusion 

(S). 

Number of 

deaths 

investigated 

involving 

incidents of 

restraint 

(R). 

Number of 

deaths 

investigated 

NOT related to 

incidents of 

S&R, (e. g., 

suicides.) 

Alabama 4 2 0 1 1 2 0 1 1 

Alaska 10 4 1 0 3 4 0 0 4 

AIC 11 0 0 0 0 0 0 0 0 

Am. Samoa 9 0 0 0 0 0 0 0 0 

Arizona 9 0 0 0 0 0 0 0 0 

Arkansas 6 0 0 0 0 0 0 0 0 

California 9 18 13 0 5 11 0 1 10 

Colorado 8 3 0 0 3 3 0 0 3 

Connecticut 1 1 0 0 1 1 0 1 0 

Delaware 3 7 6 0 1 7 0 0 7 

DC 3 3 3 0 0 3 0 0 3 

Florida 4 5 1 0 4 5 0 0 5 

Georgia 4 10 0 0 10 10 0 0 10 

Guam 9 1 0 0 1 1 0 0 1 

Hawaii 9 0 0 0 0 0 0 0 0 

Idaho 10 0 0 0 0 0 0 0 0 

Illinois 5 0 0 0 0 3 0 0 3 

Indiana 5 1 1 0 0 0 0 0 0 

Iowa 7 4 0 0 4 4 0 0 4 

Kansas 7 0 0 0 0 2 0 0 2 

Kentucky 4 6 2 0 4 2 0 0 2 

Louisiana 6 1 0 0 1 1 1 0 0 

Maine 1 1 0 0 1 1 0 0 1 

Maryland 3 69 8 0 61 3 0 0 3 

Massachusetts 1 33 33 0 0 4 0 1 3 

Michigan 5 6 4 0 2 6 0 0 6 

Minnesota 5 0 0 0 0 0 0 0 0 

Mississippi 4 0 0 0 0 0 0 0 0 

71
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The number of deaths of 

individuals reported to the P&A 

for investigation 

All Death investigations conducted involving PAIMIeligible individuals related 

State/ 

Jurisdiction 

HHS 

Region Total 

Number 

of Deaths 

Reported 

State 

The 

Center 

for 

Medicaid 

& 

Medicare 

Services 

Other 

Sources 

Total 

Number of 

Death 

Investigations 

Number of 

deaths 

investigated 

involving 

incidents of 

seclusion 

(S). 

Number of 

deaths 

investigated 

involving 

incidents of 

restraint 

(R). 

Number of 

deaths 

investigated 

NOT related to 

incidents of 

S&R, (e. g., 

suicides.) 

Missouri 7 568 568 0 0 7 0 0 7 

Montana 8 1 0 0 1 1 0 0 1 

Nebraska 7 1 0 0 1 2 0 0 2 

Nevada 9 0 0 0 0 0 0 0 0 

New Hampshire 1 1 0 0 1 1 0 1 0 

New Jersey 2 16 16 0 0 16 0 0 16 

New Mexico 6 1 0 0 1 1 1 0 0 

New York 2 6 0 0 6 6 3 0 3 

North Carolina 4 3 3 0 0 3 0 1 2 

North Dakota 8 1 1 0 0 1 0 0 1 

N. Marianas 9 0 0 0 0 0 0 0 0 

Ohio 5 6 2 0 4 6 0 0 6 

Oklahoma 6 0 0 0 0 0 0 0 0 

Oregon 10 1 0 0 1 1 0 0 1 

Pennsylvania 3 40 40 0 0 0 0 0 0 

Puerto Rico 2 0 0 0 0 0 0 0 0 

Rhode Island 1 3 2 0 1 3 0 0 3 

South Carolina 4 3 0 0 3 3 0 0 3 

South Dakota 8 3 0 0 3 3 0 0 3 

Tennessee 4 0 0 0 0 0 0 0 0 

Texas 6 6 0 0 6 6 0 0 6 

Utah 8 48 0 0 48 48 8 0 40 

Vermont 1 4 2 0 2 5 1 2 2 

Virgin Islands 2 1 0 0 1 1 0 0 1 

Virginia 3 73 71 0 2 73 0 1 72 

Washington 10 2 0 0 2 2 0 0 2 

West Virginia 3 1 0 0 1 1 0 0 1 

Wisconsin 5 9 8 0 1 9 0 0 9 

Wyoming 8 1 1 0 0 1 0 0 1 

72
 

 

The number of deaths of 

individuals reported to the P&A 

for investigation 

All Death investigations conducted involving PAIMIeligible individuals related 

State/ 

Jurisdiction 

HHS 

Region Total 

Number 

of Deaths 

Reported 

State 

The 

Center 

for 

Medicaid 

& 

Medicare 

Services 

Other 

Sources 

Total 

Number of 

Death 

Investigations 

Number of 

deaths 

investigated 

involving 

incidents of 

seclusion 

(S). 

Number of 

deaths 

investigated 

involving 

incidents of 

restraint 

(R). 

Number of 

deaths 

investigated 

NOT related to 

incidents of 

S&R, (e. g., 

suicides.) 

Totals 974 786 1 187 273 14 9 250 

73
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 9 – Analysis of Alleged Abuse – FY2017 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

Alabama 4 37 10 2 4 21 10.81 

Alaska 10 9 4 1 4 0 44.44 

AIC 11 1 0 0 0 1 0.00 

Am. Samoa 9 20 0 0 20 0 100.00 

Arizona 9 8 1 1 5 1 62.50 

Arkansas 6 19 7 1 11 0 57.89 

California 9 66 0 0 66 0 100.00 

Colorado 8 55 20 2 33 0 60.00 

Connecticut 1 1 0 0 1 0 100.00 

Delaware 3 4 2 1 1 0 25.00 

DC 3 32 3 5 23 1 71.88 

Florida 4 98 25 11 60 2 61.22 

Georgia 4 44 10 2 32 0 72.73 

Guam 9 3 2 0 1 0 33.33 

Hawaii 9 15 9 1 5 0 33.33 

Idaho 10 12 7 0 2 3 16.67 

Illinois 5 47 8 3 19 17 40.43 

Indiana 5 12 1 3 8 0 66.67 

Iowa 7 47 12 5 30 0 63.83 

Kansas 7 42 11 10 21 0 50.00 

Kentucky 4 14 4 0 8 2 57.14 

Louisiana 6 17 0 3 12 2 70.59 

Maine 1 49 2 6 34 7 69.39 

Maryland 3 44 2 4 33 5 75.00 

Massachusetts 1 45 0 7 38 0 84.44 

Michigan 5 21 5 2 4 10 19.05 

Minnesota 5 25 5 2 17 1 68.00 

Mississippi 4 8 0 0 8 0 100.00 

Missouri 7 86 1 0 84 1 97.67 

Montana 8 82 10 0 68 4 82.93 

Nebraska 7 9 3 3 3 0 33.33 

Nevada 9 8 7 1 0 0 0.00 

New Hampshire 1 46 9 4 33 0 71.74 

74
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

New Jersey 2 79 16 6 56 1 70.89 

New Mexico 6 99 5 10 75 9 75.76 

New York 2 46 2 3 40 1 86.96 

North Carolina 4 8 1 0 7 0 87.50 

North Dakota 8 37 0 4 33 0 89.19 

N. Marianas 9 1 0 0 1 0 100.00 

Ohio 5 182 3 28 150 1 82.42 

Oklahoma 6 16 0 5 11 0 68.75 

Oregon 10 17 2 4 10 1 58.82 

Pennsylvania 3 28 0 0 28 0 100.00 

Puerto Rico 2 5 1 0 2 2 40.00 

Rhode Island 1 3 1 0 2 0 66.67 

South Carolina 4 127 2 1 112 12 88.19 

South Dakota 8 13 0 4 8 1 61.54 

Tennessee 4 45 24 6 0 15 0.00 

Texas 6 180 19 22 31 108 17.22 

Utah 8 8 0 1 6 1 75.00 

Vermont 1 47 8 15 17 7 36.17 

Virgin Islands 2 4 0 0 4 0 100.00 

Virginia 3 55 4 4 47 0 85.45 

Washington 10 311 0 0 311 0 100.00 

West Virginia 3 18 1 2 14 1 77.78 

Wisconsin 5 16 4 2 10 0 62.50 

Wyoming 8 26 4 0 22 0 84.62 

Totals 2,397 277 197 1,685 238 63.43 

75
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 9 – Analysis of Alleged Abuse – FY2018 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

Alabama 4 23 1 2 13 7 56.52 

Alaska 10 2 2 0 0 0 0.00 

AIC 11 3 1 0 2 0 66.67 

Am. Samoa 9 6 0 0 6 0 100.00 

Arizona 9 28 0 0 28 0 100.00 

Arkansas 6 16 2 1 13 0 81.25 

California 9 71 6 5 59 1 83.10 

Colorado 8 20 2 0 10 8 50.00 

Connecticut 1 3 0 0 2 1 66.67 

Delaware 3 15 2 0 13 0 86.67 

DC 3 37 8 3 26 0 70.27 

Florida 4 154 33 15 105 1 68.18 

Georgia 4 34 12 4 18 0 52.94 

Guam 9 2 0 0 2 0 100.00 

Hawaii 9 5 4 1 0 0 0.00 

Idaho 10 31 4 5 21 1 67.74 

Illinois 5 55 3 4 31 17 56.36 

Indiana 5 17 3 2 12 0 70.59 

Iowa 7 33 8 6 19 0 57.58 

Kansas 7 21 6 6 4 5 19.05 

Kentucky 4 9 0 0 9 0 100.00 

Louisiana 6 5 0 1 3 1 60.00 

Maine 1 50 1 8 37 4 74.00 

Maryland 3 37 4 4 25 4 67.57 

Massachusetts 1 9 0 1 7 1 77.78 

Michigan 5 14 0 0 12 2 85.71 

Minnesota 5 33 7 8 18 0 54.55 

Mississippi 4 8 1 0 7 0 87.50 

Missouri 7 83 0 0 83 0 100.00 

Montana 8 59 32 0 17 10 28.81 

Nebraska 7 2 0 0 2 0 100.00 

Nevada 9 0 0 0 0 0 0.00 

New Hampshire 1 53 10 4 38 1 71.70 

76
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

New Jersey 2 103 22 11 68 2 66.02 

New Mexico 6 63 30 5 21 7 33.33 

New York 2 11 0 0 11 0 100.00 

North Carolina 4 17 1 1 15 0 88.24 

North Dakota 8 31 13 5 12 1 38.71 

N. Marianas 9 1 0 0 1 0 100.00 

Ohio 5 57 4 10 42 1 73.68 

Oklahoma 6 16 4 0 10 2 62.50 

Oregon 10 13 1 2 5 5 38.46 

Pennsylvania 3 18 0 0 18 0 100.00 

Puerto Rico 2 0 0 0 0 0 0.00 

Rhode Island 1 1 0 0 1 0 100.00 

South Carolina 4 129 0 0 122 7 94.57 

South Dakota 8 11 2 2 7 0 63.64 

Tennessee 4 30 9 4 13 4 43.33 

Texas 6 99 24 23 41 11 41.41 

Utah 8 8 0 1 5 2 62.50 

Vermont 1 39 5 10 22 2 56.41 

Virgin Islands 2 13 0 0 9 4 69.23 

Virginia 3 30 13 2 11 4 36.67 

Washington 10 207 0 0 207 0 100.00 

West Virginia 3 14 1 1 12 0 85.71 

Wisconsin 5 32 5 7 10 10 31.25 

Wyoming 8 21 1 0 20 0 95.24 

Totals 1,902 287 164 1,325 126 65.65 

77
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 10 – Analysis of Alleged Neglect – FY2017 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved 

in client's 

favor 

Not 

resolved 

in the 

client's 

favor 

Successful 

outcomes 

from P&A 

involvement 

Percentage 

Favorably 

Resolved 

Alabama 4 74 40 2 28 4 0 37.84 

Alaska 10 2 1 1 0 0 0 0.00 

AIC 11 1 0 0 1 0 0 100.00 

Am. Samoa 9 9 0 1 6 0 2 66.67 

Arizona 9 8 0 0 8 0 0 100.00 

Arkansas 6 18 3 1 8 1 5 44.44 

California 9 21 0 0 21 0 0 100.00 

Colorado 8 2 2 0 0 0 0 0.00 

Connecticut 1 0 0 0 0 0 0 0.00 

Delaware 3 12 0 0 10 0 2 83.33 

DC 3 43 2 8 29 4 0 67.44 

Florida 4 32 8 2 22 0 0 68.75 

Georgia 4 92 1 8 82 1 0 89.13 

Guam 9 3 0 0 3 0 0 100.00 

Hawaii 9 10 2 0 7 1 0 70.00 

Idaho 10 59 5 1 31 19 3 52.54 

Illinois 5 151 9 9 34 27 72 22.52 

Indiana 5 17 0 2 15 0 0 88.24 

Iowa 7 13 0 2 9 0 2 69.23 

Kansas 7 40 12 6 21 1 0 52.50 

Kentucky 4 16 0 0 11 0 5 68.75 

Louisiana 6 17 5 3 7 2 0 41.18 

Maine 1 37 1 4 29 3 0 78.38 

Maryland 3 20 0 0 13 0 7 65.00 

Massachusetts 1 35 2 9 22 2 0 62.86 

Michigan 5 29 3 2 5 1 18 17.24 

Minnesota 5 19 3 3 12 1 0 63.16 

Mississippi 4 9 0 0 8 1 0 88.89 

Missouri 7 95 4 4 87 0 0 91.58 

Montana 8 51 2 0 43 0 6 84.31 

Nebraska 7 3 0 0 2 0 1 66.67 

Nevada 9 11 0 5 6 0 0 54.55 

78
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved 

in client's 

favor 

Not 

resolved 

in the 

client's 

favor 

Successful 

outcomes 

from P&A 

involvement 

Percentage 

Favorably 

Resolved 

New Hampshire 1 30 3 2 23 1 1 76.67 

New Jersey 2 31 5 0 25 1 0 80.65 

New Mexico 6 199 0 5 148 46 0 74.37 

New York 2 32 0 0 2 0 30 6.25 

North Carolina 4 28 3 2 13 0 10 46.43 

North Dakota 8 30 0 0 30 0 0 100.00 

N. Marianas 9 1 0 0 0 0 1 0.00 

Ohio 5 130 1 15 78 1 35 60.00 

Oklahoma 6 10 1 1 5 3 0 50.00 

Oregon 10 14 0 2 11 1 0 78.57 

Pennsylvania 3 47 0 0 42 0 5 89.36 

Puerto Rico 2 22 13 3 1 1 4 4.55 

Rhode Island 1 19 3 2 14 0 0 73.68 

South Carolina 4 6 1 0 4 1 0 66.67 

South Dakota 8 9 0 0 8 1 0 88.89 

Tennessee 4 11 4 2 1 0 4 9.09 

Texas 6 136 15 7 20 4 90 14.71 

Utah 8 2 0 0 2 0 0 100.00 

Vermont 1 27 4 4 16 3 0 59.26 

Virgin Islands 2 1 0 0 1 0 0 100.00 

Virginia 3 61 2 1 54 4 0 88.52 

Washington 10 164 0 0 164 0 0 100.00 

West Virginia 3 32 5 8 17 2 0 53.13 

Wisconsin 5 18 3 2 13 0 0 72.22 

Wyoming 8 12 1 0 10 1 0 83.33 

Totals 2,021 169 129 1,282 138 303 62.66 

79
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 10 – Analysis of Alleged Neglect – FY2018 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved 

in client's 

favor 

Not 

resolved 

in the 

client's 

favor 

Successful 

outcomes 

from P&A 

involvement 

Percentage 

Favorably 

Resolved 

Alabama 4 59 4 4 31 20 0 52.54 

Alaska 10 2 0 0 2 0 0 100.00 

AIC 11 1 0 0 1 0 0 100.00 

Am. Samoa 9 31 1 0 22 7 1 70.97 

Arizona 9 35 0 0 35 0 0 100.00 

Arkansas 6 5 0 2 3 0 0 60.00 

California 9 23 1 3 19 0 0 82.61 

Colorado 8 20 5 1 9 5 0 45.00 

Connecticut 1 1 0 0 1 0 0 100.00 

Delaware 3 34 2 0 32 0 0 94.12 

DC 3 26 1 3 18 4 0 69.23 

Florida 4 39 5 1 33 0 0 84.62 

Georgia 4 105 5 10 89 1 0 84.76 

Guam 9 4 0 0 4 0 0 100.00 

Hawaii 9 7 4 0 2 1 0 28.57 

Idaho 10 33 4 5 23 1 0 69.70 

Illinois 5 59 6 6 24 23 0 40.68 

Indiana 5 12 1 4 7 0 0 58.33 

Iowa 7 15 8 1 3 0 3 20.00 

Kansas 7 31 5 8 16 2 0 51.61 

Kentucky 4 7 0 0 6 1 0 85.71 

Louisiana 6 5 0 1 3 1 0 60.00 

Maine 1 43 1 1 38 3 0 88.37 

Maryland 3 19 4 3 12 0 0 63.16 

Massachusetts 1 19 0 4 15 0 0 78.95 

Michigan 5 22 2 2 12 6 0 54.55 

Minnesota 5 34 2 6 24 2 0 70.59 

Mississippi 4 8 2 0 6 0 0 75.00 

Missouri 7 52 0 1 51 0 0 98.08 

Montana 8 91 75 0 15 1 0 16.48 

Nebraska 7 0 0 0 0 0 0 0.00 

Nevada 9 8 4 2 1 1 0 12.50 

80
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved 

in client's 

favor 

Not 

resolved 

in the 

client's 

favor 

Successful 

outcomes 

from P&A 

involvement 

Percentage 

Favorably 

Resolved 

New Hampshire 1 47 10 5 27 0 5 57.45 

New Jersey 2 25 2 3 20 0 0 80.00 

New Mexico 6 139 42 9 28 55 5 20.14 

New York 2 28 0 3 12 0 13 42.86 

North Carolina 4 7 1 0 6 0 0 85.71 

North Dakota 8 40 0 4 35 1 0 87.50 

N. Marianas 9 5 0 0 5 0 0 100.00 

Ohio 5 68 1 8 58 1 0 85.29 

Oklahoma 6 7 2 2 2 1 0 28.57 

Oregon 10 4 2 0 2 0 0 50.00 

Pennsylvania 3 26 0 0 25 1 0 96.15 

Puerto Rico 2 2 0 0 2 0 0 100.00 

Rhode Island 1 6 0 1 5 0 0 83.33 

South Carolina 4 12 0 1 11 0 0 91.67 

South Dakota 8 5 1 1 2 1 0 40.00 

Tennessee 4 20 8 4 7 1 0 35.00 

Texas 6 135 39 35 54 7 0 40.00 

Utah 8 0 0 0 0 0 0 0.00 

Vermont 1 25 4 2 17 2 0 68.00 

Virgin Islands 2 9 0 0 5 4 0 55.56 

Virginia 3 70 17 4 41 3 5 58.57 

Washington 10 72 0 0 72 0 0 100.00 

West Virginia 3 23 1 2 18 2 0 78.26 

Wisconsin 5 21 2 3 11 5 0 52.38 

Wyoming 8 8 0 0 8 0 0 100.00 

Totals 1,654 274 155 1,030 163 32 65.83 

81
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 11 – Analysis of Alleged Rights Violations – FY2017 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

Alabama 4 65 10 9 40 6 61.54 

Alaska 10 29 7 1 16 5 55.17 

AIC 11 13 1 1 9 2 69.23 

Am. Samoa 9 25 1 0 24 0 96.00 

Arizona 9 8 0 0 8 0 100.00 

Arkansas 6 69 1 17 48 3 69.57 

California 9 668 0 0 668 0 100.00 

Colorado 8 14 8 6 0 0 0.00 

Connecticut 1 1 0 1 0 0 0.00 

Delaware 3 58 2 0 56 0 96.55 

DC 3 32 0 5 27 0 84.38 

Florida 4 47 9 6 31 1 65.96 

Georgia 4 13 0 1 12 0 92.31 

Guam 9 19 1 4 13 1 68.42 

Hawaii 9 174 8 33 130 3 74.71 

Idaho 10 46 6 37 0 3 0.00 

Illinois 5 323 13 13 168 129 52.01 

Indiana 5 37 0 0 37 0 100.00 

Iowa 7 32 4 11 17 0 53.13 

Kansas 7 325 75 51 179 20 55.08 

Kentucky 4 45 1 3 39 2 86.67 

Louisiana 6 48 5 5 35 3 72.92 

Maine 1 85 7 23 50 5 58.82 

Maryland 3 74 10 1 51 12 68.92 

Massachusetts 1 76 1 9 66 0 86.84 

Michigan 5 27 10 3 4 10 14.81 

Minnesota 5 102 8 16 72 6 70.59 

Mississippi 4 11 0 0 11 0 100.00 

Missouri 7 130 10 5 109 6 83.85 

Montana 8 59 12 0 39 8 66.10 

Nebraska 7 3 0 1 2 0 66.67 

Nevada 9 21 2 5 11 3 52.38 

New Hampshire 1 119 17 8 93 1 78.15 

82
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

New Jersey 2 70 4 21 45 0 64.29 

New Mexico 6 44 1 1 35 7 79.55 

New York 2 121 0 0 121 0 100.00 

North Carolina 4 46 3 2 40 1 86.96 

North Dakota 8 72 0 9 61 2 84.72 

N. Marianas 9 2 0 1 0 1 0.00 

Ohio 5 354 4 97 246 7 69.49 

Oklahoma 6 11 2 1 8 0 72.73 

Oregon 10 11 0 1 10 0 90.91 

Pennsylvania 3 163 12 1 136 14 83.44 

Puerto Rico 2 38 24 3 0 11 0.00 

Rhode Island 1 62 12 17 30 3 48.39 

South Carolina 4 15 0 2 11 2 73.33 

South Dakota 8 29 0 4 21 4 72.41 

Tennessee 4 24 2 10 12 0 50.00 

Texas 6 213 71 36 3 103 1.41 

Utah 8 111 5 7 98 1 88.29 

Vermont 1 31 1 7 21 2 67.74 

Virgin Islands 2 6 0 2 1 3 16.67 

Virginia 3 12 0 0 12 0 100.00 

Washington 10 289 0 0 289 0 100.00 

West Virginia 3 29 2 5 22 0 75.86 

Wisconsin 5 36 2 6 26 2 72.22 

Wyoming 8 10 1 2 7 0 70.00 

Totals 4,597 375 510 3,320 392 66.13 

83
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 11 – Analysis of Alleged Rights Violations – FY2018 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

Alabama 4 42 3 5 33 1 78.57 

Alaska 10 23 5 5 8 5 34.78 

AIC 11 11 1 1 8 1 72.73 

Am. Samoa 9 24 0 4 16 4 66.67 

Arizona 9 27 0 0 27 0 100.00 

Arkansas 6 57 2 12 37 6 64.91 

California 9 570 4 14 535 17 93.86 

Colorado 8 34 10 3 21 0 61.76 

Connecticut 1 4 0 0 3 1 75.00 

Delaware 3 49 1 5 43 0 87.76 

DC 3 28 1 1 25 1 89.29 

Florida 4 50 8 7 34 1 68.00 

Georgia 4 5 2 0 3 0 60.00 

Guam 9 10 0 0 10 0 100.00 

Hawaii 9 99 2 21 75 1 75.76 

Idaho 10 26 3 3 18 2 69.23 

Illinois 5 234 9 11 111 103 47.44 

Indiana 5 12 0 3 9 0 75.00 

Iowa 7 21 3 2 16 0 76.19 

Kansas 7 323 77 57 143 46 44.27 

Kentucky 4 33 5 1 26 1 78.79 

Louisiana 6 10 4 2 3 1 30.00 

Maine 1 73 3 5 62 3 84.93 

Maryland 3 19 3 3 13 0 68.42 

Massachusetts 1 11 0 2 9 0 81.82 

Michigan 5 51 0 0 51 0 100.00 

Minnesota 5 51 6 12 33 0 64.71 

Mississippi 4 4 0 0 4 0 100.00 

Missouri 7 69 1 1 60 7 86.96 

Montana 8 30 4 0 20 6 66.67 

Nebraska 7 5 1 0 4 0 80.00 

Nevada 9 22 5 2 15 0 68.18 

New Hampshire 1 162 52 7 102 1 62.96 

84
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Complaints 

Closed 

Complaints 

withdrawn, 

no merit 

Complaints 

withdrawn 

by Client 

Resolved in 

client's 

favor 

Not 

resolved in 

the client's 

favor 

Percentage 

Favorably 

Resolved 

New Jersey 2 57 3 2 52 0 91.23 

New Mexico 6 32 15 0 17 0 53.13 

New York 2 81 0 0 81 0 100.00 

North Carolina 4 40 0 0 40 0 100.00 

North Dakota 8 113 0 11 101 1 89.38 

N. Marianas 9 4 0 0 4 0 100.00 

Ohio 5 351 9 48 292 2 83.19 

Oklahoma 6 7 0 1 4 2 57.14 

Oregon 10 8 1 0 6 1 75.00 

Pennsylvania 3 229 0 0 229 0 100.00 

Puerto Rico 2 3 0 0 2 1 66.67 

Rhode Island 1 17 4 3 10 0 58.82 

South Carolina 4 19 1 3 11 4 57.89 

South Dakota 8 12 0 2 9 1 75.00 

Tennessee 4 20 4 8 8 0 40.00 

Texas 6 250 51 61 118 20 47.20 

Utah 8 134 11 22 95 6 70.90 

Vermont 1 26 1 6 16 3 61.54 

Virgin Islands 2 8 0 1 7 0 87.50 

Virginia 3 25 3 2 18 2 72.00 

Washington 10 261 0 0 261 0 100.00 

West Virginia 3 36 2 7 27 0 75.00 

Wisconsin 5 49 2 5 38 4 77.55 

Wyoming 8 5 0 0 5 0 100.00 

Totals 3,976 322 371 3,028 255 74.63 

85
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 12 – Intervention Strategies – FY2017 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Intervention 

Strategies 

Short 

Term 

Assistance 

Abuse & 

Neglect 

Investigations 

Technical 

Assistance 

Administrative 

Remedies 

Negotiation/ 

Mediation 

Legal 

Remedies 

Alabama 4 176 44 52 45 2 20 13 

Alaska 10 40 23 5 0 4 1 7 

AIC 11 15 1 2 0 4 7 1 

Am. Samoa 9 54 3 18 6 4 22 1 

Arizona 9 24 19 3 1 0 1 0 

Arkansas 6 106 70 20 3 9 0 4 

California 9 850 828 4 2 4 5 7 

Colorado 8 51 6 37 5 0 2 1 

Connecticut 1 1 0 0 1 0 0 0 

Delaware 3 74 28 8 6 17 15 0 

DC 3 107 39 19 17 8 24 0 

Florida 4 179 50 5 42 1 79 2 

Georgia 4 149 25 34 10 0 80 0 

Guam 9 28 7 7 0 1 8 5 

Hawaii 9 199 126 25 7 13 28 0 

Idaho 10 117 35 22 50 7 1 2 

Illinois 5 536 343 11 129 10 38 5 

Indiana 5 61 19 0 5 18 14 5 

Iowa 7 33 7 7 1 1 10 7 

Kansas 7 390 48 1 323 3 0 15 

Kentucky 4 117 34 36 19 3 23 2 

Louisiana 6 82 28 19 0 8 15 12 

Maine 1 171 49 0 35 6 69 12 

Maryland 3 149 27 63 37 2 7 13 

Massachusetts 1 155 131 1 1 0 21 1 

Michigan 5 77 11 44 5 6 5 6 

Minnesota 5 146 64 12 46 10 8 6 

Mississippi 4 81 10 22 0 5 14 30 

Missouri 7 310 22 15 89 13 151 20 

Montana 8 192 93 95 0 0 2 2 

Nebraska 7 13 2 11 0 0 0 0 

Nevada 9 40 23 0 17 0 0 0 

New 

Hampshire 1 196 173 3 0 2 11 7 

86
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Intervention 

Strategies 

Short 

Term 

Assistance 

Abuse & 

Neglect 

Investigations 

Technical 

Assistance 

Administrative 

Remedies 

Negotiation/ 

Mediation 

Legal 

Remedies 

New Jersey 2 180 50 82 29 1 16 2 

New Mexico 6 334 272 52 3 0 6 1 

New York 2 200 104 4 60 7 24 1 

North 

Carolina 4 95 63 13 3 0 8 8 

North Dakota 8 139 55 62 5 0 15 2 

N. Marianas 9 4 0 2 0 0 1 1 

Ohio 5 624 487 81 33 2 18 3 

Oklahoma 6 37 16 4 2 0 15 0 

Oregon 10 42 11 29 0 1 1 0 

Pennsylvania 3 238 122 1 69 9 14 23 

Puerto Rico 2 65 5 15 0 9 33 3 

Rhode Island 1 85 26 5 32 4 8 10 

South 

Carolina 4 148 11 2 2 0 131 2 

South Dakota 8 51 19 2 1 3 26 0 

Tennessee 4 75 13 50 3 1 6 2 

Texas 6 529 160 167 27 75 62 38 

Utah 8 121 82 2 19 4 13 1 

Vermont 1 105 69 31 0 2 0 3 

Virgin Islands 2 8 5 2 0 1 0 0 

Virginia 3 128 54 46 2 5 21 0 

Washington 10 764 761 0 3 0 0 0 

West Virginia 3 70 31 0 24 0 15 0 

Wisconsin 5 70 28 8 3 3 27 1 

Wyoming 8 48 9 33 0 0 5 1 

Totals 9,079 4,841 1,294 1,222 288 1,146 288 

Percentages 100.00 53.32 14.25 13.46 3.17 12.62 3.17 

87
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 12 – Intervention Strategies – FY2018 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Intervention 

Strategies 

Short 

Term 

Assistance 

Abuse & 

Neglect 

Investigations 

Technical 

Assistance 

Administrative 

Remedies 

Negotiation/ 

Mediation 

Legal 

Remedies 

Alabama 4 123 29 41 30 1 5 17 

Alaska 10 27 22 0 0 1 1 3 

AIC 11 15 1 0 6 0 4 4 

Am. Samoa 9 66 10 2 8 5 39 2 

Arizona 9 91 79 3 7 1 1 0 

Arkansas 6 78 41 6 18 8 1 4 

California 9 647 624 0 0 14 7 2 

Colorado 8 73 36 14 15 1 1 6 

Connecticut 1 8 6 0 0 0 2 0 

Delaware 3 98 53 11 4 17 13 0 

DC 3 92 47 13 10 5 15 2 

Florida 4 157 80 2 16 0 28 31 

Georgia 4 144 15 52 1 1 75 0 

Guam 9 16 6 4 0 0 3 3 

Hawaii 9 111 68 12 10 4 16 1 

Idaho 10 90 28 22 36 1 2 1 

Illinois 5 424 303 0 81 6 25 9 

Indiana 5 58 16 0 3 14 22 3 

Iowa 7 40 9 13 1 5 8 4 

Kansas 7 375 45 1 310 3 4 12 

Kentucky 4 69 16 8 28 1 14 2 

Louisiana 6 32 10 10 0 6 3 3 

Maine 1 166 52 3 26 5 72 8 

Maryland 3 126 16 42 52 1 6 9 

Massachusetts 1 30 24 0 1 0 5 0 

Michigan 5 169 9 36 7 18 12 87 

Minnesota 5 118 62 22 9 4 20 1 

Mississippi 4 26 4 19 0 3 0 0 

Missouri 7 204 13 53 39 27 65 7 

Montana 8 180 71 94 5 1 2 7 

Nebraska 7 7 0 6 0 0 0 1 

Nevada 9 30 22 0 7 1 0 0 

New Hampshire 1 260 240 12 0 2 4 2 

New Jersey 2 185 34 98 25 6 16 6 

88
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State/ 

Jurisdiction 

HHS 

Region 

Total 

Intervention 

Strategies 

Short 

Term 

Assistance 

Abuse & 

Neglect 

Investigations 

Technical 

Assistance 

Administrative 

Remedies 

Negotiation/ 

Mediation 

Legal 

Remedies 

New Mexico 6 237 222 10 2 0 1 2 

New York 2 108 57 1 31 1 17 1 

North Carolina 4 64 41 3 2 3 13 2 

North Dakota 8 184 75 67 1 1 39 1 

N. Marianas 9 10 2 1 2 3 0 2 

Ohio 5 476 382 17 56 6 15 0 

Oklahoma 6 30 8 13 0 0 9 0 

Oregon 10 25 9 13 1 0 0 2 

Pennsylvania 3 273 165 3 97 2 3 3 

Puerto Rico 2 5 1 0 1 0 3 0 

Rhode Island 1 24 8 3 9 2 1 1 

South Carolina 4 160 11 5 1 3 138 2 

South Dakota 8 28 18 0 0 4 5 1 

Tennessee 4 71 13 46 1 1 10 0 

Texas 6 484 121 171 20 101 56 15 

Utah 8 100 73 4 4 4 11 4 

Vermont 1 90 69 12 0 3 1 5 

Virgin Islands 2 30 15 5 1 4 3 2 

Virginia 3 125 62 31 6 9 15 2 

Washington 10 540 522 0 3 14 1 0 

West Virginia 3 73 29 0 27 2 13 2 

Wisconsin 5 83 44 3 10 3 23 0 

Wyoming 8 34 3 21 0 1 9 0 

Totals 7,589 4,041 1,028 1,030 329 877 284 

Percentages 100.00 53.25 13.55 13.57 4.34 11.56 3.74 

89
Table 13a – Non-Case Directed Services – FY2017 

Class Action Litigation 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

Alabama 4 99,625 0 0 3 

Alaska 10 0 0 0 0 

AIC 11 1 0 0 1 

Am. Samoa 9 0 0 0 0 

Arizona 9 11,270 0 0 1 

Arkansas 6 0 0 0 0 

California 9 201 0 0 1 

Colorado 8 275 0 0 1 

Connecticut 1 178,000 0 0 1 

Delaware 3 200 1 0 0 

DC 3 200 0 1 0 

Florida 4 376,744 3 0 3 

Georgia 4 0 0 0 0 

Guam 9 0 0 0 0 

Hawaii 9 1,900 0 0 2 

Idaho 10 0 0 0 0 

Illinois 5 52,026 0 0 0 

Indiana 5 0 0 0 0 

Iowa 7 16,742 0 0 2 

Kansas 7 10,000 0 0 1 

Kentucky 4 0 0 0 0 

Louisiana 6 1,625 0 0 3 

Maine 1 5,000 0 0 0 

Maryland 3 1,000 1 0 1 

Massachusetts 1 0 0 0 0 

Michigan 5 51 1 0 0 

Minnesota 5 550 1 0 0 

Mississippi 4 200 2 0 0 

Missouri 7 0 0 0 0 

Montana 8 0 0 0 0 

Nebraska 7 0 0 0 0 

Nevada 9 0 0 0 0 

New Hampshire 1 10,000 0 0 1 

90
 

Class Action Litigation 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

New Jersey 2 0 0 0 0 

New Mexico 6 0 0 0 0 

New York 2 17,020 2 0 9 

North Carolina 4 575 1 0 0 

North Dakota 8 0 0 0 0 

N. Marianas 9 0 0 0 0 

Ohio 5 1,510,050 0 2 1 

Oklahoma 6 0 0 0 0 

Oregon 10 0 0 0 0 

Pennsylvania 3 0 0 0 0 

Puerto Rico 2 0 0 0 0 

Rhode Island 1 0 0 0 0 

South Carolina 4 3,400 1 0 1 

South Dakota 8 0 0 0 0 

Tennessee 4 0 0 0 0 

Texas 6 1,200 0 0 1 

Utah 8 2,000 1 0 2 

Vermont 1 0 0 0 0 

Virgin Islands 2 0 0 0 0 

Virginia 3 586 1 0 0 

Washington 10 61,228 3 0 4 

West Virginia 3 83,000 0 0 1 

Wisconsin 5 0 0 0 0 

Wyoming 8 0 0 0 0 

Total 2,444,669 18 3 40 

91
Table 13a – Non-Case Directed Services – FY2018 

Class Action Litigation 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

Alabama 4 100,625 1 0 3 

Alaska 10 0 0 0 0 

AIC 11 9,260 0 0 2 

Am. Samoa 9 0 0 0 0 

Arizona 9 0 0 0 0 

Arkansas 6 0 0 0 0 

California 9 964 0 0 1 

Colorado 8 500 0 0 1 

Connecticut 1 178,200 0 0 2 

Delaware 3 0 0 0 0 

DC 3 3,162 0 0 1 

Florida 4 54,100 2 1 5 

Georgia 4 153,063 0 0 4 

Guam 9 0 0 0 0 

Hawaii 9 1,900 0 0 2 

Idaho 10 0 0 0 0 

Illinois 5 147,740 0 0 4 

Indiana 5 0 0 0 0 

Iowa 7 16,742 1 0 1 

Kansas 7 0 0 0 0 

Kentucky 4 0 0 0 0 

Louisiana 6 2,750 0 0 4 

Maine 1 5,000 0 0 1 

Maryland 3 0 0 0 0 

Massachusetts 1 0 0 0 0 

Michigan 5 134,255 0 0 2 

Minnesota 5 200 0 0 1 

Mississippi 4 100 1 0 0 

Missouri 7 0 0 0 0 

Montana 8 0 0 0 0 

Nebraska 7 0 0 0 0 

Nevada 9 0 0 0 0 

New Hampshire 1 50,000 0 0 1 

92
Class Action Litigation 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

New Jersey 2 0 0 0 0 

New Mexico 6 4,737 0 0 1 

New York 2 14,977 4 0 8 

North Carolina 4 1,000 0 0 1 

North Dakota 8 0 0 0 0 

N. Marianas 9 0 0 0 0 

Ohio 5 50,170 0 0 3 

Oklahoma 6 0 0 0 0 

Oregon 10 0 0 0 0 

Pennsylvania 3 800 0 0 2 

Puerto Rico 2 0 0 0 0 

Rhode Island 1 0 0 0 0 

South Carolina 4 3,400 1 0 1 

South Dakota 8 0 0 0 0 

Tennessee 4 0 0 0 0 

Texas 6 1,200 0 0 1 

Utah 8 800 0 0 2 

Vermont 1 0 0 0 0 

Virgin Islands 2 41,000 1 0 0 

Virginia 3 15,500 4 0 0 

Washington 10 537,076 3 0 7 

West Virginia 3 83,000 0 0 1 

Wisconsin 5 0 0 0 0 

Wyoming 8 0 0 0 0 

Total 1,612,221 18 1 62 

93
Table 13b – Non-Case Directed Services – FY2017 

Non Litigation Advocacy 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

Alabama 4 1,282,001 25 15 39 

Alaska 10 323 3 13 0 

AIC 11 17 0 0 17 

Am. Samoa 9 812 58 13 6 

Arizona 9 53,889 23 0 6 

Arkansas 6 2,630 20 0 5 

California 9 831,350 1 0 10 

Colorado 8 4,816 43 0 5 

Connecticut 1 248,000 0 0 5 

Delaware 3 2,470 16 0 16 

DC 3 24,600 9 0 8 

Florida 4 2,557,829 12 0 34 

Georgia 4 615,967 73 64 64 

Guam 9 6 1 0 0 

Hawaii 9 215 0 0 2 

Idaho 10 94,032 3 0 11 

Illinois 5 703,871 6 23 32 

Indiana 5 2,650 152 0 1 

Iowa 7 907,210 63 0 13 

Kansas 7 2,050 0 0 4 

Kentucky 4 874,000 8 0 10 

Louisiana 6 44,315 3 1 17 

Maine 1 21,000 55 0 21 

Maryland 3 14,500 0 1 7 

Massachusetts 1 4,000 51 0 8 

Michigan 5 221,373 90 6 2 

Minnesota 5 76,765 54 0 3 

Mississippi 4 4,776 36 0 0 

Missouri 7 412 3 0 2 

Montana 8 23,735 5 0 10 

Nebraska 7 784 0 0 784 

Nevada 9 3,000 2 0 1 

New Hampshire 1 335 0 0 4 

94
Non Litigation Advocacy 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

New Jersey 2 328,300 2 0 6 

New Mexico 6 150,102 0 0 6 

New York 2 319,157 53 1 38 

North Carolina 4 243,262 2 0 8 

North Dakota 8 137 6 0 1 

N. Marianas 9 100 0 0 100 

Ohio 5 7,741 28 0 8 

Oklahoma 6 30,722 2 0 14 

Oregon 10 13,558 7 0 13 

Pennsylvania 3 121,002 0 0 5 

Puerto Rico 2 1,644 21 1 32 

Rhode Island 1 3,077 2 0 6 

South Carolina 4 173,350 2 0 6 

South Dakota 8 934 4 0 3 

Tennessee 4 449,207 38 5 58 

Texas 6 60,660 41 3 63 

Utah 8 34,497 26 1 10 

Vermont 1 4,760 2 0 9 

Virgin Islands 2 21,435 17 0 1 

Virginia 3 43,844 3 0 3 

Washington 10 582,011 30 0 50 

West Virginia 3 194,394 83 0 6 

Wisconsin 5 1,020,011 1 0 4 

Wyoming 8 1,844 35 0 13 

Total 12,429,482 1,220 147 1,610 

95
Table 13b – Non-Case Directed Services – FY2018 

Non Litigation Advocacy 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

Alabama 4 3,245,828 17 1 32 

Alaska 10 1,188 3 9 12 

AIC 11 45,286 0 0 10 

Am. Samoa 9 980 71 15 7 

Arizona 9 53,853 0 0 33 

Arkansas 6 2,711 3 0 10 

California 9 10,451 1 0 3 

Colorado 8 3,700 0 0 4 

Connecticut 1 420,716 0 0 13 

Delaware 3 2,233 16 0 19 

DC 3 24,700 17 0 5 

Florida 4 1,045,944 30 0 59 

Georgia 4 766,381 17 0 23 

Guam 9 46 6 0 0 

Hawaii 9 215 1 0 1 

Idaho 10 27,489 24 1 8 

Illinois 5 3,440 9 23 31 

Indiana 5 1,400 0 0 2 

Iowa 7 851,548 61 2 7 

Kansas 7 1,530 0 0 13 

Kentucky 4 194,280 11 0 0 

Louisiana 6 76,590 2 4 14 

Maine 1 21,003 30 17 30 

Maryland 3 22,110 26 0 10 

Massachusetts 1 35,080 12 0 18 

Michigan 5 435,652 37 4 48 

Minnesota 5 103,729 52 0 14 

Mississippi 4 3,982 49 0 0 

Missouri 7 1,576 9 0 0 

Montana 8 6,850 6 0 10 

Nebraska 7 5,950 29 0 4 

Nevada 9 2,200 1 0 3 

New Hampshire 1 546,777 2 0 37 

96
Non Litigation Advocacy 

State/ 

Jurisdiction 

HHS 

Region 

Total 

number of 

Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

New Jersey 2 3,034 0 0 6 

New Mexico 6 151,002 2 0 1 

New York 2 168,661 25 0 36 

North Carolina 4 243,300 2 0 8 

North Dakota 8 86 5 0 0 

N. Marianas 9 100 0 0 1 

Ohio 5 231,644 97 0 36 

Oklahoma 6 29,149 39 0 4 

Oregon 10 16,596 6 0 33 

Pennsylvania 3 1,816 7 0 19 

Puerto Rico 2 1,410 35 0 25 

Rhode Island 1 679 0 0 6 

South Carolina 4 172,320 1 0 6 

South Dakota 8 4,445 6 0 8 

Tennessee 4 0 0 0 0 

Texas 6 100,294 75 1 39 

Utah 8 155,400 21 0 12 

Vermont 1 9,160 6 0 17 

Virgin Islands 2 41,200 17 0 1 

Virginia 3 9,610 34 0 0 

Washington 10 731,503 36 0 30 

West Virginia 3 144,339 105 1 16 

Wisconsin 5 10,857 3 0 14 

Wyoming 8 1,603 27 0 16 

Total 10,193,626 1,091 78 814 

97
 

Table 13c – Non-Case Directed Services – FY2017 

Legislative & Regulatory Advocacy 

State/ 

Jurisdiction 

HHS 

Region Total number 

of Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

Alabama 4 428,538 4 0 5 

Alaska 10 1,074 0 0 1 

AIC 11 0 0 0 0 

Am. Samoa 9 459 3 2 1 

Arizona 9 40,284 1 0 0 

Arkansas 6 14,100 4 1 4 

California 9 0 0 0 0 

Colorado 8 1,000 1 0 0 

Connecticut 1 70,005 0 0 1 

Delaware 3 0 0 0 0 

DC 3 20,000 1 0 2 

Florida 4 2,453,000 10 0 14 

Georgia 4 670,876 2 2 2 

Guam 9 0 0 0 0 

Hawaii 9 500 0 0 1 

Idaho 10 122,000 3 3 3 

Illinois 5 0 0 0 3 

Indiana 5 850 0 0 1 

Iowa 7 0 0 0 0 

Kansas 7 0 0 0 0 

Kentucky 4 0 0 0 0 

Louisiana 6 35,000 2 0 0 

Maine 1 0 0 0 0 

Maryland 3 25,000 0 0 2 

Massachusetts 1 0 0 0 0 

Michigan 5 180 1 0 0 

Minnesota 5 3,770 0 0 2 

Mississippi 4 0 0 0 0 

Missouri 7 0 0 0 0 

Montana 8 12,000 1 0 0 

Nebraska 7 20,000 0 0 0 

Nevada 9 0 0 0 0 

New Hampshire 1 0 0 0 0 

98
99 

Legislative & Regulatory Advocacy

State/ 

Jurisdiction

HHS 

Region Total number 

of Individuals 

Impacted

Concluded 

Successfully

Concluded 

Unsuccessfully Ongoing 

New Jersey 2 0 0 0 0 

New Mexico 6 1,300 0 0 1 

New York 2 0 0 0 0 

North Carolina 4 0 0 0 0 

North Dakota 8 0 0 0 0 

N. Marianas 9 0 0 0 0 

Ohio 5 642,386 10 0 7 

Oklahoma 6 500 0 0 1 

Oregon 10 3,000 0 0 0 

Pennsylvania 3 0 0 0 0 

Puerto Rico 2 0 0 0 0 

Rhode Island 1 8,800 2 0 2 

South Carolina 4 1,000 0 0 2 

South Dakota 8 0 0 0 0 

Tennessee 4 448,000 0 0 1 

Texas 6 379,956 1 2 6 

Utah 8 20,000 9 0 0 

Vermont 1 422 1 0 1 

Virgin Islands 2 20,600 0 0 1 

Virginia 3 2,878 0 0 1 

Washington 10 124,760 2 0 10 

West Virginia 3 83,000 0 0 1 

Wisconsin 5 4,557,097 1 0 4 

Wyoming 8 0 0 0 0 

Total 10,212,335 59 10 80 
Table 13c – Non-Case Directed Services – FY2018 

Legislative & Regulatory Advocacy 

State/ 

Jurisdiction 

HHS 

Region Total number 

of Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

Alabama 4 283,920 5 0 7 

Alaska 10 0 0 0 0 

AIC 11 41,000 1 0 1 

Am. Samoa 9 509 3 1 1 

Arizona 9 40,284 0 0 4 

Arkansas 6 14,989 0 0 1 

California 9 0 0 0 0 

Colorado 8 300 0 0 1 

Connecticut 1 0 0 0 0 

Delaware 3 0 0 0 0 

DC 3 20,000 4 0 1 

Florida 4 356,277 0 0 4 

Georgia 4 763,602 8 0 16 

Guam 9 0 0 0 0 

Hawaii 9 500 0 0 1 

Idaho 10 262,000 7 6 4 

Illinois ̃ 5 0 0 0 0 

Indiana 5 0 0 0 0 

Iowa 7 0 0 0 0 

Kansas 7 0 0 0 0 

Kentucky 4 0 0 0 0 

Louisiana 6 70,000 3 1 0 

Maine 1 0 0 0 0 

Maryland 3 0 0 0 0 

Massachusetts 1 0 0 0 0 

Michigan 5 275,264 0 1 2 

Minnesota 5 1,500 0 0 1 

Mississippi 4 0 0 0 0 

Missouri ̃ 7 0 0 0 0 

Montana 8 30,000 0 0 4 

Nebraska 7 36,286 10 18 4 

Nevada 9 500 1 0 0 

New Hampshire 1 500 1 0 0 

100
Legislative & Regulatory Advocacy 

State/ 

Jurisdiction 

HHS 

Region Total number 

of Individuals 

Impacted 

Concluded 

Successfully 

Concluded 

Unsuccessfully Ongoing 

New Jersey 2 0 0 0 0 

New Mexico 6 8,104 0 0 1 

New York 2 739,140 6 1 1 

North Carolina 4 0 0 0 0 

North Dakota 8 0 0 0 0 

N. Marianas 9 0 0 0 0 

Ohio 5 0 2 0 22 

Oklahoma 6 236,032 6 0 2 

Oregon 10 0 0 0 0 

Pennsylvania 3 1,763,000 1 0 3 

Puerto Rico 2 0 0 0 0 

Rhode Island 1 5,000 0 0 1 

South Carolina 4 1,000 0 0 2 

South Dakota 8 10 0 1 0 

Tennessee 4 0 0 0 0 

Texas 6 17,689 0 3 7 

Utah 8 3,000,000 5 0 9 

Vermont 1 500 1 0 1 

Virgin Islands 2 1 1 0 0 

Virginia 3 10,500 11 0 0 

Washington 10 326,290 2 0 20 

West Virginia 3 83,000 2 0 3 

Wisconsin 5 350,000 1 0 6 

Wyoming 8 0 0 0 0 

Total 8,737,697 81 32 130 

101
Table 14 – Information/Referral/Public Education/Awareness & Training Activities – FY2017 

State/ 

Jurisdiction 

HHS 

Region 

Number of PAIMI 

Program 

Information & 

Referral Services 

A. 

Number of public 

awareness 

activities or 

events 

B. 

Number of 

education/training 

activities undertaken 

C. 

Number 

(approximate) of 

persons trained in 

B. 

Alabama 4 693 4 28 1,405 

Alaska 10 382 8 84 424 

AIC 11 18 9 8 422 

Am. Samoa 9 168 9 4 765 

Arizona 9 143 8 16 249 

Arkansas 6 149 21 11 324 

California 9 49 243 785 11,815 

Colorado 8 134 36 20 415 

Connecticut 1 88 9 1 40 

Delaware 3 89 9 27 564 

DC 3 268 27 111 2,127 

Florida 4 2,175 55 19 1,540 

Georgia 4 399 31 43 1,822 

Guam 9 35 12 8 350 

Hawaii 9 939 226 62 816 

Idaho 10 309 21 40 296 

Illinois 5 765 57 137 4,013 

Indiana 5 568 33 16 420 

Iowa 7 280 11 15 524 

Kansas 7 18 143 37 1,945 

Kentucky 4 717 7 23 402 

Louisiana 6 534 9 44 1,687 

Maine 1 583 148 123 3,041 

Maryland 3 282 2 13 280 

Massachusetts 1 105 4 6 200 

Michigan 5 1,418 12 8 116 

Minnesota 5 347 5 33 2,999 

Mississippi 4 134 9 22 6,410 

Missouri 7 717 24 14 450 

Montana 8 336 9 9 307 

Nebraska 7 243 30 4 197 

Nevada 9 400 7 4 565 

102
 

State/ 

Jurisdiction 

HHS 

Region 

Number of PAIMI 

Program 

Information & 

Referral Services 

A. 

Number of public 

awareness 

activities or 

events 

B. 

Number of 

education/training 

activities undertaken 

C. 

Number 

(approximate) of 

persons trained in 

B. 

New Hampshire 1 404 7 40 3,780 

New Jersey 2 537 50 36 1,251 

New Mexico 6 540 16 62 1,620 

New York 2 701 15 20 709 

North Carolina 4 137 1 15 453 

North Dakota 8 321 16 30 309 

N. Marianas 9 35 34 2 2,809 

Ohio 5 755 31 36 1,305 

Oklahoma 6 158 12 12 970 

Oregon 10 576 9 10 243 

Pennsylvania 3 444 5 4 2,337 

Puerto Rico 2 1,107 59 51 1,777 

Rhode Island 1 172 8 12 335 

South Carolina 4 628 10 24 732 

South Dakota 8 170 78 17 587 

Tennessee 4 591 151 13 632 

Texas 6 1,151 9 106 5,227 

Utah 8 671 15 11 1,260 

Vermont 1 828 15 43 311 

Virgin Islands 2 7 10 4 50 

Virginia 3 474 14 30 2,698 

Washington 10 62 16 26 1,576 

West Virginia 3 256 23 22 988 

Wisconsin 5 412 44 26 1,737 

Wyoming 8 142 24 9 127 

Totals 24,764 1,910 2,436 80,753 

103
 

Table 14 – Information/Referral/Public Education/Awareness & Training Activities – FY2018 

State/ 

Jurisdiction 

HHS 

Region 

Number of PAIMI 

Program Information 

& Referral Services 

A. 

Number of public 

awareness 

activities or 

events 

B. 

Number of 

education/training 

activities undertaken 

C. 

Number 

(approximate) of 

persons trained in 

B. 

Alabama 4 515 10 30 1,639 

Alaska 10 333 9 28 421 

AIC 11 3 2 4 343 

Am. Samoa 9 339 19 4 558 

Arizona 9 119 9 18 712 

Arkansas 6 116 22 14 799 

California 9 24 102 692 9,730 

Colorado 8 158 34 13 412 

Connecticut 1 194 16 9 240 

Delaware 3 113 11 24 473 

DC 3 234 64 68 1,271 

Florida 4 1,658 36 24 1,148 

Georgia 4 406 29 28 2,183 

Guam 9 28 45 26 738 

Hawaii 9 891 208 58 533 

Idaho 10 265 40 31 575 

Illinois 5 381 54 120 3,279 

Indiana 5 519 4 4 200 

Iowa 7 0 39 31 1,249 

Kansas 7 19 227 42 2,348 

Kentucky 4 675 21 3 394 

Louisiana 6 598 8 19 462 

Maine 1 705 164 374 10,316 

Maryland 3 219 15 19 59 

Massachusetts 1 313 8 5 144 

Michigan 5 1,631 7 6 241 

Minnesota 5 225 18 27 1,487 

Mississippi 4 129 13 25 3,837 

Missouri 7 660 20 14 431 

Montana 8 256 4 8 662 

Nebraska 7 262 99 5 109 

Nevada 9 420 1 28 1,207 

104
State/ 

Jurisdiction 

HHS 

Region 

Number of PAIMI 

Program Information 

& Referral Services 

A. 

Number of public 

awareness 

activities or 

events 

B. 

Number of 

education/training 

activities undertaken 

C. 

Number 

(approximate) of 

persons trained in 

B. 

New Hampshire 1 96 37 4 250 

New Jersey 2 491 41 40 1,625 

New Mexico 6 468 16 60 578 

New York 2 767 10 9 609 

North Carolina 4 142 1 13 312 

North Dakota 8 361 14 40 275 

N. Marianas 9 12 13 32 1,222 

Ohio 5 563 21 25 544 

Oklahoma 6 277 11 8 82 

Oregon 10 393 11 2 30 

Pennsylvania 3 656 11 31 2,970 

Puerto Rico 2 955 57 36 597 

Rhode Island 1 222 14 9 414 

South Carolina 4 687 6 24 594 

South Dakota 8 178 154 19 291 

Tennessee 4 553 117 30 667 

Texas 6 960 19 96 3,792 

Utah 8 578 14 6 220 

Vermont 1 889 0 44 2,797 

Virgin Islands 2 8 6 4 550 

Virginia 3 384 18 15 1,995 

Washington 10 127 12 26 1,047 

West Virginia 3 218 50 31 783 

Wisconsin 5 441 26 20 1,891 

Wyoming 8 195 18 3 352 

Totals 23,029 2,055 2,428 72,687 

105
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACRONYMS 

AoD Administration on Disabilities 

ACL Administration for Community Living 

ACT Assertive Community Treatment 

ADA Americans with Disabilities Act 

ADX Administrative Maximum Facility 

AIC American Indian Consortium 

AIDD Administration on Intellectual and Developmental Disabilities 

BOP Bureau of Prisons 

CHA Children’s Health Act 

CMHS Center for Mental Health Services 

CMS Centers for Medicare and Medicaid Services 

CPS Child Protective Services 

CSA Core Service Agency 

DD Act Developmental Disabilities Assistance and Bill of Rights Act 

DBH Department of Behavioral Health 

DMAT Decision-Making Assessment Tool 

DMH Department of Mental Health 

DOC Department of Corrections 

DPC Delaware Psychiatric Center 

DWCC David Wade Correctional Center 

FY Fiscal Year 

HHS Department of Health and Human Services 

HIPAA Health Insurance Portability and Accountability Act 

IAA Interagency agreement 

MMIC Mercy Maricopa Integrated Care 

NDDOL North Dakota Department of Labor 

OIG Office of Inspector General 

P&A Protection and Advocacy systems 

PAC PAIMI Advisory Council 

PADD Protection and Advocacy for Developmental Disabilities Program 

PAIMI Protection and Advocacy for Individuals with Mental Illness 

POA Power of Attorney 

PPR Program Performance Report 

PTSD Post Traumatic Stress Disorder 

RSA Rehabilitation Services Administration 

RCA Root Cause Analysis 

RTC Residential Treatment Center 

SAMHSA Substance Abuse and Mental Health Services Administration 

SCM Safe Crisis Management 

SED Serious Emotional Disturbance 

SMI Serious Mental Illness 

TASC Training Advocacy and Support Center 

T/TA Training and technical assistance 

WSH Wyoming State Hospital 

106