Group Home Residents Remain in Limbo Over Personal Care Services
By Rose Hoban
The clock is ticking until a Jan 1 deadline when thousands with mental health problems are scheduled to lose the funding that helps them stay in their small group homes.
But during legislative committee meetings Monday and Tuesday, lawmakers didn’t address the funding issue hanging over the state’s group homes for people with mental health and developmental disabilities. And no word came out of Governor Bev Perdue’s office about resolving the issue either, despite a call from House speaker Thom Tillis (R-Charlotte) for the governor to convene a special session of the legislature to fix the problem.
Pope runs 10 small not-for-profit group homes in Cabarrus and Rowan counties, housing a total of 45 residents with mental health and developmental disabilities. This week she started receiving letters from the state Medicaid agency saying that 27 out of the 45 people in her homes are no longer eligible for personal care services – payments tied to the assistance residents need with daily activities such as bathing, dressing, going to the toilet and eating.
Without the money Medicaid has been providing to cover those services, Pope said she’ll eventually go out of business, and her residents will be out on the street.
“I have been calling everyone I can,” Pope said. “Senators, representatives… we’re filing appeals. We’ve got parents who are scared and angry. Some of them are in their 80s, and they can’t physically take care of their sons and daughters.”
Because of Medicaid rules changes put into effect this past year (see box, left), reviewers went to all the group homes in the state to see what kind of assistance was being given to people with disabilities, and determine their eligibility for personal care service reimbursement.
“They wanted to see that you did hands on assistance, that you physically bathed, or dressed or fed them,” said Pope.
“But there’s more to caring for the folks we serve than us doing things for them,” she explained. “We may not go in that bathroom with them physically, but we’re talking them through the process. It might take 45 minutes of prompting to get them in to take their baths, or we may have to send them back in to finish up. They do it themselves, with us monitoring.”
Almost all of Pope’s residents are now being told Medicaid will stop payment for the care.
No word from anyone
This week, legislators met for more than nine hours in committee meetings on Monday and Tuesday where they reviewed mental health policy, and discussed health and human services. In those two days, only about five minutes was spent on the personal care services deadline.
The governor was mum too. An advisor to Perdue told NC Health News her office was working on possible solutions, but there was nothing to say now, and there was no timeline.
“You’re cutting it really close for everyone to fix this,” said Julia Adams, a lobbyist for the ARC of North Carolina, an organization that advocates for people with mental health and intellectual disabilities. The ARC also runs a number of group homes.
“It no longer matters to any of us advocates who made the mistake, or who knew what when,” Adams said. “You have a crisis on your hands, and we expect leadership. (Speaker Thom) Tillis showed some leadership, when he threw down the gauntlet, said, ‘I think the governor should call a special session and the House stands ready to come back.’ Now it’s up to the governor.”
“It’s a game of chicken,” she said.
There’s money… just not for group homes
As lawmakers made Medicaid changes during the session, they set aside $39 million for the first six months of 2013 to help adult care homes weather the changes in Medicaid rules. But tucked into the state budget was a special provision that said those millions were only for larger adult care homes that care for the elderly, not for smaller group homes that care for people with mental health and developmental disabilities.
Health and human services oversight committee co-chair Nelson Dollar (R-Cary) said he thinks part of that $39 million could be used to cover costs for the group homes.
“in my view the individuals in the group homes need to be treated the same as individuals impacted in the adult care homes or in family care homes,” Dollar said. “in all of those residential settings, we want to treat everyone impacted in a similar fashion. They are all similarly impacted for the same sets of reasons.”
“The thing that people need to keep in mind, this is temporary funding, and we’ll be looking for a longer term set of solutions, that we’ll be crafting in the course of the (upcoming) session,” Dollar said.
But other Republicans on the committee disagree with Dollar’s interpretation.
“I think that it is clear legislative intent, that group homes were not included,” said Ralph Hise (R-Spruce Pine).
Hise said the language in the budget bill means the governor can’t act without the legislature. But he disagrees with opening a special session to resolve the problem.
“When you open up the budget language, which is what you have to do, then the session is eligible to change anything that’s in the budget language,” Hise said. “No one is willing to open that Pandora’s box.”
Hise said he believes that a temporary fix is to have group home operators file Medicaid appeals for residents who’ve gotten ‘denial of service’ letters in recent days. Appealing gives Medicaid recipients an additional 90 days of service while a case is being reviewed.
The ARC’s Julia Adams agreed that’s one way to get around the problem – for now – but it puts an undue burden on the group home operators.
“It is going to cause great chaos and a lot of these group home providers are fully aware that these people do not meet the new regulations,” Adams said. “And it’s unfortunate because the end result is that it destabilizes the entire system, and puts people who are truly our most vulnerable at risk.”
“There have been a lot of tears, OK?” said group home operator Ginger Pope. “We’re proud that we run a good organization here. If you want facilities to run the right way, you need competent staff, the right insurance and then the state turns around and doesn’t give me the money to do it right?
“It’s frustrating,” she said.