By Rose Hoban
State health officials told legislators yesterday that thousands of people living in adult care homes in North Carolina could find their housing in jeopardy as soon as May 1. As many as 4,000 people who live in adult care homes, primarily residents with mental health problems, could be affected.
Officials are proposing new rules about Medicaid payment for personal care services to bring North Carolina into compliance with federal law, but that could mean that some adult care homes will lose money, or even close.
Federal officials warned North Carolina last summer that the state’s rules for providing personal care services in adult care homes violate the Americans with Disabilities Act, and rulings by the US Supreme Court. They want North Carolina to fix those problems and gave the state an April 30 deadline to make changes.
The state hopes to get approval from the federal Centers for Medicare and Medicaid Services (CMS) to extend that deadline to Jan 1.
The state has different rules for providing personal care services to people in adult care homes versus people who get those services at home. Those services include ‘activities of daily living’ such as help managing medications, preparing meals, walking, bathing, dressing and toileting.
Owners and operators of the state’s adult care homes say that if the proposal by the state Medicaid program to fix the rules goes forward, many adult care homes will have no choice but to discharge mentally ill residents who will no longer be eligible for Medicaid dollars for the personal care services. They also contend some adult care homes will go out of business as a result.
“We don’t know how to prepare,” said Ed Weeks, whose family runs two adult care homes in Cumberland County. “If Medicaid was to shift the rules, we’ll close within the month.”
“It’s highly disturbing, some of these issues have been out here for years and the solutions haven’t come forward,” said Representative Nelson Dollar who co-chairs the Health and Human Services oversight committee. “At the same time, it’s disturbing that these issues have been out there and now we’re at a crunch time with an April 30 deadline.”
Numbers game
At issue is how many services a resident in an adult care home needs in order for Medicaid to pay for personal care. Adult care homes can be reimbursed if a resident needs help with two of the so-called activities of daily living. People in adult care homes are often there because they require assistance with medication management and meal preparation. But a person who wants to stay in their own home and receive services has to require help with three activities of daily living in order to get the services and stay at home.
Advocates maintain that creates an incentive to institutionalize people with disabilities, and those people could stay in their own homes for the same amount of money, or less. Instead, they get forced into institutions.
“So now there’s finally an incentive to change the rules because Medicaid has basically said we’re not going to pay for this anymore,” said Vicki Smith, head of Disability Rights North Carolina.
Currently about 46,000 Medicaid recipients receive personal care services at an annual cost to Medicaid of about $414 million: 25,500 of them live in their own homes, and about 20,300 of them live in adult care homes.
This situation is part of what prompted Disability Rights to flag the US Department of Justice in 2010 over this ‘institutional bias’ in North Carolina’s Medicaid reimbursement system. The Department of Justice investigated the state early last year, and ruled last summer that the policy does violate the Americans with Disabilities Act, as well as some Supreme Court rulings. State officials have been negotiating with DOJ officials for the past year to settle the case.
DOJ investigators found a similar problems with housing the mentally ill in Georgia, where it cost the state $77 million to settle with the federal government. Part of Georgia’s settlement included the state creating community-based housing options for people with mental health disabilities.
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Just change the rule so that people in their own homes can get care paid for by medicaid if they need assistance with two activities of daily living instead of requiring three. That way there is no longer institutional bias. why does the solution need to be instead that folks in the care homes must need help with three activities?
Larry Hartley