Lawmakers got down to work this week on resolving North Carolina’s longstanding problems with housing for people with mental health disabilities.
By Rose Hoban
State lawmakers met with housing and finance experts and, mental health providers and advocates Wednesday in an attempt to get a handle on North Carolina’s longstanding problems with housing for people with mental health disabilities.
The four and a half hour meeting was intended primarily to educate the people in the room about the breadth and scope of the housing problem, and the intertwined issues that will complicate any solutions.
“The real problem for the state is that it does not have adequate inventory for the number of individuals who may choose to live in a community setting,” Department of Health and Human Services general counsel Emery Milliken told the panel.
Estimates are that as many as 6,000 people with mental health problems live in adult care homes – medium-to-large sized institutions that were initially intended to house the frail elderly, not people with mental illness.
Multi-pronged problems targeted
The panel was created in this year’s budget law, but the origins of the Blue Ribbon Commission on Transitions to Community Living come from a US Department of Justice investigation into North Carolina’s use of adult care homes to house the mentally ill.
The DOJ found last year that the state was in violation of the 1990 Americans with Disabilities Act and a subsequent Supreme Court ruling by using the institutions to house the mentally ill, rather than providing them with services within their own communities.
In an agreement signed last month, North Carolina did not concur with the DOJ’s findings, but nonetheless, promised the federal agency that the state would create at least 3,000 housing “slots” for people with mental health disabilities over the next eight years. The state also agreed to spend about $287 million in the effort.
North Carolina has also promised that between 100 and 300 of those housing units will become available by July 2013.
Over the next two months, the panel’s two subcommittees will need to grapple with multiple parallel, and intertwined, issues around housing. Some of the questions posed during yesterday’s meeting showed how difficult it is to grasp the depth of the problems and how long they’ve been in place.
Answers may be too late for some
But the panel has no powers of its own. It can only suggest legislation to be considered once lawmakers return to Raleigh in late January for the legislative session. And that might be too late to solve another looming mental health housing issue.
Because of changes the General Assembly made to Medicaid rules about who can receive personal care services, as many of 12,000 people living in smaller group homes could, on January 1, lose the Medicaid payments that support their housing.
In the last session, lawmakers tightened the rules, limiting personal care services to be offered to people needing help with three or more of five activities of daily living – eating, bathing, dressing, toileting or mobility.
In the past, people in adult care homes needed to require help with one activity of daily living, while people living in the community needed to require help with two or more. That inequality in requirements was part of the DOJ findings that the state is required to fix.
Lawmakers tightened those rules for fear that many in the state would “come out of the woodwork” to claim the benefit if the rules were made too loose.
“You mean to say that if someone doesn’t need help eating but can’t prepare meal, that doesn’t qualify as an (activity of daily living)?” asked Rep. Marilyn Avila (R-Raleigh).
When told that was correct, Avila continued, “So, they just sit there and starve?”
State staff further pointed out that assistance with managing medications is also not a reimbursable activity under the rules passed during the last session.
Unlike adult care homes, group homes house only two to six people, and provide services to help people with intellectual, developmental and mental health disabilities become more independent. Owners have said the homes are more likely to close because of their small size, and their dependence on the Medicaid dollars.
Group home owners and managers say that if the Medicaid cuts go into effect, many of them will have to close and thousands of former residents could end up homeless.
“We’re still working on that,” said Rep. Nelson Dollar (R-Cary). “The Department (of Health and Human Services) has come to us… their interpretation of group homes really wasn’t the interpretation I had several months ago. So, we’re going to be working with them on that. We’re well aware of the group home issue.”
Lawmakers appropriated more than $39 million in last year’s budget to help adult care home industry make the transition from housing people with mental health problems.
But the budget did nothing for group homes that might be affected by the Medicaid changes. Language in the budget bill prevents anyone but adult care homes from tapping into that $39 million.
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Let’s hope that the Blue Ribbon Commission has the expertise needed to sort out these thorny issues, and that the General Assembly will listen to what they have to say. People with severe mental illness often have functional difficulties that make it difficult for them to live independently. With the right supports, they can be successful. But without those supports, there is significant risk to health and life.