Alex Hamilton puts together his afternoon medications with help from Jenny Gadd at Hamilton's group home in Chapel Hill.
Alex Hamilton puts together his afternoon medications with help from Jenny Gadd at Hamilton's group home in Chapel Hill. Photo credit: Rose Hoban.

The budget proposed by the North Carolina Senate would throw the lives of thousands of people with disabilities into turmoil if provisions cutting Medicaid eligibility remain in the final General Assembly budget.

By Hyun Namkoong, with reporting by Rose Hoban

Alex Harrison graduated from college, got a job and was fairly successful, until he started hearing voices in his head.

“It was 1999, my first psychotic break,” he said.

Alex Harrison puts together his afternoon medications with help from Jenny Gadd at Harrison’s group home in Chapel Hill. If the Senate budget cuts are maintained, Harrison fears losing his placement at the home. Photo credit: Rose Hoban.

He couldn’t work anymore, and for about three years lived off his savings.

“I spent a lot of money. I was just paying it out of pocket,” Harrison said. “I was really lucky; I got disability when I ran out of money.”

Now Harrison lives in a group home in Chapel Hill, paid for by a combination of his disability check and state and county “special assistance” money that helps people like him pay for such services.

“I really appreciate that we have group homes, and it’s quite helpful,” Harrison said.

“I’m not able to live on my own.”

No Medicaid for ‘medically needy’

The Senate version of the budget, passed last weekend, would restrict Medicaid eligibility for people like Harrison who are currently classified as “medically needy” but earn more than 100 percent of the federal poverty level.

Generally, the state’s Medicaid eligibility stops for people who earn more than $5,720. But current provisions allow for people like Harrison who receive federal disability benefits or combined state- and county-funded special assistance in North Carolina to automatically qualify for Medicaid.

Senate budget writers hope to save the state $28.7 million. But advocates are worried that the proposed tightening of Medicaid eligibility will affect thousands of people, Harrison among them.

Harrison’s mental illness prevents him from working. His disability checks are about $1,450 a month because of the job he held before being diagnosed with psychosis. His disability checks put his income at 149 percent of the poverty level, disqualifying him for Medicaid under the proposed Senate budget.

He spends many of his days at the Carrboro-based Club Nova, a clubhouse for people with mental health disabilities that provides work opportunities, socialization and subsidized meals. That service is paid for, in part, by Medicaid.

In addition to cutting people like Harrison, an estimated 5,200 seniors and people with mental health problems who live in adult-care homes  in North Carolina would no longer be eligible for Medicaid under the Senate’s proposed budget. An additional 3,057 people receiving special assistance for in-home care are also at risk of losing their Medicaid personal care services.

Senators say that those individuals would qualify for tax subsidies to purchase health insurance through the Affordable Care Act Health Insurance Marketplace.

Harrison’s medication box. He takes almost 20 medications for psychosis, diabetes, asthma, arthritis and breathing difficulties. Photo credit: Rose Hoban

Jennifer Mahan of the Autism Society noted that private insurance policies on the marketplace would not provide the long-term care services that many of these people facing cuts need.

“If you’re a middle-income person, you could buy long-term care insurance. But I don’t think most of the folks already in some kind of facility will qualify for long-term care insurance, nor will their families be able to afford the coverage,” said Mahan, who noted most policies run between $400 and $600 per month.

Before his onset of severe mental illness, Harrison had a private health-insurance plan, but, “They didn’t cover any mental health stuff,” he said. “I paid for my own psychiatrist until I got Medicaid.”

Different and many medical needs

“Who is going to pay for Club Nova? Who is going to pay for an ACT team?” asked Jenny Gadd, the group home manager for Alberta Professional Services, which runs Harrison’s facility. “Because those are Medicaid services.”

ACT stands for assertive community treatment and is a team of professionals from different backgrounds such as social work and counseling. The ACT team targets people with severe mental illnesses who can’t be treated by traditional models of care.

Harrison described how his ACT team delivered him medications, gave him a ride to and from his medical appointments and visited him twice a week to make sure he was OK.

“That was really helpful; I think it’s a good service,” he said. “I’m on a lot of medications.”

In addition to psychosis, Harrison also has diabetes, high blood pressure, two types of arthritis and asthma. At night, he uses a CPAP machine to help him breathe.

People like Harrison are classified as medically needy because they spend so much on their multiple health care expenses that they hit close to or fall below the federal poverty level.

All of Harrison’s health care needs are paid for by Medicaid with the exception of the fee for living in a group home.

“I hope that the government will re-adjust the budget,” he said. “I don’t really have anywhere else to live.”

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Hyun Namkoong

Hyun graduated from the UNC-Chapel Hill Gillings Global School of Public Health in the health behavior department and she worked as the NC Health News intern from Jan-Aug 2014.

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