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But advocates say under a new plan proposed by the Senate, thousands of vulnerable recipients would still be left out in the cold.

By Rose Hoban

Senate leaders moved a little closer to the House’s budget position on Medicaid funding Tuesday during a public budget conference committee at the General Assembly in Raleigh.

For weeks, the two chambers of the legislature have been far apart on funding for the nearly $4 billion program that provides health care for low-income children and their parents, people with disabilities and poor elderly.

At Tuesday’s meeting, lead Senate negotiator Harry Brown (R-Jacksonville) told House committee members that the Senate was willing to scrap an earlier proposal to cut eligibility for many aged, blind and disabled people. The concession keeps funding at current levels for those beneficiaries, he said.

“That is a major concession for us. We think that you eventually have to address eligibility requirements in Medicaid if you want to control costs,” Brown told the committee.

But even though the Senate restores funding for more than 5,500 of those Medicaid recipients, at least 5,000 people living in assisted living facilities, group homes and adult care homes would lose their Medicaid. That’s because the Senate plan still prevents people from qualifying for Medicaid simply because they also qualify for special assistance funding.

Corye Dunn, director of public policy for Disability Rights North Carolina, noted that many of these folks would be people with mental health disabilities living in group homes, as well as many who live in adult care homes.

“We do know that people with disabilities will lose coverage, and that causes us concern,” Dunn said.

[box style=”2″]Tangled history of Special Assistance

Special assistance funding was created to help people with disabilities and medical problems living in facilities pay for their care.

Currently, the rate set by the state for adult care homes and mental health group homes is $1,238 per month. Residents who receive federal disability benefits, which start at about $650 per month, contribute all but $66 of those benefits to pay for their care monthly. The federal government requires the $66 be set aside to pay for necessities such as clothes and toiletries.

According to Lou Wilson, lobbyist for the North Carolina Association, Long Term Care Facilities, the average special assistance payment for Medicaid beneficiaries in these homes comes to about $202 per month.

“All special assistance does is cover the gap,” Wilson said in an interview.

But under current state rules, those people who qualify for special assistance also qualify for Medicaid. The Senate’s plan would eliminate that.

“What Medicaid pays for in our facilities is the aides who provide care for them,” Wilson said. “Even if it would pay for everything, which it won’t, there’ll be no aides working in the facilities to care for them.”

But for years, only people living in facilities such as adult care homes could qualify for special assistance. If someone with a disability was living with a family member or at home, they couldn’t qualify for the benefit. That disparity between people in institutions and people living at home constituted an “institutional bias” under the Americans with Disabilities Act and led to an investigation and finally a settlement with the U.S. Department of Justice. That settlement now provides for special assistance for both people in facilities and those living in the community.


Spotty details

Details of the Senate proposal still need to be spelled out, and that has advocates for seniors and people in assisted living facilities worried.

“We still have grave concerns about the proposal,” said Evelyn Hawthorne, who lobbies for the North Carolina Assisted Living Association. Many of her facilities also have assisted living units, many of which house people with Alzheimer’s disease.

According to Sen. Ralph Hise (R-Spruce Pine), many of those people could qualify for Medicaid because they’re medically needy.

But Hawthorne was doubtful. “We’d like to see some breakout of how the Senate  plans to fund that population,” she said.

Based on current licensure rules and the standards of care, “it would be difficult, if not impossible, to meet those expectations with the proposed cuts in reimbursement,” said Randy Jackson, director of Spring Arbor of Kinston, an assisted living and Alzheimer’s care facility in Lenior County.

Jackson said that Lenoir County Adult Protective Services is struggling to find homes for people who make too much to qualify for Medicaid but not enough to pay privately for assisted living. He said the Lenoir County Department of Social Services estimates that all 231 of the current Medicaid special assistance residents would be affected by the Senate’s current proposal.

Hawthorne also noted that the Department of Justice settlement caused changes last year to the state’s Medicaid plan, changes that needed approval from federal regulators at the Centers for Medicare and Medicaid Services.

“The North Carolina Assisted Living Association would appreciate efforts to allow changes made in the past two years to work before any more changes are taken,” she said. “We need to let the changes work. There needs to be stability for that population and the providers that serve that population.”

“All persons that are currently eligible for Special Assistance In-Home will [also] lose Medicaid eligibility,” Wilson wrote to senators this week. “That includes all the individuals that have been transitioned from adult care homes per the US Department of Justice Settlement Agreement.

“This will surely bring the US Department of Justice back to NC very quickly,” Wilson wrote.

Mental health group homes at risk

According to Hise, under the new Senate proposal some low-income people may still qualify for Medicaid because they fall under the state’s income guidelines for Medicaid of less than 49 percent of the federal poverty level, which comes to about $477 per month.

Others, Hise said, would qualify for Medicaid because they’re “medically needy.” He estimated that, in all, about 6,000 people would continue to qualify for Medicaid.

But that caused concern for Jenny Gadd, the group home manager for Alberta Professional Services, which runs group homes around the state for people with mental health disabilities.

Jenny Gadd, Alex Harrison and Jemel Sutton stand in front of the group home where Harrison lives and Sutton works.
Jenny Gadd and Jemel Sutton stand in front of the group home in Chapel Hill where resident Alex Harrison (middle) lives and Sutton works. Photo credit: Rose Hoban

Gadd explained that many people with mental health problems were never able to work, so even though their federal disability payments are quite low, around $650 per month, that’s still too much to qualify for Medicaid.

She said most of their residents receive Medicaid because they also get special assistance.

“That’s about half of everyone’s funding,” said Gadd, who noted the state has about 1,400 group home slots for people with severe and persistent mental illness.

She noted that most group home residents pay half of their expenses with Social Security and the other half with special assistance funds.

She also noted that Medicaid pays for the psychiatric medications many of her residents need to stay stabilized and engaged in the community.

“If you chop funding for group homes in half … then you don’t have that level of care available in the community,” Gadd said. “Then those people could not live independently and they’d likely be back in the hospital.”

She noted that one day in the emergency department at UNC Hospitals costs about $1,200.

“A day in an emergency department is more than the usual special assistance subsidy for someone with a mental health disability for a month,” she said.

Disability Rights’ Dunn agreed that if the state cut off funding for many of those people receiving special assistance, they’d end up in emergency departments and jails, “which are real expensive options.”

“That’s what happens when you have low-income people with serious medical needs,” Dunn said. ”There’s not a way to kick them off Medicaid and have them disappear altogether. They pop up somewhere else.”

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