By Taylor Knopf
An adult developmental vocational program serving Chatham county residents with intellectual and developmental disabilities is suspending Friday programming for the majority of its participants starting next month.
Chatham Trades receives a good chunk of its operating money from state funds funneled through a public behavioral health management company called Cardinal Innovations, which manages care for people with mental health, intellectual and developmental disabilities in 20 counties, including Chatham.
In June, Cardinal notified Chatham Trades Executive Director Shawn Poe that her organization would receive 32 percent fewer dollars from Cardinal than last year.
Chatham Trades is a relatively small day program where about 20 people with a diagnosis of intellectual or developmental disabilities (known as ID/D) come to learn skills that will assist them in the community and in work environments. The participants are paid to do a lot of bulk packaging work for local companies. For example, they put desk hardware into plastic bags, seal and label them.
The activity provides meaningful work for a paycheck that many say they are quite proud of.
Chatham Trades is the only program of its kind in the county.
“When we already don’t have enough services available, having a cut like this is painful,” said Debra Henzey, Chatham County director of community relations.
Henzey said that increasing mental health services is a priority area for the county, and said the county was looking to Chatham Trades to help fill the service gap for people with ID/D.
Chatham Trades recently received money from another funder to purchase a larger space closer to Siler City. Poe anticipates the sale to be finalized this year, and that the organization will move to the new space in the spring.
With the move, the idea is that there would be more opportunities to collaborate with other businesses and nonprofits near by. Transportation is an issue, and the current building is somewhat isolated on a country road across from a baseball field. Poe contracts transportation for program participants to and from Chatham Trades.
“It’s tragic because there are many in intellectual and developmental disability community who have ability to get training to do meaningful work,” Henzey said. “Now we have to tell them ‘Sorry, you have to go on a waiting list.’ That’s disheartening.”
“We need more daytime care,” Henzey said. “Family members get so burnt out. We don’t have a lot of options.”
While Poe can appeal to Cardinal for more money at the end of the calendar year, she said she can’t risk operating at full capacity right now in case the money doesn’t come through. So she’s had to tell some of her program participants they can’t come on Fridays for a while.
Poe also told two new people she had hoped to bring into the program this year that they can no longer join. There are at least a couple dozen people on the waiting list to get into Chatham Trades, she said.
The people affected
The Chatham Trades participants aren’t a particularly chatty bunch, but they all made it clear that they rather be at work Fridays instead of at home.
“No way! I don’t want to be off,” said one member named Rose as she named her responsibilities, such as picking up papers and packaging socks.
At almost 77 years old, Phyllis proudly points out that she’s the oldest member at Chatham Trades and has been coming for 20 years.
“I don’t like to be lazy. I like the work,” she said, adding that she likes to buy clothes and word search books with her pay.
Another member named Jason seemed a little unsure about what he will do on Fridays now.
“I’ll probably stay at home and watch TV, maybe clean the kitchen and the bathroom,” he said. “I’m going to miss being here. I like my friends.”
Tabatha, a member who communicates through sign language, looked visibly upset when one of the staff asked her what she might do on Fridays instead of coming to work.
Sandra Carroll, Chatham Trades’ work floor manager and safety coordinator, said many of the program members get agitated when their routines are disrupted. She said telling them about the Friday change has been difficult.
“I love serving these people. I like making a difference in their lives,” said Carroll who has been working at Chatham Trades for 29 years.
“This is home, and they are all our family,” she said, getting choked up. “They spend more times with us than anyone. They feel comfortable and come and talk to us about anything. If they aren’t feeling well, we can tell by their faces.”
She fears what could happen if the cuts continue.
“If we have to close our doors, what will become of them?” Carroll asked.
Statewide cuts to LME-MCOs
Cardinal Innovations is one of North Carolina’s seven behavioral health management companies or LME-MCOs which in total lost more than $86 million in so-called single stream funds this year. These funds pay for services that cannot be billed to Medicaid or any other payer, and they cover the costs for people with disabilities who have no other insurance and don’t qualify for Medicaid.
Advocates argue those dollars are used to fill in the holes in North Carolina’s safety net for people with mental health and intellectual disabilities.
In addition to this year’s reductions, the state budget cuts another $90 million in fiscal year 2018-19.
Despite the cuts, Cardinal “will maintain the same level and quality of service to members,” said Ashley Conger, Cardinal’s vice president of communications and marketing.
“We manage our finances and operations such that despite continued budget cuts, we can honor our commitments to our members, communities, providers and employees,” Conger said. “Cardinal Innovations will not cut funding, employees or community projects in reaction to the N.C. state budget cuts.”
Meanwhile, Julia Adams, a long-time lobbyist for people with disabilities who represents the NC Association of Rehabilitation Facilities (NCARF), said budget cuts are affecting organizations like Chatham Trades at similar rates across the state. She is tracking the organizations and said the reductions have been widespread across other agencies paid by the LME-MCOs.
“The majority of people being served through single stream state funding are seeing reductions,” Adams said.
For people who receive Medicaid, for instance, there are federal requirements to provide certain levels of services which make that money harder to cut. But Adams said people with I/DD will continue to see services reduced because there is little regulatory protection around the single stream funding.
“If providers continue to see these reductions, they can’t help their clients and they will run into issues with staffing,” Adams said.
She added that if the budget cuts continue, program participants will have to go home, staffing will be cut, and guardians will have to figure out a new system of caring for their family member.
“There is a natural domino effect,” Adams said.
When asked why Chatham Trades funding was cut, Conger said, “Cardinal Innovations bases future state funding decisions on past utilization and anticipated future utilization for all providers, including this one.”
“Secondly, the provider did not follow procedures outlined in detail one year ago, in which they are required to register new members with Cardinal Innovations,” Conger added. “This provider kept their own private waiting list, without notifying Cardinal Innovations. If Chatham Trades begins to follow the proper procedures, they will have the opportunity mid-year to request additional funds which would be considered based on their utilization and available funds.”
Poe was confused by the response Cardinal gave to NC Health News. She said she was told the reductions were due to state budget cuts.
Poe also said the amount of money her organization spends in a given year can fluctuate beyond her control.
“We can only bill Cardinal for the units of service that we have been authorized for in a week,” Poe said. “Underutilization that occurred was a result of unplanned absences by consumers from the program.”
Even so, Chatham Trades has used all but an average of 3 percent of funds received from Cardinal Innovations over the last four years, according to financial records supplied by Poe.
In regards to the keeping of private wait lists, Poe said she was only asked to transfer the wait list to Cardinal last month. The Cardinal memo asking for wait lists from providers is dated June 28, 2017, the day the General Assembly overrode Gov. Roy Cooper’s veto of the state budget.