It has only just begun, but some 135 adult care homes in North Carolina may be looking at a loss of Medicaid funding to cover their residents. The federal government has determined it will withhold Medicaid for homes where more than half the residents are mentally ill. That kind of mix is regarded as not safe for elderly and infirm residents. Despite the homes’ good intentions, those residents can be at risk from mentally ill residents, some of whom may be inclined to lose control.

After all, younger mentally ill people can behave violently as a consequence not of their intentions but their illnesses. Setting a ceiling on the percentage of mentally ill residents allowed in a home reflects a reasonable expectation by the government that such places will be safer as a result. It also furthers the worthwhile aim of encouraging more of the mentally ill to live on their own.

North Carolina has responded in part to new federal rules by setting aside almost $40 million to replace lost Medicaid money. But that seems both a stopgap measure and one that will be inadequate in the long term.

Reform’s wake

Owners of adult care homes aren’t happy about the new rules. But both state and federal officials should be looking out for the welfare of the homes’ residents, many of them poor as well as elderly. That means encouraging independence and the security it brings (while ensuring that care is good) and spending those Medicaid dollars in a manner that’s not just the most efficient but the most helpful to people who need it.

By now, most North Carolinians are painfully aware of the disastrous mental health “reform” that began a little more than 10 years ago. In a 2008 series, The News & Observer showed that so-called reform, part of which aimed at putting the mentally ill who were capable of doing more for themselves back in their communities instead of in institutions, was a failure. Hundreds of millions of dollars had been wasted on alleged community services that didn’t amount to much but for which the state paid inflated amounts.

Today, the mentally ill still are hurting for services, and the closing of Dorothea Dix Hospital in Raleigh in favor of a new hospital, Central Regional, in Butner and an effort to help the mentally ill live more normal, non-institutional lives are causing problems, however well-meaning such efforts may be.

Too ambitious?

Adult care homes, which are thought of generally as places of residence for the elderly, are among the places too many mentally ill people end up, when, given the option, they might be able to live more happily and productively in a more personalized environment.

Most of the homes no doubt are sincere in their intention to take care of all patients. But it’s a tough business, and the revenue (from Medicaid for some) that enables them to fill beds is important. Does that need cause some to try to house people they’re not really equipped to house?

It’s a fair question to which the answer in at least some cases would seem to be “yes.”

North Carolina, having been stung by the failure of reform and frustrated and perplexed as to what to do next, clearly needs to address this issue with more than temporary appropriations that probably aren’t adequate anyway.

Those who are mentally ill and their families who cannot afford to put them in expensive private care deserve more than perpetual uncertainty, just as the families of the elderly and disabled in adult care homes deserve to expect safety and security.