Medicaid changes put lodging for 2,000 in group homes at risk

Medicaid changes could affect group home residents

lbonner@newsobserver.comNovember 12, 2012 

About 2,000 people with mental disabilities are in danger of losing their lodging in group homes on Jan. 1, their evictions triggered by changing Medicaid rules.

State officials and advocates for the disabled have been talking about the problem for months but have not come to a resolution. The new regulations have group home operators and state health administrators talking about strategies that could keep group homes open when a vital source of income is threatened.

“We’re continuing to struggle with the problem,” said Sen. Louis Pate, a Republican from Mount Olive and a co-chairman of a health and human services legislative oversight committee. “It’s awfully difficult when the feds are basically telling us what to do.”

The issue is how people qualify for services such as help eating, bathing and moving that are paid by the government health insurance program.

For years, the state’s standards made it harder for people to qualify for such services if they lived at home, but that violated federal rules. To get in compliance, the state changed its system so that those living in licensed facilities had to meet the same qualifications as those living in a private home.

Those new rules, effective Jan. 1, make it harder for people living in group homes to qualify. The changes affect about 10,000 people in adult care homes, too, but the legislature set aside $39.7 million in the budget to spend through June to help adult care homes compensate for the loss of federal money. Group homes were not included in the plan.

Rep. Nelson Dollar, a Cary Republican and budget writer, said legislators would be willing to consider changing the law to make group homes eligible for the Medicaid replacement money. But the legislature won’t start passing more laws until Jan. 30, leaving a gap of at least a month when most group home residents wouldn’t be eligible for personal care under Medicaid.

To buy time, advocates for group home residents are encouraging them to file administrative appeals after the state gives notice that they no longer qualify. Residents who file timely appeals will have their services continue until final decisions on their cases. That could take months, giving the legislature time to approve payments to group homes, said Ann Akland, former president of NAMI-Wake County, an advocacy group for people with mental illnesses.

“The state only has a few people to hear the complaints,” Akland said. “It would be stalling it off for months, and it will take a number of months to change the statute. Then they could get alternative payments to group home owners.”

NAMI-Wake County is holding a press conference and rally outside the Legislative Building on Wednesday afternoon to draw attention to the problem.

Al Delia, acting secretary for the state Department of Health and Human Services, said the state expects up to 10,000 appeals related to the new rules. “With the number of appeals we expect, there’s no way we’re going to get through all the appeals in 30 days,” he said.

The ARC of North Carolina, which providers services for people with developmental disabilities, is encouraging group home residents to appeal, said executive director Dave Richard. But it would be best if the state resolved the problem rather than forcing appeals as stop-gap measures.

“It’s a lot of money and expense to put people through if you have a solution,” he said. It would cost less than $7 million to cover personal care services for people in group homes for six months, he said.

Personal care payments provide about $6,000 a year for each person in a group home for mentally ill residents, said Jenny Gadd, a group home operator with Alberta Professional Services.. The four-bed home in Orange County that Gadd operates is for seriously ill people who have been hospitalized repeatedly. The six-bed home in Chatham is for people who are able to participate in a daily social, recreational and job program.

The personal care money covers about one-third of each resident’s expenses, she said.. The state needs a long-term strategy for replacing the personal care money that is suitable for people in group homes, Gadd said.

“If we don’t have group homes, which are essential services, what are those folks who are stepping out of the hospital and don’t have the skills to step into their own apartments going to do?” Gadd asked. “This keeps them from being homeless and out of the criminal justice system.”

Dollar said Gov. Bev Perdue could remedy the problem by finding money in the DHHS budget to cover group homes until the legislature acts.

Delia said DHHS officials asked the legislature to allow money from the $39.7 million fund to be used for group homes, for attorneys to handle appeals and for other costs related to the new rules. But the budget limited use to adult care homes, he said, so Perdue cannot use additional funds to expand its purpose.

“There is a realization now that some of the $39.7 million should probably go to pay for group homes,” he said. “I have some confidence the legislature realizes this is a problem that needs to be resolved.”

Bonner: 919-829-4821

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