Group home funding slow to emerge

The money was meant to serve as "bridge funding" for those who no longer qualify for certain services under the state-federal Medicaid program but who have neither the ability nor money to live on their own. 

"It's ridiculous," said Elizabeth Scott at Durham County Community Living Programs, who runs seven group homes for those with developmental and intellectual disabilities.

Scott said 23 of her residents are directly affected by the shortfall situation. "There's not a process in place for that money to be disseminated."

Her group home has been able to weather the delays in funding, but she has loaned money to smaller group home operations that needed help buying food for their residents. 

"We can't do that indefinitely," she said. 

Group homes are small, less-formal settings for those who don't need constant round-the-clock nursing care but need help with everyday activities, such as remembering to take medication. Residents who lose their placements could be forced into more expensive and restrictive institutional settings, such as nursing homes, back home with aging parents ill-equipped to handle their needs or adrift with few good housing options. 

The problems for these residents first arose in 2012 when federally mandated changes to the state Medicaid program meant that many no longer qualified for so-called "personal care services." Gov. Bev Perdue released $1 million meant to be a short-term patch for those residents in late 2012. The General Assembly passed a bill in early 2013 to help further patch the funding. At the time, lawmakers believed they would come up with a long-term solution to the group home problem in the budget that passed July 1. 

However, with no long-term solution worked out by late May, legislators included a $4.6 million patch in the budget that passed in late June. They directed the Department of Health and Human Services to come up with a long-term solution by last April and, in the meantime, use the patch money to make sure group home residents were not displaced. 

"The Division of Mental Health had to finalize the best possible way to efficiently distribute the funds to those who need it," department spokesman Ricky Diaz said in an email response.

Information regarding the amount of money allocated to each local management entity was distributed Wednesday, he said.

"Allocations began today, and the plan is that providers will be able to receive payments for services rendered since July 1, 2013. We've been in communication with group homes and associations about these allocations."

However, Scott and other mental health service providers interviewed Wednesday said they have not yet seen the procedure. 

As outlined by the Aug. 21 memo, group homes are supposed to apply through one of 11 regional Local Management Entities, companies that oversee Medicaid and state spending for mental health services. These companies have taken over the task of managing local mental health funding from county governments in recent years. 

A spokeswoman for Cardinal Innovations, which oversees services in 15 counties including Orange, Chatham and Vance, said they had not yet received their portion of the $4.6 million or instructions on how to access it. Alliance Behavioral Health, which serves people in Cumberland, Durham, Johnston and Wake counties, is also waiting for instructions on how to apply for and administer the funds. 

"The process hasn't started yet in terms of execution," said Doug Fuller, a spokesman for Alliance.

Neither Alliance nor Cardinal said they had seen any group home providers close or change hands as a result of the bridge funding holdup. But group home operators say it's only a matter of time before some smaller operations have to close their doors. 

"There's no way we're seeing any of that money," said Jenny Gadd, who manages two group homes in Chatham County.

Gadd said the same legislation that sets aside the $4.6 million requires group homes to submit a raft of financial documents detailing other sources of income.

"That $4.6 million is less than half of what's needed," she said.

Group homes, like hers, that get extra money from the county will likely be unable to tap money that will be shunted to smaller operations with no extra support from their local governments.

If she's indeed unable to tap the bridge funding, Gadd said, it would amount to a $60,000 per year hit to her operation. That, she said, is the equivalent of her grocery bill for the year or the salaries for three full-time staff members. 

The lack of bridge funding, said Gadd and Scott, is compounding other problems in dealing with DHHS. Glitches in a new computer system, Scott said, means her operation has not been able to get Medicaid payments for patients who qualify for personal care services. The problem, she said, appears to be that her company's name is logged incorrectly in the system. 

"We wanted the money to get out into circulation in time to ensure that individuals that are in group homes do not lose their placements," said Rep. Nelson Dollar, R-Wake, a senior budget writer in the House.

Getting the money to group homes, he said, was particularly important because many run on shoestring budgets with little by way of savings. "Many of those group homes may not be financially stable."

The $4.6 million the state is spending, he said, could ultimately save money in the long run by avoiding a situation in which residents find themselves in more expensive settings.

"I would hope that the department has been attentive to what's going on on the ground there with those group homes and hopefully they have been monitoring that situation," Dollar said.