Raleigh, N.C. — Hundreds of adults with long-term disabilities such as autism, traumatic brain injuries or Down's syndrome could lose their spots in group homes that help them lead independent lives if the state does not quickly tamp down the recurrence of an issue first encountered more than two years ago.
North Carolina Department of Health and Human Services officials say they are close to both a short-term funding fix and a permanent solution to the problem, but those who run group homes say they are nearing the point where they will have to begin the process of turning some of their residents away.
"Unless there's some solution found by April 1, we will most likely give the families notice," said Marc Phillips, executive director of Autism Services of Mecklenburg County, which runs eight group homes in the Charlotte area.
Seven of his group's 48 residents are in jeopardy of losing their placements, Phillips said.
"Of these seven people, four have autism. Just about all of them have some co-existing mental health diagnosis and medical issues," he said.
The funding problem is a complicated and involves Medicaid, the public health insurance program for the poor and disabled jointly funded by the state and federal governments. For certain beneficiaries, federal rulings forced North Carolina's Medicaid program to greatly scale back payments for personal care services, which paid for things such as helping patients dress or eat.
To make up for the loss of that money, the state in 2013 began providing "bridge funding" that was supposed to help tide group home providers over until a permanent funding fix could be put in place. DHHS officials say they are nearing that permanent fix but haven't rolled it out yet.
In the mean time, group home providers say they were told that the money has run out when they tried to bill for services that were provided in January. For Autism Services of Mecklenburg County, this problem affects seven residents they care for with an annual impact of $39,000 per year.
"We just can't afford to serve these people if we lose this money," Phillips said.
Fixes on the way
Deputy DHHS Secretary Dave Richard said last week that the administration was getting ready to report on its proposed long-term fix to the General Assembly in the coming weeks. At the same time, he said, the department is getting ready to propose a solution to the short-term problem.
"I can't guarantee it, but we're closing in on options that we think will work," Richard said.
Most likely, he said, that will involve shuffling money from different programs in the department into group home bridge funding.
When DHHS first confronted this problem in 2012 at the end of the Perdue administration, many group homes issued notices that they would have to discharge some of their residents. That led to protests at the state Legislative Building and much worry among families.
Without a short-term fix, Phillips said, similar letters could be going out this spring that would give families 60 days' notice that they need to find a new situation for their loved ones.
"Giving them notice is certainly frightening, but it may also let some people know we're serious," Phillips said. "We're not complaining just because we're getting less money. It's a necessity."
As of yet, no group home in North Carolina has issued such a notice in 2015, Richard said.
"We're hoping they would notify us before that happens," he said.
Richard said that he believed the state would be able to move quickly enough to head off any such letters being sent this year.
Whatever solution DHHS develops will affect group homes throughout a broad swath of North Carolina. Nine nonprofit managed care organizations, known as LME-MCOs, are responsible for dolling out mental health funding throughout the state. Richard said the following four of those agencies are out of bridge funding:
- Cardinal Innovations, which handles mental health in 16 counties, including Mecklenburg and Triangle-area counties Orange, Granville and Franklin.
- Partners Behavioral Health Management, which operates in eight western counties.
- Smoky Mountain Center, which handles care in the state's western-most areas.
- East Carolina Behavioral Health, which handles public mental health care in about 20 counties from Jones to Currituck.
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.
When the state does develop a long-term fix, it will almost certainly have to ask the federal government for permission to make those changes. Typically, the federal government makes those decisions in a matter of months, which means that the state will need a temporary funding fix not only through the end of the fiscal year in June but potentially throughout 2015.
That could leave group home providers like Autism Services of Mecklenburg playing administrative chicken with their funding stream throughout the year.
"We are committed to finding solutions to address the needs of people who live in these groups homes," Richard said.