Federal rule change threatens adult group home funding

Raleigh, N.C. — Thousands of Medicaid patients in North Carolina could soon lose their adult home care because of a federal rule change.

The Center for Medicare and Medicaid Services told the state last year that personal care services, such as assistance with eating and bathing, must be reimbursed at the same rate for Medicaid patients who live in private homes and for those in group homes.

The move, which is set to take effect April 30, would effectively cut $414 million in Medicaid payments to North Carolina group homes, which patient advocates say could force some homes to shut down and put 4,000 or so patients on the streets.

"I think we'll see a lot of business owners potentially, if they have high Medicaid populations, go out of business," Peggy Smith, executive director of the North Carolina Assisted Living Association, said Tuesday. "Homelessness could be a reality."

Group home owners say they need the higher reimbursement rate they have been getting to help pay for round-the-clock care and the higher standards to which the state holds them.

Frustrated state lawmakers are searching for options, and the state Department of Health and Human Services has asked for an extension.

"We are certainly putting as much pressure as we can on federal officials at CMS and elsewhere to make sure they know the difficult situation North Carolina is in," DHHS Secretary Al Delia said.

Gov. Beverly Perdue said Wednesday that the state cannot allow patients to be forced from group homes.

"I really believe that we need to work together to come up with a solution. I will not be a part of dumping 20,000 older people without any capacity to serve them on the streets of North Carolina," Perdue said.

State officials said they plan to enlist the help of North Carolina's congressional delegation to delay the change until the end of the year.

North Carolina doesn't have a fallback plan if the government enforces the deadline, which worries people like Janice Thompson.

Thompson's 93-year-old mother, Mattie Davis, suffers from Alzheimer's disease and is cared for at the Special Care Unit at Carolina House in Wake Forest.

"My home is not safe for her," Thompson said.

She said there could be a high cost if cuts force Medicaid patients like her mother to move from group homes.

"It would be the end of her. It would be a death sentence for her," she said.

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I guess some of the posters here would just put their parents on an ice floe and let the tide carry them out to sea.

fayncmike
March 14, 2012 5:05 p.m.

There are so many hands in the till that after it is all said and done very little goes into the actual care of many of these in need but more into the pockets of those who control the funds,without line item accountability who really can tell who is getting what,just medicaid and medicare alone are two of the major programs that are always being exposed for fraud,prevention is needed not exposure after the fact.

muggs
March 14, 2012 3:43 p.m.

"Amazing WRAL ignores the reality that the rule comes directly from Obamacare and zero mention of the new costs released by the CBO..." - UNC006

Actually these changes Medicaid reimbursement rules for assistance with eating and bathing were put in place 7 years ago during the Bush administration with a implementation date of April 30, 2012.

Why should a much higher rate be paid for one setting (group homes) over private homes. I believe a single rate should be paid no matter what the setting is. The rate that Medicaid was reimbursing group homes for assistance with eating and bathing is a form of fraud itself at over $100K per year. What do they pay the assistants who work in the homes - under $20K per year with a ratio of 1 caretaker to 10 patients on average. Tell me why a group home should be getting over one million dollars per year for each employee who provides assistance with eating and bathing.

westernwake1
March 14, 2012 3:33 p.m.

"Whatever happened to family responsibility and taking care of our own. Why is it now always up to the state to take care of everyone?"

So we should have children and rear them to become caregivers? like people used their children for farmhands a century ago?

That's an interesting idea and it could work but it it has some implications too.

tran
March 14, 2012 2:18 p.m.

"Yeah really, so you are saying that the DEMS always kept well abreast of every Federal Change. The fact is this change comes down from a Democrat Administration that is controlling these agencies."

Before posting again, please do at least 10 seconds of research. This policy has been on the books for 7 years. It was passed under the Bush administration. Everyone knew it was coming. When it came time to actually implement it here, our legislature dropped the ball. They have already asked for a prior extension and STILL haven't done anything about it.

BTW - the law just says that the feds are just going to reimburse care at 1 rate and not pay more or less depending on the setting. It is really simple. The state can either adopt that policy too OR allocate more state level funding if they want to pay certain caregivers more/less.

bill0
March 14, 2012 12:57 p.m.