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Originally published: 2012-12-01 18:41:26
Last modified: 2012-12-01 18:41:26

Group homes won’t be left in the cold, leaders say

by Anna Oakes

Group homes across the state — including two in Watauga — are weeks away from significant budget shortfalls as a result of new Medicaid rules, and if state leaders fail to act before Jan. 1, many could be forced to close.

On Friday, N.C. Speaker of the House Thom Tillis sent a letter to Gov. Bev Perdue asking that she call a special session of the General Assembly to address the issue before the end of the year. In response, the governor stated she is “reviewing all possible options” to fix the problem.

Effective Jan. 1, 2013, changes to Medicaid enacted by the General Assembly this year increase the eligibility requirements for persons receiving the Medicaid personal care services subsidy — a significant funding source for residential facilities in which persons with developmental disabilities and mental illnesses are placed.

Recently, the federal government said North Carolina could not continue to set different eligibility requirements for individuals who receive personal care services in community-based homes versus those in adult residential facilities.

To address this, the General Assembly enacted new rules requiring persons to need limited hands-on assistance with three daily living activities — including eating, dressing, bathing, toileting and mobility — or two daily living activities in which one requires extensive assistance to receive Medicaid personal care services reimbursement, no matter where they receive the services.
But here’s the problem for group homes: Since 1995, when the state shifted a portion of funding for group home residents over to Medicaid, the personal care services reimbursement has represented about a third of a group home’s budget revenue.

Many developmentally disabled adults — such as those who live in the group homes of Watauga Opportunities — don’t need hand-over-hand assistance with tasks such as eating, dressing and bathing, which means they no longer qualify for the personal care services subsidy.
“One-third of our funding for the group home would disappear,” said Michael Maybee, director of Watauga Opportunities.

The General Assembly allocated $39 million to adult care homes — where persons with serious mental illness are often placed — to assist in the transition and mitigate the loss of income from residents who no longer qualify for Medicaid personal care services reimbursement, but group homes received no transitional funding.

Maybee said the $39 million represents about six months of “stopgap” funding to aid adult care homes until state leaders can find a long-term solution. He said it group homes across the state would need an additional $10 million to cover them over the same period.

In his letter, Tillis said, “The General Assembly has been working diligently over the last several weeks and months to determine solutions that would prevent the potential unintended closure of mental health and (intellectual and developmental disabilities) group homes at the conclusion of this calendar year. It is now incumbent upon all of us to do what is necessary to solve this problem.”
The regular legislative session of the General Assembly does not begin until mid-January, but the governor has constitutional authority to convene special sessions of the legislature.

“As a result of the General Assembly’s budget, I have been reviewing all possible options to address this important issue including a special session,” Perdue said Friday. “I look forward to working with both the House and the Senate to fix the problem as soon as possible so that hundreds of North Carolinians are not out in the street at the end of the year.”

Maybee said the group home community has been communicating with state leaders about solutions to the state’s funding model for at least two years.

“This whole system is exhausted from change,” he added. “All they’re able to do is go from one crisis response to another, totally foregoing any long-range planning. Nothing’s being done proactively — everything’s being done reactively.

“In the meantime,” he added, “the least enabled of our citizens suffer.”