Tuesday's Joint Legislative Oversight Committee on Health and Human Services Meeting (May 15, 2012) focused a great deal on the Department of Justice Complaint (filed by Disability Rights of NC in 2010) and the 16-page DOJ letter of findings resulting from that Complaint.
- View the DRNC Complaint to the DOJ; September 10, 2010.
- View the DOJ Findings Letter; July 28, 2011.
- View the agenda, materials, presentations, documents and handouts (including the DOJ Findings) from Tuesday's JLOC on HHS meeting; May 15, 2012.
The 53-page Complaint and supporting documents focused on NC's Mental Health System and the service delivery to persons with Mental Illness in Adult Care Homes and other settings across the state, alleging namely the improper placement of mentally ill persons in adult care homes and the failure to provide necessary treatment by mental health professionals as well as supports for community integration and independent living, violations of the Americans with Disabilities Act and Olmstead Act.
It should be noted that the initial Complaint to DOJ was not news to the State of North Carolina. Here are just a few examples from the 5 page synopsis of NC's mental health care history spanning more than a decade:
- In 2001, North Carolina undertook a massive effort to reform mental health care, including the privatization of many mental health services and the creation of regional management entities that replaced local county mental health agencies. North Carolina’s State Plan 2001: A Blueprint for Change, emphasized the need to provide meaningful integrated services in accessible community settings for adults with severe and persistent mental illness. (page 4)
- In 2003, just two years following the initiation of mental health care reform, “a number of North Carolina communities were already ‘seeing increasing numbers of psychiatrists refusing to see Medicaid patients due to low reimbursement levels.’" (page 6)
- An advocacy group, NC Policy Watch, reports that nearly 1,200 people who were discharged from psychiatric hospitals ended up in homeless shelters in 2007. (page 6)
- A 2008 study commissioned by the North Carolina General Assembly magnified Disability Rights NC’s concern about Adult Care Homes and the lack of true, integrated community placements for adults with mental illness in Adult Care Homes. (page 3)
- To the detriment of community integration efforts, the N.C. General Assembly directed DHHS to eliminated Case Management as a service in 2009 as a stand-alone service to adults who receive mental health services. Some of Case Management’s functions have been absorbed into the new Community Support Team service, but where Community Support Team services are inappropriate or unavailable, Case Management services do not exist. (page 6)
- The General Assembly’s 2010 Budget Bill instructed the Department to replace Medicaid funded community PCS with two new services: In-Home Care for Children (IHCC) and In-Home Care for Adults (IHCA). The In-Home Care services perform the same function as PCS, but the eligibility criteria for IHC are much stricter. It is estimated that more than one-half of the 37,000 current PCS recipients will not meet the eligibility criteria for IHCA and will subsequently lose the services that allow them to live in their own homes. Earlier policy changes also altered the eligibility requirements to only authorize community PCS when a person required hands-on assistance in performing an ADL. Mental capacity was no longer considered to be a factor in eligibility, but instead could only be taken into consideration after a person was found to be eligible for community PCS, and only then to allow a small increase in the total number of hours. While community PCS were drastically cut and access to the service restricted, PCS for Adult Care Home residents remained intact, essentially unaffected by budget cuts. As a result of this drastic cut in community-based services, thousands of individuals who have been living successfully in the community will be at risk of institutionalization in violation of Olmstead as they will be forced into Adult Care Homes, Assisted Living Facilities, and other non-community settings in order to obtain needed Personal Care Services. (pages 7-8)
The Department of Justice Civil Rights Division, found the adult care homes to be "Segregated, Institutional Settings"... and from their I. Summary of Findings (pages 1-3):
We conclude that the State fails to provide services to individuals with mental illness in the most integrated setting appropriate to their needs in violation of the ADA. The State plans, structures, and administers its mental health service system to deliver services to thousands of persons with mental illness in large, segregated adult care homes, and to allocate funding to serve individuals in adult care homes rather than in integrated settings. Adult care homes are institutional settings that segregate residents from the community and impede residents' interactions with people who do not have disabilities. Most people with mental illness receiving services in adult care homes could be served in more integrated settings, but are relegated indefinitely and unnecessarily to adult care homes because of systemic State actions and policies, which include:
- The State's failure to develop a sufficient quantity of community-based alternatives for individuals with mental illness unnecessarily and indefinitely confined to adult care homes;
- The State's failure to redirect resources already available to expand community-based alternatives;
- The State's prioritization of investment in institutional settings at the expense of community-based settings; and
- The use of policies and practices that cause individuals with mental illness to enter adult care homes to obtain support services.
Our findings are consistent with the following conclusions made in several State-issued and State-funded reports:
- Adult care homes "are not optimal for community integration" and "[r]esidents of
ACHs may be cut off from active participation in the local community.
- Adult care homes are "highly likely to qualify as restricted settings'
- There is an "institutional bias" in North Carolina: "People who enter an ACH or other type of facility can obtain certain financial assistance, services, and supports that are not equally available to people with similar levels of disability and financial need who choose to remain in their own homes'
- "[M]any with mental illnesses continue to live in long term care settings because there are not yet more appropriate alternatives available to them in their communities'", Adult care homes are not the most appropriate setting for people with mental illness because they are not designed to provide services to allow people with mental illness to achieve greater independence.' and
- Supportive housing promotes community integration and achieves "positive impacts in terms of cost-effectiveness and improvement in quality of life, housing stability and health and behavioral outcomes for people with mental illnesses, developmental disabilities and substance abuse disorders.
We agree with these conclusions and observations. Reliance on unnecessary institutional settings violates the civil rights of people with disabilities. Community integration will permit the State to support people with disabilities in settings appropriate to their needs in a cost effective manner.
It's not necessarily a matter of the State seeing the error of their ways after 10 or 15 years however, but rather the year-long negotiations with the US DOJ and the knowledge of numerous other states who have also been investigated for similar ADA and Olmstead violations and the financial consequences they are now facing, like New Jersey's 2009 5-year court order for $752 million annually or Georgia's $685 million annual required payment to the federal government, Texas at $464 million, and Virginia, who entered into a total settlement of $2.1 million.
Bottom line: money talks... especially if it's due to come out of your pocket book.
Durring DOJ update portion of the JLOC meeting by DHHS General Council, Emery Millikin, Senator Tommy Tucker asked if NC had just been sweeping this problem under the rug for 10 or 15 years and "now the chickens have come home to roost?" Attorney Millikin denied any under-rug-sweeping, though did acknowledge, that the chickens of North Carolina have indeed come home to roost.
*I'll be explaining more about what this means to DD families and how this is due to affect our children as Medicaid recipients...
