Tillis Requests Special Session To Address PCS/Group Home Crisis

From The Arc of North Carolina

Tillis Requests Special Session To Address PCS/Group Home Crisis

Special Session first step to solve crisis before Holiday break   Speaker of the NC House Thom Tillis has formally requested that Governor Perdue convene a Special Session of the General Assembly in order to address the looming Personal Care Services (PCS) crisis that threatens the housing of thousands of people with disabilities living in group homes. The Arc of North Carolina is thrilled by this development and appreciates the Speaker's leadership on this issue and his continued dedication to North Carolinians with intellectual and developmental disabilities. The Arc will continue to keep you updated on the PCS/Group Home Crisis as it develops. Please check www.ArcNC.org for information as it happens. The Arc's advocacy staff is evaluating it's next steps in terms of advocacy. Look for an action alert next week. The letter from the Speaker's office is below. See a copy of the original here. --- Governor Perdue, As you know, the General Assembly appropriated $39.7 million in this year's budget to provide for temporary, short-term assistance to residents who would no longer be eligible to receive Medicaid State Plan Personal Care Services under the new eligibility criteria, effective January 1, 2013. The budget provision was drafted as a short-term measure to ensure the funds went to those affected residents who would be potentially discharged from their facility, but would not immediately have a safe community placement. This budget provision was intended to prevent the Department of Health & Human Services from using funds for administrative expenses, appeals, rent deposits, or other items, as requested by the Department during budget negotiations. The Blue Ribbon Commission was summarily tasked with developing long-term solutions to ensure Medicaid beneficiaries receive the services they need. 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 IDD 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. In order to ensure that our state's most vulnerable citizens are protected and allowed to remain in their homes, it is my opinion that legislative action by the General Assembly is needed. Therefore, I respectfully request that you convene a Special Session of the General Assembly under the authority granted to you by Article Ill, Section 5(7) of the North Carolina Constitution. The North Carolina House of Representatives stands ready to take immediate action to resolve this impending problem. If you should decide to convene a Special Session, you have my word that no additional matters will be taken up by the House of Representatives. We will act quickly and decisively to protect the residents of mental health and IDD group homes, and the session will end when that action is concluded. I look forward to your prompt reply. Thank you for your time and attention concerning this very important matter. Sincerely, Thom Tillis   cc: Senator Phil Berger

Crisis in PCS in NC, & How to Address It

From The Arc of North Carolina

Crisis in Personal Care Services in NC, and How to Address It

[ original post ]

Issue:

For thousands of North Carolina citizens with intellectual and developmental disabilities (I/DD), as well as people with mental illness, the Medicaid State plan service "Personal Care" (or PCS) has provided supplemental funding for housing supports in small licensed group homes.

Earlier this year, the General Assembly raised the level of disability needed to receive PCS. Now, individuals must require assistance with three activities of daily living [ADL’s]. This rule applies to both in-home and facility based services, to achieve legally required comparability. Unfortunately, most individuals living in licensed group homes will no longer qualify.

This change could reduce a group home’s budget by up to 30%, creating significant budget shortfalls- yet another hardship for an already struggling community-based option.

Not only does this reduction affect the provider’s ability to provide basic support services, in many cases it could lead to an inability to meet the group home’s debt obligations. Many of these homes were financed using US Dept. of Housing & Urban Development (HUD) funding streams, and a significant number are tied together through HUD approved refinancing methods. If vacancy rates rise due to lack of support services, well over 250 properties could be at risk of failing.

Recommendations:

For most people living in these types of homes, PCS was not their most needed service. Individuals living in these settings most often need support services to allow them to live successfully in communities. For people with I/DD, they are most likely support services that are habilitative and for people with mental illness they would be recovery based support services.

For both populations there are Medicaid options that, if designed correctly, could support people in these settings and other community based options that should not increase the state funds needed to provide these supports. Unfortunately, it is impossible to get these new service definitions designed and approved by the Center for Medicaid Services by December 31- the end date of the current PCS definition.

With this in mind, we would recommend the following course of action.

1. Extend the state funds available to people living in Adult Care Homes to licensed group homes. Thirty-nine million dollars is already set aside for adult care homes during this period of transition. This reserve should be extended to licensed group homes as well. People living in licensed group homes often have more significant disabilities than the individuals in adult care homes and deserve the same protection provided by the funds appropriated for adult care home residents.
2. For people with IDD- Immediately begin the work of creating a specific 1915i option for services[s] that would support individuals living in community settings- both licensed and non-licensed. The 1915i option is a near perfect fit for this type of service. Not only can it provide funding to offset the loss of PCS, it could be designed to offset the state services dollars that are used in group homes and provide another meaningful Medicaid service for people living in other community settings. The match money for these services could come from already appropriated community base state funds. Preliminary estimates by The Arc indicate that a carefully crafted 1915i option could support individuals in these homes and make a significant dent in the waiting list without any additional appropriations from the State.
3. For people with Mental Illness– It is possible that the same type of 1915i option services may make sense for people with Mental Illness. It may be more difficult to craft services definitions that assure cost neutrality, but this option should be explored immediately.

At the same time, the state should review the possibility of creating a recovery-based support service under Medicaid that could be used in non-licensed community settings as well as licensed settings. Since Mental Health services are recovery based, such a service could be created without the use of a 1915i. In both cases, 1915i or state plan service funds already used for community services for people with mental illness could be used for match.

These recommendations are straightforward solutions to what will become a significant crisis if we do not act. While there may be other options, we suggest the above actions because they have to potential to solve the problem short term and create a low cost solution for the long term that is consistent with best practice. If we are able to follow this path we not only stabilize the licensed community based options but create good options for individuals who choose to live in less restrictive settings.