Feds want eligible people with mental-health challenges moved out of adult-care homes
Posted: Saturday, October 11, 2014 9:02 pm
Richard Craver/Winston-Salem Journal
North Carolina appears to be making slower progress than other states in complying with a federal requirement to move eligible residents with mental-health challenges from adult-care homes to independent housing.
The initiative is the latest development in the Olmstead legal case, which involves the U.S. Justice Department and the integration aspect of the Americans With Disabilities Act.That aspect is intended to provide individuals with disabilities the opportunity to live their lives like those without disabilities. North Carolina and Justice officials reached an agreement in August 2011 on allegations North Carolina was violating the act. The transition initiative was a key part of the settlement.
Eligible to participate are people living in adult-care homes with a diagnosis of serious and persistent mental illness, or those who have been in treatment for more than 90 days at a state hospital.
Federal officials have reached similar settlements in Ohio and Virginia, two of three states whose Medicaid directors made presentations Monday to a N.C. legislative subcommittee about their reform efforts. The third state, Florida, remains in litigation with the federal agencies.
Nine managed-care organizations (MCOs) in North Carolina, including CenterPoint Human Services, have until 2021 to move about 3,000 individuals. CenterPoint oversees behavioral health services in Davie, Forsyth, Rockingham and Stokes counties.
The transition initiative began in the spring of 2013. The MCOs are responsible for arranging care coordination; suitable safe housing with developers and realty companies, including a rental subsidy; and services for individuals, including moving expenses. Each person receives $2,000 in transition costs.
The N.C. Department of Health and Human Services said Tuesday that 317 individuals statewide have been placed in home or community housing settings, or just more than 10 percent.
That includes 33 individuals in CenterPoint’s area, ranking it fifth among the nine MCOs. There are another 193 in the transition process, including two in CenterPoint, ranking it last. CenterPoint is required to move at least three individuals a month.
“Each individual, and thus each case, is unique, which makes it challenging to make for a smooth transition and still meet the mandate,” Dr. Chad Stephens, CenterPoint’s medical director, said in June.
DHHS spokesman Kevin Howell said the statewide transition total is 273 as of Oct. 1. He said 21 individuals have moved into a more restrictive level of care, 13 moved in with family, moved out of state or into another independent living arrangement, seven have died and three are in a state hospital.
By comparison, Ohio surpassed this summer the 5,000 mark of transitioned individuals through the Home Choice initiative launched in 2008. The initial goal was transferring 2,000. In 2013, Ohio had the nation’s second highest number of transitioned individuals, as well as the highest number of those with mental health issues.
Virginia is obligated to move about 4,170 individuals, according to a federal report update in April. The total number of transitioned individuals was not available. Most individuals are those with intellectual and non-intellectual disabilities.
John McCarthy, Ohio’s Medicaid director, said the state’s spending for affected individuals is at 51 percent for home and community based settings and 49 percent for institutional settings. He said the initiative is an example of where “the money follows the person.”
“The reason this took off is that we hired a housing coordinator, and so did mental health,” McCarthy said. “They had lived in nursing homes because they had no other place to go. They now qualify for vouchers for rents and other costs.”
The independent auditor for the Virginia initiatives said the state “has achieved compliance with many provisions of the agreement.” That includes creating and distributing more than the minimum required number of waiver slots, and placing at least 310 individuals in community housing settings as of April.
“Despite these efforts, the Commonwealth is significantly behind schedule with repeated delays in complying with certain obligations,” the auditor said. “It is essential the Commonwealth redouble its efforts and expedite its plans to meet its commitments.”
Virginia Gov. Terry McAuliffe has made creating behavioral health homes for people with serious mental illness a top health-care priority for his administration.
“Our goal has been to move more people into community setting and not let them in the nursing home in the first place with preadmission screening,” said Cindi Jones, Virginia’s Medicaid director.
A CenterPoint human-rights committee submitted a letter to N.C. DHHS officials in January that sought assistance in helping it get relief from the federal mandate. CenterPoint Chairman Bryan Thompson said last week the agency’s human right committee met with state health officials on the issue
“We got a full on presentation from DHHS that provided alternatives and resolved the issues,” Thompson said.
Vicki Smith, executive director of Disability Rights N.C., said it appears CenterPoint wants DHHS “to draw a line and say, ‘These people are too fragile. Don’t bother with them.’ ”
“We know (the MCOs) had a slow start. We expect that they will hit their targets this year.”