RALEIGH – Thousands of North Carolina residents mostly living in North Carolina adult care homes could lose Medicaid personal assistance services this spring as regulators comply with federal mandates to align service qualifications with people living in their own residences.
Top regulators in North Carolina’s Medicaid office told a legislative committee Tuesday as many as 4,000 people currently covered by Medicaid for personal care services could no longer be eligible for them under a certain program starting May 1. The paid assistance helps people with disabilities, older adults and the mentally ill with things like bathing, dressing and cooking.
State Medicaid leaders told lawmakers the changes are set to take effect April 30. They’re asking the federal government for a delay but they don’t know if they’ll receive it.
N.C. Rep. Nelson Dollar, R-Wake, a co-chairman of the Joint Legislative Oversight Committee for Health and Human Services, said state residents are disturbed the deadline is approaching and plans aren’t in place to house adult care home residents that could be displaced if the homes can’t afford to keep serving them.
“So what we’re potentially faced with after April 30 is literally thousands of citizens – vulnerable, at-risk citizens – that may not have housing in the state of North Carolina,” Dollar said.
Adult-care home operators fear the proposed rules could lead to facilities being closed – and residents looking for new places to live – because the caregivers won’t be reimbursed by Medicaid for the services.
Medicaid, the federal-state government health care plan for mostly poor children, older adults and the disabled, provides about one-third of funding for the adult-care home residents, said Lou Wilson with the North Carolina Association of Long Term Care Facilities, which represent adult-care homes with 16,000 beds. The Medicaid money is spend on hire staff that gives direct care to residents and supervises them, she said.
“There’ll be nobody in a facility to change a diaper, there’ll be nobody in facilities to give medications (and) there’ll be nobody in facilities to supervise folks,” Wilson said, adding that “for our state to go forward with a plan ... that they know is going to put people out of a home, it’s a shame.”
Tara Larson, chief clinical operating officer at the state Division of Medical Assistance, which manages Medicaid, said the state doesn’t yet have all the alternative housing needed for adult care home residents who no longer qualify for the Medicaid-paid personal care services.
“We do not have a place identified for every individual living in an adult care home for an alternative placement,” Lawson told the oversight committee.
The Centers for Medicare & Medicaid Services and advocates for people who are disabled have been pressing the Division of Medical Assistance for years to set the same eligibility standards for all 46,000 recipients of personal care services so as to comply with federal law and court rulings. The program is expected to cost $414 million for the fiscal year ending June 30.
Residents in adult care homes historically have had to meet less stringent eligibility requirements to qualify for Medicaid help. They’ve needed to show trouble performing at least one “activity of daily living,” such as dressing, eating and going to the bathroom. But people living at home and wanting an outside aide to help them needed to show trouble with two activities. That differentiation, according to patient advocate group Disability Rights North Carolina, has created a bias toward residents in institutional care and away from independent living.
Under the streamlined rules, some adult care home residents will fall below the need requirements. Al Delia, acting director of the Department of Health and Human Services, said in an interview late Tuesday an undetermined portion of the 4,000 residents that could lose the services may qualify under another Medicaid program for people with development disabilities.
The Department of Health and Human Services began a new personal care services policy following the passage of a 2010 law, but Disability Rights North Carolina sued Delia’s predecessor on behalf of the consumers who had been denied coverage under the new policy. A federal judge in December blocked the new policy from being carried out, but a federal appeals court last week placed a stay on the lower court’s injunction. The department is now preparing to carry out a largely similar policy, Delia said.
Adult-care home operators said they’re also worried about new living standards they would have to provide residents because they say it could harm patient safety. The proposed standards would include letting residents have visitors any time and 24-hour access to appliances. Larson said the adult-care home still could restrict disruptive activities.
Ed Weeks, owner and administrator of Eastover Garden Special Care, which offers about 125 adult care and Alzheimer’s patient beds in Cumberland County, said it’s difficult to prepare for the uncertainty.
“I feel like we’ve been operating under the rules and the regulations, and we’ve been providing housing, jobs, paying our taxes, paying our payroll,” Weeks said. “I feel like those same rules are what’s going to shut us down.”