Elderly and disabled at risk of being pushed out of adult care homes

I had the opportunity to meet about a dozen elderly and disabled residents of Danby House in southwest Winston-Salem yesterday. One of the residents, 55-year-old Terry Cochrain, worked in construction for 30 years before becoming disabled, requiring him to take an array of medications to treat high blood pressure. Medicaid benefits help him pay for services at the adult care home. He’s one of 20,300 North Carolinians who receive personal care services in adult care homes through Medicaid, according to the NC Department of Health and Human Services.

Cochrain told me if he were to lose his Medicaid benefits, he would end up on the street and sleeping under a bridge. He said he would probably be dead within six months.

The bureaucratic backdrop for this unfolding catastrophe is that the NC Department of Health and Human Services, or DHHS, has been in negotiation with the federal Centers for Medicare and Medicaid Services, the federal agency that administers those programs to bring the state’s Medicaid personal care services program into compliance with federal mandates. These Medicaid payments pay for help with activities of daily living, including eating, dressing, bathing, toileting and walking.

The federal government is on the state’s case to create uniformity in eligibility requirements, billing rates and scope of services between people who receive Medicaid-funded personal care services in adult care homes and those who live in independent settings. The state is pursuing a waiver known as 1915i under the Affordable Care Act (AKA Obamacare) as the best means to bring its program into compliance with the federal guidelines.

DHHS leaders appeared before state lawmakers in the Legislative Oversight Committee on Health and Human Services yesterday morning to answer questions. Before the committee convened, DHHS and the feds had reached an agreement to push back the deadline for compliance from April 30 to Dec. 31.

Brad Deen, a spokesman for the DHHS, described the situation as “enormously complicated and not easy to explain.”

Sen. Pete Brunstetter, a senior budget writer from Forsyth County, told me he probably won’t comment on a possible funding gap because “this is complicated stuff” and lawmakers still don’t have all the information they need.

The sideshow in this matter is North Carolina's divided government. DHHS under Democratic Gov. Beverly Perdue is responsible for administering the program; the General Assembly under the control of the Republican leadership is responsible for the state budget. Both sides will have ample opportunity to cast blame.

The nut of the current morass can be found in a set of talking points prepared for acting Secretary Albert Delia’s presentation to the General Assembly on Wednesday:

“The agreement does not… change the fact that 1915i implementation will come with eligibility criteria that will not cover a relatively small number of current residents. (This will be difficult and hard to manage process [sic] with a number of potential unintended consequences.)”

More to the point, “3,700 to 4,000 recipients may not meet the 1915i eligibility criteria.”

For what it’s worth, the talking points characterize the state’s compliance plan as avoiding a “disaster” scenario; they hopefully offer that the extended deadline gives DHHS time to “assess the 20,000 residents currently living in [adult care homes]” and “address housing issues/capacity.”

I’m not done with my reporting yet, but until someone can tell me what I’m missing here, this doesn’t seem that complicated.