Virginia will have to cut programs that help intellectually disabled people live independently

From The News-Leader in Staunton, Va.

Community-based programs that help people with intellectual disabilities live independently rely on Medicaid funding, but for the past decade, the rates have remained stagnant at best, while costs have soared.

With a proposed 5 percent funding cut looming, service providers face even more difficulty helping their clients live in their communities.

In-home services pay for an agency or community services board employee to help a disabled person with a variety of daily living tasks, such as cooking, budgeting and laundry. In-home workers also drive clients to medical and dental appointments, the grocery store or on social outings.

The waiver program depends on funds from state and local mental health agencies and Medicaid — the joint federal-state health insurance system for the poor and disabled. The rate set by the state to pay for in-home service has remained at $18.86 per hour for 10 years.

“That sounds like a lot of money, but you also have to factor in benefits and mileage,” said Jim Hall, Waynesboro branch director for DePaul Community Resources. “Including benefits, you end up paying around $14 or $15 per hour.”

Rising insurance rates and cost-of-living expenses eat into what’s left and then some, making the service a money loser for many agencies. Agencies also have to give employees time to fill out paperwork and complete documentation — time that the agency can’t bill the state, said Hall, who at one time considered offering it.

“It’s not a cost-efficient program for an organization to run,” he said. “The way to make it work is to hire part-timers, but I’ve always had difficulty keeping them because they need more hours or benefits.”

As a result, the few agencies in Staunton, Waynesboro and Augusta County that have offered it in the past no longer do.

Worse, advocates and families are bracing for a 5 percent cut across community-based services, including in-home services, set to take effect in July.

Residents in Staunton, Waynesboro and Augusta County can get the service through Valley Community Services Board or Creative Family Solutions, a Christiansburg-based agency.

Creative Family Solutions specializes in providing in-home services throughout the state, including the Central Valley. It makes the low reimbursement rates work by actively recruiting part-time employees who get benefits from another full-time job or through a spouse, said agency director Scott Worley.

“Many have jobs with other companies,” he said. “We get, a lot of times, people from DSS (Department of Social Services) and (community service boards). Sometimes we’ll hear that a teacher from the individual’s school system did a great job with that person, so we’ll go to the school and try to recruit them.”

VCSB is the local organization through which intellectually disabled residents apply for Medicaid waiver and, once approved, are connected with services. It has one full-time and eight part-time employees who provide in-home services.

For the time being, VCSB doesn’t have a waiting list for people seeking in-home services, said Kathy Kristiansen, director of client services. It receives about one request a month for the service, she said.

“We’re hoping to grow a little bit in the in-home area,” said Karen Belcher, who leads one of four support teams at VCSB for people with intellectual disabilities, mental illness or both. “We are looking at increasing it so that if we get new referrals, we can take them.”

Belcher added that VCSB might look at identifying people in sponsored placement — an adult foster-care program — who might be able to live on their own with support from in-home services.

“We have quite a few individuals already who are living in their own apartments and receive this service,” she said. “Something else we could look at in the coming years is getting people in sponsored placement into an independent living situation with in-home services.”

Advocates say many people now living in group homes, which typically house four to six people, have the potential to live alone or with one roommate if they could get in-home services. But the service will continue to dwindle if it isn’t adequately funded.

“Anytime you have a group situation, it creates some restrictions,” said Christy Collins, who owns and operates CC & Associates with her husband. The agency no longer offers in-home in the Staunton-area because the costs of operating the program have outpaced the reimbursement rate. “In a group-home situation, there have to be some house rules.

“In-home is the least restrictive service,” said Collins, who worked as a advocate for 10 years before starting CC & Associates. “It is what allows the most independence for people.”