Virginia officials are pushing ahead with plans to close most of the state’s residential facilities for people with disabilities, but families, advocates and service providers say that more funding and possibly more time is needed to prepare for the closure of Northern Virginia Training Center next year.
Closing the training centers, which serves residents with disabilities, is a key facet of a state plan crafted for a 2012 settlement agreement with the Department of Justice, which was investigating the state for not complying with federal protections for people with disabilities.
At a public hearing on the state budget last week, groups that sometimes find themselves at odds came together to ask for more support from lawmakers.
They say the rates that Virginia’s Medicaid program pays to service providers are inadequate to meet the needs of people currently receiving around-the-clock care in the training centers.
Maurine Houser, a member of Parents and Associates of the Northern Virginia Training Center and an advocate for keeping the training center open, said her group has met with a number of providers that are willing to expand, but can’t afford to.
“Under the current waiver system, they cannot afford to build in the Northern Virginia area,” she said. “What they have to offer are facilities out of the area.”
As a member of her brother Kim’s support system at the Northern Virginia Training Center, Houser can’t fathom having to move him someplace hours away.
“I see it as their rights being violated when you move them that distance from their primary supports,” she said.
Individuals with disabilities in Virginia become eligible to have certain types of community-based care and services provided, depending on their individual needs, by applying for Medicaid waivers. The funding levels associated with the waivers are capped, as is the number of waivers avaialable.
According to an independent review, Virginia’s funding for residential care providers has remained relatively flat since the 1990s.
A report by a group of Northern Virginia providers asking for Medicaid waiver reform states that Virginia expects to spend less than half of the average $224,225 annual cost to provide residential care in the training centers.
“A service provider cannot be expected to ensure health and safety and accommodate numerous regulatory requirements when Medicaid waiver funding for the same individuals is less than half of what providers receive to service these
individuals while residing at training centers,” the report states. “The individual has the same complex needs.”
Even one of the most vocal opponents of institutions, The Arc of Northern Virginia, is joining with the NVTC parents to ask for higher rates for caregivers and funding for a greater number of Medicaid waivers. The waiting list to receive waiver funding is about 7,500 people statewide.
“It is absolutely our position that, with the right funding and the right supports, anyone … can be effectively supported and living in the communty,” said Arc of Northern Virginia Executive Director Rikki Epstein. “We just have to get adequate support from the state to make that happen.”
She said there needs to be some one-time bridge funding to establish housing and services for the approximately 125 NVTC residents, as well as the larger problem of insufficient waiver funding, which affects many other people with disabilities and their families.
“The waiver process and transformation will ultimately have an effect on everybody,” Epstein said. “There are so many people who are living in the community with their families who are also struggling because it doesn’t always provide the level of funding that is needed.”
Epstein said she believes local providers could, if given adequate funding, still work to meet the state’s 2015 deadline.
However, Houser and other NVTC families believe the deadline should be extended.
“Everybody has said you can’t meet the schedule. Let’s suspend the schedule and tie it to reality,” said Peter Kinzler, also a member of NVTC Parents and Associates.
His son Jason has lived at the training center for 35 years. Kinzler believes that Jason would have less access to activities, services and care living in a community setting than he currently gets at the training center.
“He is more likely to spend time in a house, isolated from others, than he is now,” Kinzler said.
Houser and Kinzler also suggest “right sizing” the training centers to reduce the costs associated with institutional care while still preserving the local slots for families who refuse community placement and maintaining the specialized services available at the training center.
The Northern Virginia Training Center offers specialized therapies, dental care and other services for individuals with disabilities both living at the training center and in the community.
“They need to consider alternatives,” Kinzler said.