Medicaid funding for disabled on chopping block

Virginia's budget-setting season is always a nail-biting time for people like Barbara Kimble.

Will there be enough money to help her and her husband care for their 25-year-old mentally disabled son at their Chesapeake home, or will they have to wait another year - or two, or three?

This year, the news was about as bad as it has ever been. Not only is there no additional funding for the Medicaid waiver program that helps families keep disabled or elderly relatives at home instead of at institutions, but there's a one-year freeze on the existing waivers.

That means even if someone already in the program dies, drops out or moves out of state, the money for that slot can't be used for someone on the waiting list.

"People will be institutionalized who never, ever would have considered it," said Maureen Hollowell, director of advocacy and services at The Endependence Center in Norfolk, which helps the disabled. "There will be no option for them."

Medicaid is a shared federal and state insurance program that insures low-income families and the disabled. People with disabilities use Medicaid dollars to pay for care in state facilities, private long-term care centers or nursing homes. The Medicaid waiver program was created in 1991 to shift people from institutional care to home care, which is generally less expensive. The money pays for personal aides, respite care and other services.

One waiver is used for people with mental disabilities. That's the waiting list Kimble's son, Michael Ward, is on, along with 5,000 other Virginians, more than half of whom are considered in urgent need of help. Ward has been on the list since he finished public school in 2006.

Another waiver for people with developmental disabilities like autism has about 870 Virginians on the waiting list. There's also a waiver that helps elderly people and those with Alzheimer's disease stay at home rather than move into nursing homes. In the past, there hasn't been much of a waiting list for that waiver, but a freeze would mean a year long gap in new people getting home-based services under the program.

The proposed budget also calls for cuts for people who already have one of the waivers, such as a reduction in the amount paid to personal care assistants and fewer respite care hours for parents and caregivers.

Samantha Gregg-Montella of Virginia Beach has a waiver to care for her 12-year-old son, David. He has autism, cerebral palsy and a seizure disorder. State budget cuts would reduce the amount paid to personal care assistants for David. Already, it's difficult to keep the aides because the pay is low.

Cuts would also reduce the number of respite hours for families to have some time away from their disabled relatives. Gregg-Montella and her husband have three other children, 16, 14 and 8: "There are times you need the one-on-one time with your other children."

The budget reductions are doubly difficult for Norfolk resident Julia Newton, who has a 26-year-old son on the waiting list for a waiver for the mentally disabled. Newton also works as a personal care assistant for others who already have the waiver.

Her pay will be cut by 5 percent under the proposed budget cuts, and she also worries the drop in respite care hours will result in less work for her.

Meanwhile, she waits for her son's turn at a waiver for the mentally disabled to come up.

"I feel like I'm going from being a taxpayer to a tax burden," she said.

Proposed budget cuts also call for closing Commonwealth Center for Children in Staunton and two units of the Southwestern Virginia Mental Health Institute in Marion.

Spared from this year's budget cuts is the Southeastern Virginia Training Center in Chesapeake. In December 2008, former Gov. Timothy M. Kaine proposed closing that state facility, which cares for people with severe mental disabilities.

However, there was an outcry from families of residents, and instead, legislators provided $23 million to build a down sized 75-bed facility and $8.4 million in housing for the disabled throughout Hampton Roads.

Contracts were awarded last month for those facilities, which are scheduled to be finished in 2011.

The Arc of Virginia, however, has protested rebuilding the Southeastern Virginia Training Center. The Richmond-based organization, which advocates for the mentally disabled, has sent a letter to Gov. Bob McDonnell asking that money be reallocated for disabled people living in family and community homes, particularly in light of this year's budget cuts.

"The proposed cuts are devastating to the system. They erase years of work by advocates and the General Assembly," said Jamie Liban, executive director of The Arc of Virginia. "The one-year freeze for enrollment reverts to a policy of institutionalization."

Elizabeth Simpson, (757)446-2635, elizabeth.simpson@pilotonline.com