Virginia faces $2B in overhaul cost for health care for disabled

RICHMOND

The cost of bringing Virginia's care for the developmentally disabled into compliance with federal laws could be steep, state lawmakers learned Wednesday.

The state's health and human resources secretary, Dr. Bill Hazel, told the House Appropriations Committee that it would take $80 million to $90 million to address the most critical, immediate issues involving Virginia's mentally disabled citizens. Those include problems identified in a recent U.S. Justice Department report on residents in state facilities such as Southeastern Virginia Training Center in Chesapeake.

It would cost more than $2 billion over 10 years to eliminate the backlog of Virginians on waiting lists for Medicaid waivers allowing them to receive care in their communities, according to a 2009 state report. One lawmaker called th e cost figures "staggering."

Current waiting lists have more than 6,600 people, including those with intellectual and developmental disabilities. Training center residents are in the category of those with intellectual disabilit ies, state officials said.

To help with the transition from institutional to community care, Gov. Bob McDonnell has proposed legislation that would allow the General Assembly to contribute money to a trust fund dedicated to behavioral health and developmental services.

It is also sends a message to lawmakers - and the Justice Department, which could take legal action if the state doesn't address its findings - that the federal report is being taken seriously.

Hazel's deputy, Keith Hare, said the administration is hopeful that the select group of lawmakers who negotiate the budget will invest in the fund to build on the $30 million down payment McDonnell proposed in the budget for improvements to the state mental health system.

McDonnell's legislation also directs Hazel to develop a plan to move training center residents with intellectual disabilities out of institutional settings. Versions of the bill are being carried by House Majority Leader Kirk Cox, R-Colonial Heights, and Sen. Ralph Northam, D-Norfolk.

The Justice Department report, released last week, concluded that the state had violated the civil rights of training center residents by keeping them in institutions instead of moving them into community-care settings.

It was the culmination of an investigation that began in 2008 to determine whether the state had violated the Americans with Disabilities Act in regard to residents at Lynchburg's Central Virginia Training Center. That investigation later expanded to include all the state training centers, including the one in Chesapeake.

McDonnell's budget proposal includes funds for crisis stabilization and to cover 275 additional Medicaid waiver slots to subsidize community-based care as an alternative to institutions.

The report said the state needs to more quickly move people out of institutional settings and needs more waivers.

Despite those critiques, Hazel said it's "premature" to speculate about whether the state ultimately will shutter the training centers.

Yet at least one lawmaker believes that's what the Justice Department wants.

"They want to shut down our training centers," said Sen. Steve Newman, R-Lynchburg, who delivered an impassioned floor speech on the subject Wednesday afternoon. "It upsets me that they are not being up front about that."

Training center populations have dwindled from 5,500 residents to about 1,100, according to state figures.

Newman maintains that the training centers remain the best place to care for the most challenging patients.

His fear is that the current move toward community-based care will be reversed back to an institutional approach in the future, after patients already have been displaced.

Lawmakers will weigh how much to put in the fund as they finalize the state budget over the next 10 days. Cox said some are contemplating adding $30 million as an initial investment.

Calling the costs estimates detailed by Hazel "staggering," Cox said, "Maybe it will give us an impetus to get this done."

Ultimately, "the federal government is going to tell us what the dollar amount is going to be," said Del. Clarence Phillips, D-Dickenson County. "And then we've got to figure out where that money's going to come from."

Bill Sizemore, (804) 697-1560, bill.sizemore@pilotonline.com

Julian Walker, (804) 697-1564, julian.walker@pilotonline.com