DHHS advocate fears crisis among adults who need care

Posted April 20, 2012, at 7:19 p.m.

AUGUSTA, Maine — A state advocate is warning that overspending by the Department of Health and Human Services is leaving people with intellectual disabilities no place to turn in a crisis.

A DHHS account that pays for residential services for adults with intellectual disabilities and autism is projected to run into the red by $4.3 million this quarter. More than 600 people covered by the state’s Medicaid program are already on a waiting list for those services.

Without resources to take those recipients off the waiting list and place them into assisted living or other support facilities, the state is leaving people with intellectual disabilities in the lurch, said Richard Estabrook, head of DHHS’ office of advocacy.

In the most dire cases, such as those involving a risk of violence or neglect, wait-listed residents are sent temporarily to crisis facilities. But only a handful of crisis beds are available across the state, sometimes located hundreds of miles from the resident’s community, Estabrook said.

“Many families now are struggling to provide services to their loved ones,” he said. “A certain number cannot do it. What has happened is those people then go to the crisis service beds and fill those up. So what has happened is, particularly now in the southern part of the state, there are no beds left for people to move into.”

As of Friday, two crisis beds were open in Caribou and one bed each in Bangor, Monmouth and Gray, according to DHHS. The daily count fluctuates as people move in and out of temporary crisis services.

“There are crisis beds available and there are crisis staff available,” said Ricker Hamilton, acting director of the department’s office of adult cognitive and physical disability services.

Crisis services will continue as his office works to get a handle on the overspending and better assess consumers’ needs, he said.

The $4.3 million in red ink projected by the end of June is in an account that has been historically overspent, he said. In 2010, the account was overdrawn to the tune of $3.4 million, Hamilton said.

More wait-listed residents may have been set up with services than the account could pay for, he said.

His office is reassessing that spending and reviewing a waiting list to ensure that recipients are matched with the appropriate services, he said.

“We want to find out exactly what the number is and what the needs are of the people we serve,” Hamilton said.

Another $6.4 million was transferred out of the account as part of the Legislature’s efforts to close a $120 million shortfall within DHHS this fiscal year, Hamilton said. The transfer was temporary and those funds will be shifted back, he said. Details were unavailable Friday about when the money was transferred and to which specific accounts.

Residents with intellectual disabilities and autism who already are receiving housing will continue to receive those services, Hamilton said.

No federal matching funds will be lost as a result of the overspent account, he said.

Only the neediest residents come off the waiting list and are set up with permanent housing. In 2011, 84 adults with intellectual disabilities and autism began receiving residential services. So far in 2012, two have come off the waiting list, both in January, according to DHHS.

For the first time since the waiting list began in 2008, the department earlier this year directed that no one come off the list for the indefinite future, Estabrook said. He cited a March 26 email from program manager Karen Mason to a regional manager who had inquired about crisis situations.

The one-sentence email reads: “For the foreseeable future there are no funds available to place anyone on to Section 21 services.”

Residential and other services are provided under Section 21 of the MaineCare benefits manual.

“It is a mathematical certainty that a certain number of those individuals who are on the wait list either will not have families at all or will not have families capable of providing the intense, really nursing home-level care, that these individuals have been determined to need,” Estabrook said.

Estabrook is slated to lose his job in July with the elimination of the office of advocacy, an independent division within DHHS. A bill to restructure the department will outsource advocacy services to the Disability Rights Center.

Hamilton said no one came off the waiting list in March, but two people were identified this week to be removed from the list and connected with services. The goal over the next four to six weeks is to remove two more each week, he said.

His office is reviewing the waiting list to ensure that adults with intellectual disabilities and autism are appropriately prioritized, he said.

“That really is our daily focus,” Hamilton said. “The first thing I think about when I come in the office each morning is that wait list.”

The DHHS restructuring will steer administrative firepower from vacant positions toward quality assurance staff tasked with improving care plans for people with intellectual disabilities and autism, he said. That could lead to cost efficiencies, Hamilton said.

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