NC judge orders community services for more people with disabilities. The state objects, saying the deadlines are unrealistic.

Thousands of people with disabilities would receive services to help keep them out of institutions, and a waiting list of more than 16,000 North Carolinians needing direct care would be whittled to zero over 10 years under a sweeping court order issued this week.

Superior Court Judge Allen Baddour’s order follows his 2020 decision that the state is breaking the law by failing to provide needed services that would enable people with intellectual and developmental disabilities to live outside institutions. The order is part of the “Samantha R.” lawsuit Disability Rights NC filed in 2017 on behalf of people who were institutionalized or faced institutionalization.

“It’s a very big deal,” said Tim Rhoney, Samantha’s father.

Samantha R. is Samantha Rhoney, 33, whose parents admitted her to the state’s J. Iverson Riddle Developmental Center in Morganton under duress after the regional mental health agency cut back the in-home services she received. After seven years in the Riddle Center, she has now has her own place and 24-hour assistance.

“Our hope was, even though this happened to my daughter, Samantha, and she suffered, that it would help other people,” Tim Rhoney said. “Their time’s up. They’re going to have to help these people.”

The court order means people with disabilities can live to their full potential, said Samantha’s mother Dana Rhoney. The Riddle Center is wonderful, she said, and her daughter attends a day program there. But she should not be forced to live there.

“The Institute is a wonderful place,” and a great resource for people who need it, she said. “There are some individuals due to their disabilities that this is the appropriate placement. There are those like my daughter who can thrive in the community, and they need extra support. That’s the point. Don’t limit their lives because they have to have some special care for them to function in the community.”

The order sets timetables for moving people out of institutions and actions the state must take to keep people from entering them. The order includes annual benchmarks, with 25% of the yearly requirement to be met by transitioning people from institutions and into community settings. The other 75% of the requirement would be people successfully kept from being admitted.

“It means that they should have a real option to make an informed decision to be served in the community,” said Lisa Grafstein, a lawyer with Disability Rights NC.

No one would be forced to leave a place where they wanted to stay, she said. “The idea is to create community services that have not existed in the past.” she said.

The state must also cut the list of people waiting for services under the Innovations Waiver, a source of Medicaid money for community-based care, from more than 16,000 people to zero by July 1, 2032.

The order may not be the last word. The state Department of Health and Human Services disagrees with it.

The state is reviewing the order, said Dave Richard, deputy secretary for NC Medicaid at the state Department of Health and Human Services. The agency hasn’t decided whether to appeal.

“Right now, we’re considering whether appeal is the right answer,” he said. “We do have objections to the order as it exists today.”

Richard told reporters Wednesday that the state is committed to providing community services, but Baddour’s order does not reflect the complexities of doing it. The directive that the state stop admitting people to institutions after Jan. 1, 2028, would force hundreds of small group homes that serve six people or fewer to close, Richard said.

Baddour’s order says that it does not require any institutions to close, but Richard said that would be the result if new admissions aren’t allowed.

“If you wind up saying to folks that you can’t have any admissions, then you actually do wind up closing those facilities, which then impacts the choice” of people who live in those homes, he said.

Late last year, DHHS published a document called the Olmstead Plan to provide people with disabilities services in community settings.

Richard said the state’s plan is the best way to achieve its community services goal.

In his order, Baddour said DHHS hasn’t followed the recommendations in its own plan. The agency didn’t provide an action plan with “specific and measurable goals,” the order says.

The Innovations Waiver is administered through regional mental health agencies, called Local Management Entities/Managed Care Organizations. These agencies are responsible for maintaining networks of community service providers. A shortage of direct-care workers means that even some people who are approved for services don’t get them.

Baddour wants DHHS to come up with data on services that are approved this year but not delivered because of staff shortages. Lawyers for the two sides are then to meet to see if the information can be used to develop a plan for increasing staff. Another court order with specific and measurable goals for expanding staff will follow.

Grafstein said the order can spur investment in human services and create thousands of jobs throughout the state, including in rural communities.

“There is a big gap where we want to be and where we are right now,” she said. “We have to build out a human services infrastructure.” Direct care workers need to be paid more and treated like professionals, she said.

With the shortages of direct care workers, developing provider networks is difficult, Richard said.

“We are working very hard on plans to develop a network,” he said. “It doesn’t come out of thin air. Again, the first thing we know is we have to have increased rates to be able to do that. We appreciate the work we do collaboratively with the General Assembly and frankly, the advocates and providers across the state to raise those rates in the past year. Is it enough? Of course it’s not enough.”

The state’s Olmstead plan has a plan to work on building the workforce, he said.

“We believe it has to be something we all work together on, and that artificial timelines don’t automatically move that forward and may very well create a different kind of crisis,” Richard said.

DHHS is under a similar federal order to move people with mental illnesses out of institutions and keep them from being institutionalized in the first place by providing adequate community mental health care.

DHHS has had trouble meeting the goals set out in that 2012 settlement. The court order set out an eight-year timetable.  A federal judge gave the state two extra years to comply with the agreement, Policy Watch has reported.

Grafstein said the strategies used to move people with mental illnesses from hospitals and adult care homes could be applied to people with disabilities as the state meets the requirements of the new state court order.

“Lessons can be learned and applied here,” she said.