NAMI North Carolina's
Heard in the Halls
April 27,  2012

Adult Care Homes

Personal Care

April 27,  2012
Edition 39


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This issue will update you on the latest developments with our state's problems with adult care homes, department of justice, and personal care medicaid services.


Debra Dihoff, MA

Executive Director

NAMI North Carolina


What's the latest with Adult Care Homes? 

We all know the problems:  The Department of Justice is investigating to determine if our homes violate the IMD (Institutions for Mental Disease) definitions which would then cause people living in homes with over 16 beds, between the ages of 21 and 64 to lose their medicaid if more than 50% of the residents have mental illness or substance abuse disorders. Assessments have been completed on residents whose billing showed they probably had a mental illness or substance abuse disorder; if more than 50% of the residents have this as their primary diagnosis then the facility falls into the IMD status (which causes the loss of medicaid).  Next step- to do the math and determine which of the homes might be at risk of being an IMD. 


And then there's the problem of personal care, currently funded by medicaid.  Many people living in these homes receive personal care.  Our state has been called out on this issue, because we've had a different standard for eligibility if you live in your own home, vs. a licensed facility, and that is not permissible.  The state has applied for a new federal medicaid program, under the 1915 i waiver provision, to deal with this problem. 


North Carolina has a corrective action plan to deal with these problems.  Here are some of the important dates and findings:


  • as of April l3, 21 of 25 facilities  have been reviewed to determine their risk of qualifying for an IMD.  (currently there are l000 recipients in these 25 homes, 700 of which are under review)
  • 4 are at risk of IMD designation
  • 12 are deferred for further information
  • 2 need an on site review
  • So far, no final determinations have been made; goal is to complete for the first 25 homes by 6/30/2012
  • Goal is to complete IMD determination by July l, 2012 Require IMD attestation to Division of Medical Assistance by September l, 2012
  • Complete housing analysis by 5/30/2012 (inventory)
  • Assess facilities to see if they meet the new home and community standards (i waiver, see below)
  • Complete transitions to alternative living situations by 12/1/2012

What can you do?

If you have a loved one in an adult care home, find out where they are in the process.  Has the facility been determined to be an IMD?  If not, where are they in the process?  Stay informed!







The 1915 i  Waiver
Everyone has heard that there may be about 4000 medicaid patients who could lose personal care services, like help with eating and bathing, because NC needs to make changes so that eligibility and reimbursement rates are the same, whether you live at home, or in a licensed home.  Thankfully, NC got an extension from the original date of April 30 that would have cut medicaid payments.  The i waiver is being designed to help with the potential loss personal care due to federal findings in NC.   Currently 46,000 medicaid recipients receive PC (25,500 of these get pc in home; 20,300 of them in Adult Care Homes; total cost is $414M for 2012).  Around 4000 people may not meet the 1915 i eligibility criteria. 
What exactly is the i waiver?
Most states use their i waiver for innovative programs.  We are moving towards using it for patching together solutions to  a series of errors that have been made in failure to plan for a robust and complete series of housing options for those with disabilities.  While it is good, certainly, to make sure we care for people who are in these facilities, and many of them are receiving good care, we also need to always progress towards more choice, less restrictive options, more homelike options, if that is appropriate for the person. 
The waiver is different from regular medicaid in that you can specify that just certain individuals qualify.  But it must meet home and community based standards, which is a dilemma in applying the i waiver to solving some of the problems within the Adult Care Home facilities. This means that people must live in a home with access to a kitchen, visitors any time they want, they can come and go:  much like if they were to live in their own home.  Many of these adult care homes are not able to provide access to telephones, kitchens, and other homelike characteristics. 
 NC's i waiver defines three target populations:
Physical Disabilities
Mental Illness, IDD, and Cognitive Impairment (l8 and older)
Eligibility must be the same for those who live at home or in licensed homes
Under the new i plan, officials expect to have what is called a "woodworking effect" - more eligible people will come forward to claim these benefits.  The immediate challenge is to plan for those 4000 or so people living in adult care homes, who may lose their personal care services.

What can you do?


1. If you have a loved one in an Adult Care home, stay informed on their IMD status, and their planning for transitions

2. Are you on a CFAC?  If not, no matter!  Advocate with your LME for them to plan for those who may have to move from the IMD and for those who may lose personal care.  Ask for lists, date specific plans.

 3. Advocate for your LME to create more housing and housing support options for these individuals.  They now have the tools, and the ability, under the waiver, to shift their focus to recovery supports (for those who are now officially waiver sites)  They might hire peer support specialists to work individually with people to find more suitable housing.

4. It's election time:  get involved, get registered, and ask questions.  Ask them their stance on funding more housing in North Carolina.

See you at the Walk May 5th, Dix campus!


Deby Dihoff, MA
Executive Director, NAMI NC