Action taken last Thursday to help six people with developmental disabilities continue to live at home could be only the beginning of budget chaos that will be caused by state cutbacks in Medicaid, county officials warned.
The Johnson County Commission scooped up the people in an improvised safety net to prevent them losing their home services just a day before their care provider, Cornerstone Supports, closed its doors Friday ].
But while commissioners unanimously approved emergency funding, they also warned that it is a short-term fix. Changes in state funding could cause more providers to close and leave more people without the help they need, they said.
“I’m afraid this may be the first example of more of these to come,” said Chad VonAhnen, head of the county developmental supports department. “Our system is really stressed and coming to the breaking point.”
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Some commissioners expressed frustration with the state, particularly for a $56 million cut to KanCare (formerly Medicaid) and policy changes that have reduced supports, making it tough for independent caregivers to survive financially.
A few independent care givers were also on hand at the commission meeting, expressing similar frustration with the county for not giving them financial aid in the form of direct tax money.
Ultimately the commission okayed six new staff positions and will send a letter to the statehouse delegation outlining their concerns. The problem is one more example, of the state passing its budget problems on to Johnson County taxpayers, several commissioners said.
VonAhnen described the closing of Cornerstone as a “crisis situation” that began around a month ago, when its closing was announced, meaning sixteen people getting home care would have to find a new provider.
People with disabilities can get a range of home care to help them avoid being institutionalized. The type of care varies widely, depending on the severity of the disability. The most independent residents, who are able to have jobs, may need a daily visit for help with such things as laundry, shopping or cooking. But there are some who need more intensive, round-the-clock care.
The county was able to help find replacement care from other providers for most of the Cornerstone clients. But it was difficult as most independent care providers were reluctant to take on more clients because of their own financial uncertainty.
The county contacted 27 providers of residential services but 17 of them said low state reimbursement rates and inability to find staff to work for the low pay stopped them from adding clients.
By Thursday six were left in need of home care. Most of them needed either continuous or daily support.
The commission approved a plan to expand the county developmental supports budget by $44,000 for the rest of this year and $292,000 next year so that six new employees can be hired. That won’t result in new spending, though.
Medicaid is expected to pay for all but $2,300 this year and $46,000 next year. The developmental supports department will pay the difference out of its $3 million reserve fund.
Vickie Vermillion, the Olathe owner of Cornerstone, said the changes in the state system and a continued low reimbursement rate was what finally did her in. Constant changes from the state have left many care givers uncertain from one month to the next about what kind of care they can give, she said.
“Everybody’s afraid to grow,” she said. “They’re afraid to accept new people because they don’t know what’s coming.”
Cornerstone provided care for people in eight homes and apartments. Vermillion said she got started years ago as a way to help her daughter, now 41, who has a progressive neuromuscular disease. She opened Cornerstone in 2013, but was for years before that the first independent parent case manager in the state, she said.
The change in care could fall hard on the residents also, because they will have to pay to break their lease, she said. In order to continue their care, the county has moved or will eventually move all six into other homes.
The financial health of the independent affiliates is a concern to the county because the number is dropping. For now, there are 78 providers, compared to 88 five years ago, according to county records.
Several local caregivers made emotional appeals to the commission for help.
As it is now, Johnson County provides non-monetary support to them but not tax money, as Wyandotte County does. The low state reimbursement rate and lack of county money makes it hard to find employees who will work long hours for around $9 an hour and no benefits, they said.
“We give you so much more as affiliates,” said Meredith Funkhauser of Overland Park. “I would ask you to re-look into sharing that...money with all the affiliates in the county,” not just county developmental supports.
Marilyn Kubler of Shawnee, a care provider whose daughter has Down’s Syndrome, said many affiliates are uncertain how long they can survive on what the state pays. “Frankly, I am so sad and confused and frightened for all the individuals out there right now,” she said. “We’re working our butts off to try to make sure people hear what we have to say. We don’t get paid extra but we work hard because we’re passionate about what we do, we’re passionate about the people we serve. You’ve got to help us step up and make sure the state does what they’re supposed to do.”
Gayle Richardson, chair of the county developmental supports governing board, said that as a parent of a disabled adult who has received services from both independent affiliates and the county, “I share your pain.” But there are few options, she said.
“Our local community should not have to supply what the state refuses to do,” but there was nowhere else to turn but to the county, she added.
The letter the commission will send to the statehouse delegation expresses a sense of outrage at a recent opinion piece in the Wichitheta Eagle penned by Tim Keck, acting secretary of the Kansas Department of Aging and Disability Services. The article, which appeared Oct. 24, said the state safety net is “strong and improving.”
The county letter countered with examples of cuts to Medicaid and the Osawatomie State Hospital.
Commissioners also noted at the meeting that Medicaid reimbursement rates haven’t increased since 2008. But they debated whether the county should enable the state’s policies by taking up the slack in services.
Commission Chairman Ed Eilert described an “elephant in the room,” on the state decision to drastically reduce income taxes, which resulted in less revenues and budget cuts. “They might say we don’t have the money, but the reason they don’t have the money is because they created a situation where they don’t have the money,” Eilert said. That decision “is going to probably end up costing local taxpayers more and more.”
Commissioner Steve Klika mentioned the impending property tax lid as another problem that could limit the county’s ability to deal with the issue. He urged the advocates at the meeting to continue talking to state leaders.
Commissioner John Toplikar voted for the emergency funding, but did not join in the statehouse bashing. The county could ask voters for money to address the problem as it has on the courthouse, he said. “We don’t need to sit here and blame everything on the state,” he said.
But Eilert countered, “If it’s a state program, the state needs to step up and fund it.”