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Direct services prohibited by Centers for Medicare & Medicaid Services
mahoning valley
YOUNGSTOWN
Sheltered workshops eventually will be removed from the boards of developmental disabilities in Mahoning, Columbiana and Trumbull counties and throughout the state.
“It’s coming. It’s just a matter of time,” said Ed Stark, superintendent of the Trumbull County Board of Developmental Disabilities.
“If a county BDD provides case management and direct services, such as does Mahoning County with its sheltered workshops, we will have to move away from one or the other,” said William Whitacre, superintendent of the Mahoning County Board of Developmental Disabilities.
“We give clients great choices. ... Their lives are full. It’s hard for them and their parents to understand that things are changing,” said William Devon, Columbiana County Board of Developmental Disabilities superintendent.
A sheltered workshop is a workplace that provides physically or mentally challenged people an opportunity to acquire job skills and vocational experience.
The unsettling change is being driven by several forces, officials said.
In March 2014, the Centers for Medicare & Medicaid Services, or CMS, rolled out a new rule that says federal Medicaid funds no longer can be used to pay for waiver services in facilities that offer both case-management and direct services.
The CMS believes such an arrangement is a potential conflict of interest and is concerned that a workshop may result in isolating individuals, said Kerry Francis, spokeswoman for the Ohio Department of Developmental Disabilities.
Medicaid waivers fund long-term care services in home- and community-based settings with the county and federal government each paying a portion.
Mahoning County BDD has more than 800 clients on Medicaid waivers; Columbiana County BDD, 297; and Trumbull County BDD, 300.
“We need to comply. We can’t put those people’s services at risk,” Whitacre said.
While the CMS rule is the big gorilla in the room, Francis said some county BDDs with multiple facilities have made the business decision to close one or more of their locations due to decreasing demand for this service.
Lastly, Francis said, the activist group Disability Rights Ohio believes Ohio is violating the Americans with Disabilities Act and has threatened to sue, saying the state’s system for providing clients with services “favors segregation and institutional placement.”
Francis said the DODD this month plans to submit a transition plan to CMS that includes a proposal to ensure all individuals are receiving waiver services in compliant settings by 2024.
A major part of the problem at the local level, Whitacre said, is that boards are in a holding pattern.
“We don’t know the true time frame, which makes it difficult to make plans and projections,” Whitacre said.
Even with the time uncertainty, Whitacre said in the back of his mind he is thinking about the best way of preparing clients and parents and staff for the change.
“This impacts people’s lives. Clients may have been coming here for 15 to 20 years,” he said.
Whitacre said the changes do not affect the Leonard Kirtz School in Austintown because it is not a Medicaid-waiver service.
“Eventually, we may have to cut staff. We know the potential. The timing and how it all plays out, those are the unknowns,” he said.
Devon said the Clients Bill of Rights gives them free choice of providers, and he believes forcing the county BDDs out of the services business takes one of their choices away.
“Competition has made county boards more proactive. I don’t mind the competition, I just don’t like being taken out as an option,” he said.
Stark said it’s “on us” to prepare clients and their families for the change and to make sure their choices for services are a good fit.
He said the Ohio Superintendents of County Boards of Developmental Disabilities Association is lobbying the DODD to assign county boards as overseers of the private agencies that take over providing services.
Devon said his biggest hope is the integrity and quality county boards have developed not be lost, and that clients have the same or better quality as before the change.
“I will do what I have to do, given what the state and federal governments say, but I will make it as easy as possible on the clients. It all comes down to heart and ability now,” Devon said.