North Carolina is violating state laws and the constitutional rights of thousands of citizens with intellectual and developmental disabilities, charges a lawsuit filed in Wake County Superior Court. The state’s programs for disabled people pay excessively for services that deliver inferior care.
Lawyers representing five people and Disability Rights North Carolina on Wednesday filed the suit, naming the state, the Department of Health and Human Services, and DHHS Secretary Mandy Cohen as defendants.
They claim the state is warehousing special-needs people in expensive institutional settings, and systematically denying them essential services, training, and housing that would help keep them in community-based settings closer to families.
Vicki Smith, executive director of Disability Rights North Carolina, said in a news release that North Carolina’s system of care favors institutionalization over community-based services. The state spends about $150,000 on average per year to keep a person in a facility. The average yearly expense of providing services in a community-based setting is less than $60,000.
The lawsuit claims widespread failure by DHHS and its network of Local Management Entity/Managed Care Organizations in serving citizens with intellectual disabilities, formerly called mental retardation, and developmental disabilities, such as cerebral palsy, Down Syndrome, and autism.
North Carolina ranks 48th in the overall effect of state policies and practices on promoting independence for people with I/DD, according to a 2016 national report published by United Cerebral Palsy.
The lawsuit claims the state’s service system illegally promotes segregating or institutionalizing individuals based on disabilities, violating state laws as well as constitutional due process and liberty rights.
Those placed in various institutions used by the state “experience dangerous conditions and discriminatory treatment that result in lasting trauma, injuries, and loss of function, including sexual and physical abuse and neglect, and chemical or physical restraint,” the suit states.
Three types of institutions are used to house I/DD clients. Developmental Disability Centers cost $235,000 per year per resident. Private Intermediate Care Facilities cost $110,000 per year per individual, and the state pays more than $100 million for those in adult care and family care homes, the least appropriate settings for I/DD individuals.
The defendants have failed to hold the LME/MCOs accountable for their statutory and constitutional requirements to help individuals transition from institutions to community-based programs, the lawsuit contends.
The state and LME/MCOs use state and federal Medicaid money and direct state allocations to fund the services.
The suit contends the way the payment system is structured — reimbursing the organizations on a per-patient basis rather than on the amount of services provided — incentivizes the LME/MCOs to reduce budgets and services even if those services are needed.
The state’s contract with the LME/MCOs allows them to keep all unspent funds at the end of the contract period. That encourages them to reduce services, the suit claims. Meanwhile, there are 10,000 people on a growing waiting list.
Case management is among the service cuts. The absence of professional advocacy and expertise result in many clients remaining in institutions rather than receiving a better community-based treatment plan, according to the suit.
Studies and reports over the past decade have identified bias in the I/DD programs that keep clients institutionalized, or put them at risk of placement in institutions, and the defendants have not attempted to fix the problem, the suit states.