The Justice Department also accused the commonwealth of “misalignment of resources that prioritizes investment in institutions rather than community-based services.”
Of particular concern was the lack of availability of Medicaid Home and Community-Based Services Intellectual Disability Waivers that would provide community-based day and residential services to intellectually disabled citizens. These ID waivers, as they are called, would help satisfy the “integration mandate” of the Americans with Disabilities Act.
About 8,600 Virginians are receiving services through ID waivers. However, more than 6,000 Virginians are on a waiting list for ID waivers.
Of the individuals waiting for services, 3,500 are classified as “urgent” due to risk factors such as aging caregivers, abuse or neglect.
The Justice Department’s investigation noted that the waiting list exists even though community care is less expensive than institutionalization: Virginia spends on average $194,000 to house an individual within a training center as opposed to $76,400 for community-based services provided by an ID waiver.
“Theoretically, there’s no limit to the waivers,” said Richard Hemp, co-author of the State of the States in Developmental Disabilities, a research project administered by the University of Colorado.
“Think of it as a push-pull phenomenon, where the federal government is trying to push the waivers to the state because … they are convinced by the research that shows that waivers are clearly the most cost effective way to go.”
Mental health advocates applaud the settlement agreement as long overdue.
In April, a coalition of 70 advocacy groups signed and presented to Judge Gibney a statement saying, “The settlement affords an historic opportunity for thousands of Virginians with intellectual and developmental disabilities to live full lives in their own homes and communities.”
Among other features, the agreement would create 4,170 more ID waiver slots by 2021.
That “will make a huge difference in the lives of thousands of citizens with ID who will have access to person-centered services and better quality of life,” said Silva Bey, executive director of Community Living Alternatives, a day support and residential program in Fairfax.
In addition, the agreement calls for the closure of four of the existing training centers within 10 years, creation of crisis services and regional mobile dispatch teams, as well as vocational and housing assistance.
“Virginia has the opportunity to make things right,” said Jamie Liban, executive director of The Arc of Virginia, a leading advocacy group for individuals with intellectual and developmental disabilities.
“The settlement agreement provides a solid framework to help Virginia responsibly transition to a community-based system of care that is focused on safety, quality and community integration.”
