Colorado cuts Medicaid funding to provider caring for adults with disabilities

Since June, Ron and Melanie Chaffin’s intellectually disabled son has lived in seven different places in Colorado, passed from agency to agency because of his high level of need.

After the constant shuffle, the Chaffins were hopeful when their 21-year-old son Owen, who is severely autistic and functions at the level of a 3-year-old, seemed to settle into a home in Lakewood under the care of Belk Model LLC, a home- and community-based service provider that cares for adults with intellectual and developmental disabilities.

“We had high hopes, and honestly those high hopes haven’t been broken,” Melanie Chaffin said. “Belk has done everything for Owen that could have or should have been done.”

“Belk has been able to keep him for five weeks, when nobody else made it two days,” Ron Chaffin said.

But their son’s stay at Belk is coming to an end. The state is terminating Belk Model’s Medicaid funding, effective Friday, because of 19 rule violations documented at its facilities during the last year that have led to “significant health and safety concerns,” according to records provided by the Colorado Department of Health Care Policy and Financing, which administers the state’s Medicaid system.

The termination, a rare move by the state, puts some families, like the Chaffins, into a crunch. Residents need to quickly find new placements at a time when a severe staffing shortage is exacerbating Coloradans’ already poor access to long-term care, particularly for adults with severe behavioral issues. (The state on Tuesday was ranked worst in the nation for adult access to mental health care by Mental Health America, a national nonprofit organization.)

“The whole provider community is in a staffing crisis,” said Sally Montgomery, executive director in northern Colorado for Mosaic, a nonprofit organization that supports people with intellectual and developmental disabilities. “So it’s very difficult to take on new folks.”

Belk is set to lose its funding Friday, which means, barring an extension, clients need to be out of the agency’s 25 residential facilities in Colorado by Thursday.

The company was notified of the termination on Sept. 22 after authorities found numerous problems at its facilities, including that the agency failed to properly train staff, did not have enough staff, wrongly used physical restraints, did not check on the breathing and circulation of people while they were in restraints, failed to administer medications, and did not investigate allegations of abuse, among other violations.

Calls to Belk Model seeking comment were not returned.

Fewer than 100 residents will be affected by the termination, said Marc Williams, spokesman for the Department of Health Care Policy and Financing. He declined to give specific numbers.

The provider has been under increased supervision since the termination notice was sent, Williams said. The state tries to avoid terminating providers, preferring instead to work with them to gain compliance, but Belk Model did not fix its problems, he said.

“In this case, there were, over the period of several months, multiple inspections done where Belk was found not to be abiding by the terms of our provider agreement,” he said.

Finding new placements

By Tuesday, the majority of people who were under Belk Model’s care had found new placements, Williams said. But a handful — including the Chaffins’ son —  still have no solid plans for where they will go when the funding is cut off. He declined to give specific numbers.

The Chaffins worry their son will be sent to a hospital room and held there until a new placement is found — an issue the Department of Health Care Policy and Financing was sued over in juvenile cases last month.

“Last time our son was in the hospital, he was spending eight hours a day or more in physical restraints, basically strapped to a bed, because of his behaviors,” Ron Chaffin said.

They hoped an 11th-hour meeting between Belk and state officials on Tuesday — two days before the deadline — would allow their son to stay in Belk’s care until a new placement could be found. And that is a possibility, Williams said.

“We are prepared to extend the termination until successful transition plans are in place for all people who received services through Belk,” he said.

It wasn’t clear Tuesday whether that would actually happen, and the last-minute scramble is frustrating to the Chaffins and other families who haven’t found placements.

“You should have had an endgame for the people living there,” said one father, who spoke to The Denver Post on condition of anonymity to avoid jeopardizing his son’s future placement. “If you don’t think they’re in a good place, why still give a month’s (notice)? And if you are going to give a month, why not give more notice until there are placements for everyone?”

Waitlists at regional hubs

Colorado’s regional centers, which are centralized state-run facilities in Grand Junction, Pueblo and Wheat Ridge, have about 50 open beds, but also have a waitlist, because incoming residents must be matched to the right home based on that client’s particular needs.

The Chaffins said their son is on a waitlist for a regional center placement.

“He’s been accepted, they simply don’t have the staffing,” Ron Chaffin said.

About 52 of 233 direct care positions at the Wheat Ridge Regional Center — 22% of positions — are empty, said Madlynn Ruble, spokeswoman for the state’s Department of Human Services. Across the state, the centers have 520 direct care positions. Of those positions, 73 are vacant.

“Staffing is not the only measurable criteria for waiting on a bed,” Ruble said. “They look at compatibility for roommates, needs, staffing and/or location.”

She said it’s rare for the centers to be fully staffed and that staffing needs fluctuate.

“Like trends across the U.S., staffing shortages have impacted the regional centers, but residents are well cared for with highly skilled and trained staff,” she said.

Setting aside the regional centers, Belk Model is one of 318 residential providers in Colorado, Williams said, and the state does not anticipate its termination “will result in any long-lasting negative impact to the provider system.”

But it does come at a tough time, particularly for the most severely intellectually or developmentally disabled (IDD) adults who require complex care.

“Like many industries currently, there have been discussions amongst many in the IDD community that anecdotally it’s probably one of the worst staffing shortages that we’ve all ever experienced,” said Rob DeHerrera, executive director at the Developmental Disabilities Resource Center, which has been working to find new homes for some of Belk’s residents.

Wider staffing struggles

Many home care agencies and health care providers are struggling to staff their facilities, and in some cases, that’s limiting how many people can receive care.

“Even if we hired 10 people, we would still be short-staffed,” said DeeAnna Powers, administrator at A Little R&R Home Care in Loveland, which serves older adults. She’s serving about 15 fewer clients now than before the pandemic because of low staffing, she said. Although her agency, which employs about 100 people, doesn’t care for developmentally disabled adults, she said she’s received calls from people seeking those placements.

“I’ll say, ‘Have you tried this agency, this agency and this agency?’ And they’ll say, ‘Yes, yes and yes. Nobody is taking clients,’” she said.

The agency’s employees typically make between $14 and $22 an hour, she said, based largely on Medicaid’s set reimbursement rates, out of which the agency pays wages, taxes, overhead and insurance.

“Prices in Colorado keep going up and the Medicaid reimbursement rates are very low,” she said.

At Mosaic, which does serve intellectually and developmentally disabled adults, Montgomery said she’s been having conversations with other providers about taking on their clients in an emergency capacity if their staffing dips too low.

“I know a lot of providers who are really concerned about the day they don’t have staff to come in, and what will happen,” she said.

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