The U.S. Justice Department’s recent legal settlement with Virginia over caring for people with severe disabilities has government leaders grappling with the prospect of shifting hundreds of people from large institutions to community-based settings.
The settlement commits to the closure of the state’s five regional institutions for people with disabilities, including the Northern Virginia Training Center on Braddock Road in Fairfax County. That institution is scheduled to close by 2015.
“Important questions remain to be answered,” George Braunstein, executive director of the Fairfax-Falls Church Community Service Board, wrote in a Feb. 6 memo circulating among CSB staff and stakeholders.
Under the 10-year, $2.1 billion settlement, Virginia said it will close all but one of its five large institutions and move hundreds of people with disabilities into family homes or group homes. The decision followed decades of documentation showing that Virginia had fallen behind other states in integrating people with disabilities into the community.
Although the settlement’s 10-year plan requires the establishment of 4,170 waivers — which is the term for packages funded by Medicaid to provide services for disabled people in their homes or noninstitutional settings — the need is already great, Braunstein wrote. The state waiting list has 5,932 people with disabilities, including 3,316 with urgent needs.
“As of January 1, 2012, in Fairfax-Falls Church we have 737 Medicaid waiver eligible people on our waiting list, and of that number, 417 have urgent needs,” Braunstein wrote. “If Medicaid Waivers are allocated based on the formula the state has used with previous allocations, we will receive approximately 250 Waivers over a ten-year period for people on our waiting list.”
His memo notes that the settlement also allocates 805 waivers for transitioning people out of the training centers.
The settlement between Virginia and the Justice Department, announced late last month, was also the subject of an emotional meeting Wednesday night involving members of the disabled community and lawyers with the Department of Justice civil rights division, which set in motion the plan to close Virginia’s large institutions.
At Wednesday’s meeting, two attorneys from the special litigation section of the Justice Department’s Civil Rights Division — Aaron B. Zisser and Benjamin O. Tayloe Jr., who is the section’s deputy chief — downplayed the federal government’s role in the decision to close four of the five institutions in Virginia. The lawyers said it was Virginia’s choice to close the centers.
But Virginia Secretary of Health and Human Resources Bill Hazel said the commonwealth had few options because there are not adequate resources to operate the centers, which were originally created to serve about 6,000 people, while expanding a network of community-based settings such as group homes, as the settlement requires.
“We had a choice but not a lot of options,” Hazel said in an interview Thursday.
The Justice officials said the agency pressured Virginia to expand community services for all people with disabilities, including those with the most complex needs, not necessarily close the institutions, even though the demand for institutions should fall.
“Our settlements do not require people to accept community-based care if they make an informed choice for institutional care,” Justice spokeswoman Xochitl Hinojosa said. “In addition, under our settlement, people cannot be moved unless and until adequate community services are available to meet their needs.”
Hinojosa said the department has also been transparent about updating stakeholders during negotiations, “subject to the limits of confidentiality,” and defended the request made by the Justice attorneys that the meeting be considered private so that people could speak candidly. The Washington Post, along with Fairfax County officials, considered the meeting public. Supervisor John C. Cook (R-Braddock) attended the meeting, and a woman was tweeting about it for the Arc of Northern Virginia (#TheArcofNoVa).
Several officials have said that there needs to be more transparency.
“I think one of the frustrating parts of this whole process is that this was mostly behind closed doors between Virginia and the Department of Justice,” said Del. David Bulova (D-Fairfax), whose district is home to the training center. He said the decision to close the four centers was abrupt, and came as he and other political leaders were working toward a regional approach to transform the Braddock Road facility into a campus that would serve people’s needs for intensive, institutional care and more open, community-like service.
“None of us knows what was said behind the scenes,” Bulova said. “I understand why the Department of Justice got the ball rolling. I’m just concerned where we came out the other end of the process and whether that’s the best thing for everybody involved.”