Disabled Services Shrink In D.C.

The city kept rates the same for more than five years but last year provided a one-time jump of 19.2 percent. Nuss said future cost-of-living adjustments are accounted for in the rates.

The rates are set by the city's Medical Assistance Administration, which will soon be renamed the Department of Healthcare Finances. Under Mayor Adrian M. Fenty (D), Nuss, who runs the Developmental Disabilities Administration, has more say in setting future rates.

"We're not stopping at 19 percent," Nuss said. "We're actively going forward."

Care providers and advocates for the developmentally disabled say improved rates are essential to improving care because more money allows hiring of better staff and better training. Numerous providers contract with the city for residential services as well as medical and other types of care.

"The rates are simply too low," said Marsha Thompson, who formerly headed D.C.'s agency overseeing the developmentally disabled and now works for Careco, a healthcare provider. "You're not going to get the quality you need. If [a provider] can't make the dollars back that you invest, you can't stay in business."

The two providers leaving the District had been here two years, replacing another agency that had been criticized for poor care. Some providers say there could be more turnover unless rates increase.

Care of the developmentally disabled has been a long-running problem for the District, which was sued 30 years ago by advocates for residents in group homes. In March 2007, U.S. District Judge Ellen S. Huvelle ruled that the city had failed those residents and called their care "inadequate."

In May, a federal court monitor reported that "serious deficits" remained in care for the developmentally disabled. Huvelle has ordered hearings in December to determine what must be done to improve care, possibly including a court takeover.