RICHMOND — A U.S. District Court judge on Friday postponed a decision on whether to force Virginia to speed efforts to overhaul how the state treats people with severe disabilities.
Judge John A. Gibney said he would rule in December on a Department of Justice request for hard deadlines in implementing changes agreed to in a 2012 court settlement. The agreement, based on the Americans with Disabilities Act and a related Supreme Court ruling, said that disabled people are entitled to treatment in community settings instead of in large institutions.
The settlement established a set of goals to achieve by 2022, including moving people out of the five state-run institutions for the disabled and creating more opportunities for those adults to find jobs or other activities in community settings.
With seven years left, the state has moved about half of the 1,018 disabled residents who were institutionalized. But it has been sluggish in financing efforts to build smaller group homes for those who have been left behind.
Virginia has also delayed implementing a crisis-prevention program for children with disabilities and fully launching a system in which state officials can monitor the quality of care being given to people with intellectual and developmental disabilities.
During the court hearing, the office of Attorney General Mark R. Herring (D) said that much of the state’s strategy for complying with the settlement lies in the expectation that the General Assembly will approve funds for Virginia to restructure its system of Medicaid vouchers available to the disabled.
The vouchers, 11,500 of which are now in circulation, allow disabled patients to pay for care and receive other services inside their homes or in private health-care facilities.
Advocates say the state’s reimbursement rates are too low to cover those costs and note that about 10,000 people are on a waiting list for vouchers.
Allyson Tysinger, a senior assistant attorney general in Herring’s office, estimated that the state will need $21 million to add more vouchers and increase reimbursement rates during fiscal 2017. An additional $40 million will be needed each subsequent year, she said.
“If the General Assembly does not approve it, we will have to come up with another plan,” Tysinger said at the hearing.
Virginia lawmakers rejected a proposal for funding more Medicaid vouchers earlier this year, a fact noted by Justice Department attorney Kyle Smiddie.
In response to pledges of new funding during the hearing, Smiddie said, “We’ve heard that before.”
State Del. S. Chris Jones (R-Suffolk), chairman of the House Appropriations Committee, said in an interview Friday that additional funding for the vouchers is likely. But with the state’s fiscal health still wobbly, Smith said he was unsure of the dollar amounts. He said he has yet to be briefed on the proposed rates for the vouchers and the services they would cover.
“We have been supportive,” Jones said of the state’s efforts to comply with the settlement. “But, of course, we need to look at the details and the particulars of the waiver redesign as we move forward.”
Gibney indicated that he was willing to give Virginia time to reach compliance if it appears that it is making progress. But he warned that he would take a harder line if funding for new vouchers doesn’t come through.
“The changes that are required in the decree will occur,” Gibney said, adding that he isn’t against appointing someone to carry out the changes or forcing Virginia to comply through a contempt-of-court order. “It will be done.”