02:02 PM CST on Sunday, November 2, 2008
By EMILY RAMSHAW / The Dallas Morning News
eramshaw@dallasnews.com
Tom and Cindy Berry devoted their careers to the severely disabled and opened their home to people without one. In 2004, the Rowlett couple and their children turned their passion into a small but bustling business: matching people with profound disabilities with foster families.
Now, a federally mandated funding change is threatening to close their doors – a move they and dozens of other foster-care businesses say will halve their income and force more people with disabilities out of family homes and into group homes.
“The state told us that sometimes there are winners and sometimes there are losers, and in this case we’re the losers,” Mr. Berry said. “But we’re not just going to be losers. We’re going to be closed. And foster care is going to be a thing of the past.”
Under Texas’ Home and Community-based Services – a Medicaid waiver program that is an alternative to living in a state institution – people with profound disabilities can receive care while living independently, in a group home or in foster care with their own family or another family.
Care providers range from large multistate corporations, which often run 100 or more group homes, to owner-operated businesses like the Berrys’, working predominantly in foster care.
For years, all of these care providers have received a lump-sum administrative fee for every client they oversee, money that pays salaries, rent and other business expenses. But a new federal mandate is forcing the state to itemize this administrative fee, and the proposed pricing structure will increase payments for group-home placements while cutting them for foster care.
Trying to be fair
State health officials caution that the new pricing structure isn’t final and doesn’t go into effect until next year. They say they’re working hard to ensure the rate adjustment is fair to everyone, including the group-home providers who say the previous system left them under-compensated.
“We’re looking to see what we can do to make sure the folks providing foster homes still have the resources they need,” said Stephanie Goodman, spokeswoman for the Texas Health and Human Services Commission. “When you reallocate funds, there are always people who get more and people who get less.”
Under the proposal, the Berrys say, their business will hemorrhage $80,000 a month – revenue they and other foster-care providers need to stay operational.
And people like Amelia Granado, who serves as a foster parent for her 24-year-old son, say they’ll lose the providers they’ve come to rely on. Ms. Granado said the Berrys have become a family unit for her, helping Robert, who has cerebral palsy and epilepsy, participate in bowling and horse-and-buggy rides, and to get a wheelchair-accessible van.
“It’ll be a great loss for a lot of us that work so hard to keep our children at home,” Ms. Granado said. “I know for some people group homes work, but for us, it wasn’t an option.”
Care providers who work predominantly in group homes say their administrative fees should be higher, because the services they provide are generally more extensive. They say businesses that work solely in foster care may need to consider diversifying into group homes or partnering with other companies to stay profitable.
“I know the foster-care folks think this is creating a hardship on them, but for those of us who have a lot of [group-home] clients, we’ve lived with a hardship for a long time,” said Mickey Atkins, president of D&S Residential Services, which operates more than 100 group homes in Texas. “I feel for them, I do. Hopefully, they’ll still be able to make money. But they’re going to have to look at changing their business model.”
What people want
Foster-care providers dispute the idea that group homes have higher administrative costs. Nor do family-run businesses have the start-up capital to buy and operate multiple group homes, they say, even if they want to.
And, the foster-care providers say, they got into the business because it’s what consumers want. About 45 percent of the people who receive these Medicaid waivers are in foster care; 32 percent are in group homes.
“The data shows that families and consumers are choosing foster care more than residential right now,” said Carole Smith, executive director of the Private Providers Association of Texas, which represents both foster-care and group homes. “Our goal is to ask the Legislature for more dollars … or for transitional dollars while people restructure their businesses.”
For the Berrys, the change stings even more because they practice what they preached. They say they pay their 35 salaried employees and 200 contract workers higher-than-average wages. They take personal care of their 160 foster families. And they and their adult children currently foster people with severe disabilities in their own homes.
“These people are getting penalized because of the way they’ve chosen to operate,” said state Sen. Bob Deuell, R-Greenville. “If they go out of business, there’s not going to be anybody out there doing what they’re doing.”
HOME AND COMMUNITY-BASED SERVICES IN TEXAS
