Thousands of New Mexicans with developmental disabilities have been getting few if any services ranging from speech therapy to respite care during the COVID-19 lockdown, even though the private agencies that provide them are being paid 80% of their normal Medicaid fees.
Nearly 70 private provider agencies in the state requested the payments under an amendment to the Developmentally Disabled Waiver program approved by the federal agency that oversees Medicaid and Medicare.
The money is supposed to pay for retaining staff, but more than three months into the lockdown, parents and guardians are chafing at the lack of services and asking if the state knows how the agencies are spending the money they’ve been getting.
“There is no incentive for these provider agencies to offer any services,” Jill Tatz, the mother of two adult children with cognitive disabilities, said in an interview. “There is no transparency on how they are spending the money or if they have retained staff.”
June Montoya, the mother of a 33-year-old daughter with cerebral palsy, said, “There is no oversight, just the expectation that these agencies would do the right thing.”
There is no timetable for resumption of services, and Tatz and Montoya say the state didn’t encourage providers to offer any online or virtual services during the lockdown. They said that in the past two weeks there have been a few Zoom meetings involving people who attended the day programs so they could see their friends.
The state shut down services in mid-March and only recently has begun discussing how to safely start offering services.
The authorization for the retainer payments from the Centers for Medicare and Medicaid Services ends on June 30.
According to a state memo sent to providers and others on Thursday, CMS plans to issue additional guidelines to states for continuing the retainer payments.
Parents such as June Montoya said they had to push state officials to get included in the online discussion on how to reopen.
Tim Gardner, legal director for Disability Rights New Mexico, an advocacy group, said some agencies are trying to provide some services while others are doing nothing.
In response to written questions, Department of Health spokesman David Morgan said the Developmental Disabilities Supports Division “has implemented a process to track the 80% retainer payment for each DD Waiver provider agency.”
He said the division contacts the providers biweekly to monitor staffing levels for day program and employment providers.
Gardner said his organization told the state when the payments began in March that there should be oversight of the agencies.
“To be fair, at the start, they (state agencies) were very busy,” Gardner said. “But at this point, it is hard to understand how there is no clear oversight structure.”
“The state has been open about how they are struggling with this,” Gardner said.
DD Waiver program
New Mexico is one of 30 states that received federal approval to make “retainer” payments to private agencies that serve intellectually and developmentally disabled adults.
The agencies receiving the money provide a wide range of services to people under the state’s two Developmentally Disabled Waiver programs.
People in the waiver programs may have different agencies providing different types of services ranging from physical and speech therapy to respite care for parents and guardians.
Without the programs, adults with intellectual and developmental disabilities might be institutionalized but instead live at home, semi-independently or in group homes.
Informally, the programs are divided into two categories: day services and residential services.
There are 3,154 people in the traditional DD Waiver system and another 1,679 in the Mi Via Waiver program, which gives guardians a greater say in how money is spent.
The budget for the entire program is $390 million a year with 72% of that coming from federal Medicaid.
Mandy’s Farm is one of the agencies that have received the retainer payments and was offered as an example by the Department of Health as an agency that is doing what is expected under the retainer program. (Tatz’s and Montoya’s adult children do not receive services from Mandy’s Farm.)
Melissa McCue, executive director of Mandy’s Farm, said the agency has been able to keep its employees during the pandemic, paying 75% of salaries and 100% of their health care premiums.
The agency offers day services, employment services and residential services. It has continued to provide residential services in group homes but has not offered any employment or day services to the 98 people with disabilities in those programs because of the COVID-19 lockdown.
Employees in the residential services are being paid an additional $3 to $4 an hour for extra duties they are performing, such as providing lunch or working longer hours because the group home residents are not leaving to attend programs outside the home.
Many of the other employees do not work but are supposed to continue receiving 75% of their salaries.
McCue said the payments will help the agency avoid the costs of rehiring workers or conducting background screenings and training for new employees unfamiliar with the needs of the people the agency serves when programs ramp back up.
Tatz said she and her husband began having questions about the retainer program when they saw invoices from a provider who provides services to their children – even though the provider has been closed during the lockdown.
Their adult children are in the Mi Via Waiver program, and the parents are supposed to have authority to approve invoices before the state pays them.
That process is bypassed by the retainer payment program implemented since the beginning of the pandemic.
Tatz, who has served on boards of developmentally disabled advocacy groups and programs, said she began asking questions after seeing the invoices but didn’t get any answers.
“We have heard that staff members were furloughed,” she said. “But we don’t know what that means or if the furloughed staff applied for unemployment, while the agency received payments from the state.
“We don’t know if they have applied for any of the federal loans or grants. What we do know is they haven’t been providing any services.”
The state says it is tracking the agencies to make sure they haven’t laid off employees and has told all agencies that they will have to account for the retainer money in the coming months.
Morgan, of the DOH, said agencies were told in a memo in May that to apply for the 80% retainer payments the agencies were not to lay off any employees involved in direct care programs.
“Agencies that received retainer payments must provide evidence to the state on how the payments were spent,” he said.
The provider agencies also must disclose whether they received any other types of assistance such Small Business Administration loans or other loans from the federal government under the CARES Act.
Morgan said the agencies are subject to administrative penalties if any of the money was misspent.