A few weeks ago, Gov. Jim Justice, who is running for an open U.S. Senate seat, asked the public to “stay tuned” regarding funding for programs that help people with disabilities.

West Virginia’s low Medicaid reimbursement rate has led to staffing shortages for workers who help people with intellectual and developmental disabilities (IDD) eat, bathe and live in home-like settings. 

As the Republican governor and the Department of Human Services haven’t yet addressed the rates, a group home in Martinsburg for about a dozen people with disabilities will close due to staffing shortages. 

“It’s awful. People we serve may have to locate hours away from their family or relocate to live with someone they don’t know,” said Ray Ratke, CEO of enCircle. The Virginia-based company operates the group homes under the name of Stonebrook. 

Half of the individuals have no family members who can care for them, he added, meaning they could end up in state-run institutions that were never meant to house individuals long term. 

Ratke said the closure, planned for Nov. 1, was due to the state’s failure to address the Medicaid reimbursement rate issue and raise worker pay rates. 

West Virginia Behavioral Healthcare Providers Association CEO Brad Story said it wasn’t likely other providers would be able to take the displaced Martinsburg patients as they’re all grappling with staffing shortages due to the reimbursement rate issue.

“In order to rehome or transfer a client, you’ve got to have another [provider] ready to provide this service. No one I know of is ready to accept clients right now. It’s going to be very, very challenging,” Story said. 

There’s a waitlist of more than 700 people for the state’s IDD waiver program, which allows them to access services like in-home care. A DoHS leader said in April that around 6,000 people were served by the program. 

Lawmakers bolstered IDD funding during the May special legislative session but didn’t mandate how DoHS spent the money. Many argued the department already had the money to fund the increase but hadn’t chosen to.

West Virginia Watch reached out to DoHS for this story and asked if the closure was connected to the state’s Medicaid reimbursement rate issue.

In an email, DoHS Director of Communications Whitney Wetzel said: “The West Virginia Department of Human Services is aware of the closure and DoHS Bureau for Medical Services Commissioner Cindy Beane has met with the facility. 

“We recommend reaching out to the facility for questions regarding its business decision to close.”

Rate increase could happen this fall, but is it soon enough?

The state uses state and federal money from Medicaid to reimburse private companies that employ direct care workers.

Caregivers currently earn around $11 an hour. A rate study last year suggested that a salary range should be closer to $15.50-$18.60 per hour. 

Ratke said his company, which plans to lay off around 65 workers, has struggled to staff in-home workers while paying $13.66 an hour — particularly in the Eastern Panhandle where people can easily travel to nearby border states for higher pay.

In April, he stood in the Senate chamber before lawmakers and DoHS leaders and pleaded for a reimbursement rate increase. He warned a closure could happen without an adequate fix.

“It’s very frustrating and disheartening we have been working for two years educating legislators and the governors’ office about this issue,” Ratke said on Monday.

After slashing IDD funding during the regular legislative session, lawmakers in May passed a bill that gave DoHS roughly $180 million in a reserve for department leaders to dip into for limited reasons when needed. It could be used on the Medicaid reimbursement rates. 

Lawmakers were wary about giving DoHS money for the reimbursement rate after learning in April that the department previously spent millions of dollars earmarked for people with disabilities on things like in-home COVID-19 tests and contract nurses’ salaries.

Leaders with DoHS have told lawmakers, lobbyists and West Virginia Watch that they’re considering a reimbursement rate increase that would go into effect in October. 

Story was hopeful that providers would see a rate increase. 

“We’re thankful they’re going to give us that, and [DoHS Secretary] Cynthia Persily has taken every meeting we’ve asked for,” he said.

Under current regulations, private companies wouldn’t be required to spend the rate increase money on staff raises, though many have committed to it. Other providers, including those that serve elderly residents through the state’s Aged and Disabled Waiver Program, have also said they need a rate increase.

For Ratke and the individuals he serves, the possible increase may come too late. He stressed that these individuals are receiving necessary state-funded care due no fault of their own.

Institutionalized individuals, he noted, will cost the state much more than properly funding community-based services like the ones he plans to shutter.  

“You can either serve people and serve them well, or you can run into problems and have to pay much more,” he said.