The guidelines, concocted by the N.C. Division of Medical Assistance and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, mandate drastic cuts to a widely used, community-based program that provides services to some of the state's most vulnerable citizens. Tucked away in a technical amendment to the Community Alternatives Program, or CAP, is a revision to the current structure of services that CAP clients--over 5,500 children and adults statewide--receive. Before the changes, children in the CAP program were entitled to an average five or six hours of daily in-home support and therapy. However, the technical amendment reduces the hours school-age CAP clients can receive to two per day, regardless of the clients' disability, diagnosis, or need.
The cuts have not been widely announced. Many parents and clients remain unaware of the planned service reductions, initially scheduled to take effect March 1. At a recent meeting of the Legislative Oversight Committee on Mental Health, though, DMH's Chief of State Operated Services Stan Slawinski discounted the documented March start date as a "rumor." He said that the actual start date could be as late as May. But no matter the date of implementation, the effect the cuts will have will be impossible to ignore.
For many families, the CAP services are a lifeline to normalcy. Under the program, workers trained in developmental disabilities spend time each day with CAP recipients, teaching self-care skills, working on behavioral and educational goals, and providing supportive counseling to people who greatly need such assistance. Each CAP client has unique strengths and faces unique challenges, differences that CAP habilitation services have been tailored to meet.
Under the proposed new rules, though, each client will be treated essentially the same. No matter how severe the disability, no matter how significant the diagnosis, all young clients will receive the same two hours of service per day.
Regarding the dramatic reduction in services to school-aged kids, Lisa Haire of the CAP branch of DMH explained the cut to the Legislative Committee using simple math. It was felt by bureaucrats that eight hours of attention per day was enough for children. Since most children spend six hours a day at school, it was then logical to subtract these hours from the arbitrary eight-hour limit, leaving only two hours for after-school therapy and support services.
The CAP program is funded partially through federal Medicaid allocations. Those dollars are not set to decrease. The decision to restrict services is a state, not a federal, one. The rationale behind the cut, Haire explained, was to reduce the state's wait list, composed of thousands of people approved but not currently funded for CAP services. However, no figures were available detailing how much the wait list would be reduced, or even if it would. Any possible savings would only be seen after the cuts were in effect.
The Divisions of Mental Health and Medical Assistance are still taking comments on the proposed changes. Send them to: Richard Visingardi, Director, DMH/DD/SAS, 325 N. Salisbury St., Raleigh, NC 27603, or Nina Yeager, Director, DMA, 1985 Umstead Dr., Raleigh, NC 27603.