Proposed federal and state Medicaid reductions are putting at risk essential support services for thousands of North Carolinians with severe intellectual and developmental disabilities (IDD), experts and families warn.
Nonprofits like TLC, a Raleigh-based provider of group homes and round-the-clock care, face mounting pressures that could force staffing shortages, service disruptions, and even closures, leaving vulnerable residents and their loved ones in precarious positions.
It is yet another case of a healthcare system which, whatever the intentions of politicians or the private sector, is struggling to provide affordable healthcare to Americans in need.
North Carolina Health News looked at the case of Jennifer Shigley, a 49-year-old woman with profound disabilities who has called a TLC group home her residence for eight years.
Her father, retired child psychologist Hal Shigley, described the immense daily needs his daughter faces. “She requires total care,” Shigley said, noting that Jennifer cannot speak, walk, feed, or bathe herself and possesses the mental capacity of a toddler. He expressed deep gratitude for the facility’s role amid her challenges. “Thank goodness she is in a facility where she’s taken good care of.”
The financial burden of such care is staggering. Shigley estimated that Medicaid reimburses TLC approximately $150,000 annually for Jennifer’s support. “It’s very expensive to care for people like Jennifer and people who have similar disabilities,” he said.
TLC, formerly known as the Tammy Lynn Center, serves about 30 adults in its group homes with an average annual cost of $230,000 per person.
Without Medicaid, families would be left to shoulder impossible costs.
Advocates point to the disproportionate reliance of people with disabilities on Medicaid for specialized services often excluded from private insurance.
Corye Dunn, director of public policy for Disability Rights North Carolina, asserted that exemptions in the cuts offer little real protection.
“There is no way to make the massive cuts the federal government has made without hurting people with disabilities,” Dunn said. “We are disproportionately reliant on Medicaid, even when we have private insurance because so many of the services people with disabilities need are not covered, traditionally, with private insurance,” she told NCHN.
Dunn also addressed the critical issue of workforce stability in care facilities. “Anytime there’s a threat to rates, it’s really a threat to staff salaries,” she said. “People leave the field if they can’t make enough money to live. You wind up with a less stable and overall lower-quality pool of staff available to people with disabilities when you threaten rates. That’s just as true in a group home as it is in an intermediate care facility.”
As North Carolina’s Medicaid program grapples with these federal mandates and a state budget that includes $1.5 billion in reductions over two years, stakeholders urge lawmakers to prioritize IDD services. With an estimated 100,000 residents affected statewide, the cuts risk unraveling decades of progress in community-based care, potentially forcing many back into institutional settings or family homes ill-equipped to cope.