Disability Rights NC and the state reach an agreement in lawsuit over services for disabled people

The state Department of Health and Human Services and Disability Rights NC have agreed to a plan aimed at providing more people with disabilities support that would allow them to live in communities. 

The agreement is a proposed consent order that grew from mediation and negotiations in the case known as Samantha R. 

Disability Rights NC sued the state Department of Health and Human Services in 2017 for failing to provide enough community or home-based services that would allow people with intellectual or developmental disabilities to leave institutions or avoid having to live in them. 

The proposed consent order announced Wednesday would replace the sweeping court order Judge Allen Baddour issued in November 2022 that included a 10-year timeline for eliminating the waiting list for community services. The waiting list has grown since November 2022 from about 16,000 people to more than 17,500 as of December 2023. The agreement announced Wednesday does not require elimination of the waitlist. 

DHHS said the requirements Baddour outlined in 2022 were unrealistic. The state appealed the order.  The two sides requested mediation before the Court of Appeals last summer. 

As a result of the new agreement, DHHS drops its appeal and Disability Rights agrees to a compromise plan. Baddour is scheduled to hold a hearing on the proposed order next week. 

It defines actions DHHS must take over the next few years to move people out of institutions. It also requires DHHS to make sure regional mental health offices, called Local Management Entities/Managed Care Organizations, maintain adequate provider networks. The LME/MCOs are responsible for paying the providers of in-home and community-based services.

LMEs will face more robust measures of provider adequacy. 

Under the agreement, DHHS would move at least 249 people out of institutions and into community-based settings through June 2027. 

The state has a shortage of the direct care workers who provide the services for people with disabilities.  Their wages are low and the field offers little chance for advancement. A study published earlier this year found that direct care workers had a median wage of $13.62 an hour in 2022. In 2021, 17% had no health insurance. 

Recommendations from the North Carolina Area Health Education Centers for expanding the pool of direct care workers are incorporated into the agreement. 

“We are grateful for the partnership with DRNC that enabled us to reach this agreement so we can do what is right for people in North Carolina with intellectual and developmental disabilities,” Kelly Crosbie, director of the Division of Mental Health, Developmental Disabilities, and Substance Use Services, said in a statement. 

Disability Rights said in an email that the order does not end the lawsuit. After two years, the parties would meet and recommend next steps, Disability Rights said in a written explanation of the consent order. The state could ask to end the case, or the court could issue additional orders. 

“This proposed agreement marks the beginning of change, not the end,” Disability Rights NC legal director Emma Kinyanjui said in a statement. “By working together, DRNC and NCDHHS will spend the next two years making sure the system is pointed in the right direction — getting change started now — instead of spending time and focus on the appeal.”